2013-566 TOWN OF QUEENSBURY
F
742 Bay Road,Qucensbury,NY 12804-5902 (518) 761-8201
Community Development - Building & Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: P20130566 Date Issued: Monday, December 16, 2013
This is to certify that work requested to be done as shown by Permit Number P20130566
has been completed.
Tax Map Number: 523400-308-014-0001-068-000-0000
Location: 29 TRIPHAMMER Rd
Owner: PHILIP & SANDRA JARROSIAK
Applicant: PHILIP & SANDRA JARROSIAK
This structure may be occupied as a:
Septic Alteration Residential
By Order of Town Board
TOWN OF QUEENSBURY
Issuance of this Certificate of Compliance DOES NOT relieve the 4
property owner of the responsibility for compliance with Site Plan, ,L)j
Variance, or other issues and conditions as a result of approvals by the
Director of Building& Code nfor 4 cnt
Planning Board or Zoning Board of Appeals.
1
ow;
TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development-Building& Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20130566 Application Number: A20130566
Tax Map No: 523400-308-014-0001-068-000-0000
Permission is hereby granted to: PHILIP& SANDRA JARROSIAK
For property located at: 29 TRIPHAMMER Rd
in the Town of Queensbury,to construct or place
at the above location in accordance with application together with plot plans and other information hereto filed
and approved and in compliance with the NYS Uniform Building Codes and the Queensbury Zoning
Ordinance. Type of Construction Value
Owner Address: PHILIP& SANDRA JARROSIAK Septic Alteration Residential
29 TRIPHAMMER Rd Total Value
QUEENSBURY,NY 12804
Contractor or Builder's Name/Address Electrical Inspection Agency
SANITARY SEWER
GEORGE DRELLOS 792-7257
PO BOX 224
GLENS FALLS NY
Plans&Specifications
2013-566
Res. Septic Alteration
$40.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Wednesday,December 10,2014
(If a longer period is required,an application for an extension must be made to the code Enforcement Officer
of the Town of Queensbury before the expiration date.)
Dated at the Town nsbu A Tu_ a/ D• .•mber 10,2013
SIGNED BY t for the Town of Queensbury.
Director of Building&Code Enforcement
{
CommunityDevelopment Office
��:`<-_=:-:., p _
Town of Queensbury • 742 Bay Road • Queensbury, New York •12804 ULT' U 201
3
Office Use Only pp
TAX MAP NO. 30� ,`y -�-to c� PERMIT NO. /3 — S(OLD PERMIT FEE 4/0 417
APPROVALS: ZONING TOWN CLERK
APPLICATION FOR SEPTIC DISPOSAL SYSTEM PERMIT: A PERMIT MUST BE OBTAINED
BEFORE WORK BEGINS.APPLICATION IS SUBJECT TO REVIEW BEFORE ISSUANCE OF A VALID PERMIT.
OWNER: Q.kik
k Ll JGt ('r 0-c INSTALLER: Q�/a"�1 7f ,Jv'�A _fe/',r�i
ADDRESS: .7C / r 1 vAO h• M . ' e/ r�' ADDRESS: ° �` z "
PHONE NOS. 3-1f 7/ " Z F-2 u PHONE NOS. - 7 -72`f 7
LOCATION OF INSTALLATION: F('42`."'1 y
RESIDENCE INFORMATION:
YEAR BUILT NO.OF X COMPUTATION = TOTAL DAILY FLOW
BEDROOMS (Gallons per bedroom) GARBAGE GRINDER
1980 or older X 150 = INSTALLED? /k
1981 -1991 X 130 = SPA OR HOT TUEt„f
1992-present Y X 110 = yyp INSTALLED?
PARCEL INFORMATION:
✓ TOPOGRAPHY: FLAT ROLLING x STEEP SLOPE %SLOPE
✓ SOIL NATURE: SAND ).2 LOAM CLAY OTHER
✓ GROUNDWATER: AT WHAT DEPTH? /1'4
✓ BEDROCK/IMPERVIOUS MATERIAL: AT WHAT DEPTH? /✓/j-
✓ DOMESTIC WATER SUPLY: MUNICIPAL> WELL (If well:water supply from any septic system absorption is: ft)
✓ PERCOLATION TEST: RATE IS / f PER MIINUTE PER INCH[mpi] (Test to be completed by a licensed professional
engineer or architect)
PROPOSED SYSTEM FOR NEW CONSTRUCTION: All individual sewage disposal systems must be designed by a licensed professional engineer or
architect(unless installed in a Planning Board approved subdivision).
TANK SIZE:/ GALLON(MIN. SIZE IS 1,000 GAL.)Add 250 gallons to the size of the septic tank for each garbage grinder,
spa or whirlpool tub.
SYSTEM TYPE:
❑ABSORPTION FIELD(WITH NO.2 STONE) Total length ft. Each trench X _
❑ SEEPAGE PIT(S)(WITH NO.3 STONE) How many? Size?
;ALTERNATIVE SYSTEM Bed or other type? 020 >C. Z S'
o HOLDING TANK SYSTEM Total required capacity? Tank size? Number of tanks?
NOTE: ALARM SYSTEM AND ASSOCIATED ELECTRICAL WORK MUST BE INSPECTED BY A TOWN APPROVED ELECTRICAL
INSPECTION AGENCY. PLEASE REVIEW LIST PROVIDED.
For your protection,please note that pursuant to Section 136-29 of the Code of the Town of Queensbury,any permit or approval
granted which is based upon or is granted in reliance upon any material misrepresentation or failure to make a material fact or
circumstance known by or on behalf of an applicant,shall be void.
I have read regulations with respect to this application and agree to
abide b + --e and all requirem-nts of the Town of Queensbury QUESTIONS? CALL 761-8256 OR EMAIL
Sanit- a po . codesf@queensburv.net
( codes queensbury.net
v D• _ L -/ o-r3
Signa ure of Person Responsible Date VISIT OUR WEBSITE FOR MORE INFORMATION
ovww.queensbury.net
Town of Queensbury Building & Code Enforcement hWiklea \11,3o
Office No. (518) 761-8256
Septic Inspection Report
Inspection request received:
Name: 1_,..1C tt DC7: k6L1S O Inspected on: _ — - i
vi
Location: C l ‘ � .� �' Arrive: IP' Ar p.m.
e
Permit No.: /3 - 66or!o Inspector's Initials:
Comments and/or diagram
Soil Type S�!Clay
Type of Water. Munic. lA_Lell Water
Waterline separation distance \2--ft.
Well separation distance _ft.
Other wells: ft.
Well Casing Length 50'+/- _Y_N N/A
[150'to well required if NO]
Absorption Field: Total length ()f5 ft.
Length of each trench eft. 1i9 \--c c ' L-- '‘-i'`,)eQ-V----
Depth of trenches Z ft.
Size of Stone — _
Seepage Pits: Number
Size: x
Stone Size:
Piping Size Type
Building to tank
Tank to Distribution Box LV"h ---. 5----
Distribution
Distribution Box to Field/Pitv- Vi?----- S-ta4 �-z�
"fib ' tA� savT_
Opening Sealed: i�Y_V
End Cap _Y/_✓N \ 3"V' L_DID ;-7
Inlet/Outlet Pipes&Baffles t/Y N
Manholes 12"or less below grade
t
[provide extension collar if Yes] _Y_N
Location/Separations
Foundation to tank ...-",14,61—ft.
•
Foundation to absorption 'L""j ft.
Separation of Pits ft.
Conforms as per Plot Plan Y_N
Engineer Report and As-Built _Y N
ETU Maintenance Contract provided _Y_N
Location f-System on Property: -
Front R— r Left Side ,. Right Sid . the Front Middle Rear
System Use St us:
V Approved
Partial Approved and needs to be re-inspected, please call the Building&Codes Office
Disapproved
Septic Inspection Report
6 1° 1 3_ 5-e,
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PEPTIC PLOT PLAN /
I HAVE SEEN OR OBSERVED ALL OBJECTS
SUCH AS HOUSES, WELLS, TREES, FENCES, ETC ,
SHOWN ON THIS DOCUMENT.I HAVE PERSONALLY f �f e /
MEAS,HE .T SET FO N THIS DIAGRAM. Yr/
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..Hr /L—w-i3 / illy SIG. !:T RE DATE
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LEO 1 0 2013
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CENTER PROJECT
SERVICES °13
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73 Sheridan Street, Glens Falls, NY 12801
Phone-518-796-2515
December 10, 2013
1 �3J�(Q44 Project# 178
George Drellos
Sanitary Sewer Services
Luzerne Road
Queensbury,NY 12804
Re: Proposed Replacement Septic
Jarrosiak Residence—29 Triphammer Road, Queensbury,NY
Dear George:
At your request we have reviewed your proposed replacement septic system design of the
existing 4 bedroom house at 29 Triphammer Road in Queensbury. As per our conversation the
residence has an existing failed septic system.
We have reviewed the proposed replacement septic system design and we agree that a standard
absorption bed is acceptable and that the owner has agreed to remove the tree in the area of the
proposed replacement system. Based upon a design flow rate of 440 GPD and a percolation rate
of 1 to 5 minutes, you will need 463 square feet of absorptive area. We recommend using a 20 ft
wide by 25 ft long absorption bed with 4 — 20 foot long laterals, which will provide 500 sf of
absorptive area. The absorption bed can be constructed with the existing 1,000 gallon septic tank,
new distribution box, and 4 inch diameter perforated pipe and stone.
Please feel free to contact me at 796-2515 if you have any questions and that you for your
assistance with this request.
Sincerely,
Cwt,
Thomas R. Center Jr, P.E.
Septic Inspection Report
Office No. (518) 761-8256 Date Ins ion �y- :ce' -r:
Queensbury Building &Code Enforcement Arrive: Iv % s'' . i part:
742 Bay Rd., Queensbury, NY 12804 Ins ...•`�pector's Initials: /'
NAME: t I S2 )t \A ")AF�f�J• • • ff NO.: . I---1\.;c)1 t�l�
LOCATION: a - K) • PECT ON: \?(c)—13
RECHECK:
798 --aqz‘ Comments and/or diagram
Soil Type: Sand/ Loam/ Clay
Type of Water: Municipal/ Well Water \
Waterline separation distance ft. ! E '–c\ c_ '5 `� b-N- V\
Well separation distance ft.
Other wells: ft.
Well Casing Length 50' + / - Y N N/A \ . L�10\) 1� ' \ C-01 1
[150'to well required if NO]
Absorption Field: Total length ft. v-c\. c9 S\ol3E 'N--7
Length of each trench ft.
Depth of trenches ft. LE A V\ \_ O -- E \ -t
Size of Stone
Seepage Pits: Number (3.6� --i
•ii
Size: x
Stone Size:
Piping Size Tyke
Building to tank
Tank to Distribution Box
Distribution Box to Field/ Pit
Opening Sealed: _Y_N
End Cap _Y_ N
Inlet/Outlet Pipes&Baffles _Y— N
Manholes 12"or less below grade _Y_ N
[provide extension collar if Yes] _Y_ N
Location / Separations
Foundation to tank __ft.
Foundation to absorption ft.
Separation of Pits ft.
Conforms as per Plot Plan _Y_ N
Engineer Report and As-Built Y N
ETU Maintenance Contract _Y_ N
provided
Location of System on Property:
Front Rear Left Side Right Side Middle Front Middle Rear
System Use Status:
pproved
Partial Approved and needs to be re-inspected, please call the Building &Codes Office
Disapproved
L:\Pam Whiting\2010\Building Codes Forms\Inspection Forms\Septic Inspection Report 03 29 10.doc