2014-192 eak TOWN OF QUEENSBURY
742 Ba•Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development - Building & Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: P20140192 Date Issued: Monday, June 09, 2014
This is to certify that work requested to be done as shown by Permit Number P20140192
has been completed.
Tax Map Number: 523400-301-013-0001-088-000-0000
Location: 564 WEST MT. Rd
Owner: PAUL & KELLY THOMAS
Applicant: PAUL & KELLY TI-IOMAS
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 (-- j /45t---
41
property owner of the responsibility for compliance with Site Plan,
Variance, or other issues and conditions as a result of approvals by the Director of Building&Code Enforcement
Planning Board or Zoning Board of Appeals.
aTOWN OF QUEENSBURY
`ON 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development- Building& Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20140192 Application Number: A20140192
Tax Map No: 523400-301-013-0001-088-000-0000
Permission is hereby granted to: PAUL& KELLY THOMAS
For property located at: 564 WEST MT. 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: PAUL& KELLY THOMAS Septic Alteration Residential
564 WEST MT. Rd
Total Value
QUEENSBURY, NY 12804
Contractor or Builder's Name /Address Electrical Inspection Agency
Plans&Specifications
2014-192
Res. Septic Alteration
$40.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Friday, May 29,2015
(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 f Que by 4Th. . t 29,2014
i
SIGNET)BY for the Town of Queensbury.
Director of Building&Code Enforcement
Office Use Only
Town of Queensbury Building; Code5�' ��T -::':::7:
Re ivied:
;Ti x M p ID: Z1
SEPTIC DISPOSAL P R �
A permit must be obtained before beg n sons n2 PritNo.: �;
7 2014
Permit fee: $ r �
_ ,__._,_Approvals: V
TOWN OF QUEENSBU RY 1
BUILDING &CODES � /` ����''
Applicant: InstallerlBuilder ✓'r/v i 71/4 r fn–s-'re- c;-,--<c
Address: Address ,0- gox 22 V
/67/tis- A4/7/- /lam' /2 /
Phone: ��(
Po. Phone 792-72- 7
Owner: � /i Ofli/�I Location of Installation SG`V weJfr-/�/4-n,
Address: S`6 4' G✓ 5j /317 4,a
Sit P6°:if C'ek y /1'i
Phone 79'6 ` Y3/7
Contact Person for Building&Code Compliance: a bs-x; DayPhone: f6 f7�(J
p �
Residence Information:
Year Built #of Bedrooms x Gallons per bedroom =Total Daily Flow
1980 or older x 150 = Garbage Grinder installed?/Le
1981-1991 x 130 = Spa or Hot Tub Installed? /
ird
1992—Present 1-! x 110 = ![L/E)
Parcel Information:
Topography Flat Rolling _Steep Slope %Slope
Soil Nature and Loam Clay Other
Groundwater At what depth? /' -
Bedrock/Impervious Material At hat depth? / /
Domestic Water Supply ;Municipal Well(if well,water supply from any septic system absorption is ft.)
Percolation Test Rate- per minute per inch(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 l237-2 gallon(minimum size 1,000 gallons),add 250 gallons to size of septic tank for each garbage grinder,spa or whirlpool tub
System Type: Absorption Field(with#2 stone) Total length ft. Each trench X
Seepage Pit(S)(with#3 stone) How many? Size?
Alternative System Bed or other type? /_S--X
Holding Tank System Total required capacity? Tank size? #of tanks?
NOTE: 1)Alarm system and associated electrical work must be inspected by a Town approved electrical inspection agency-see Certified Electrical form
on Town website; 2) Effective as of March 23, 2006 Septic System-As Built Plot Plan: The Building Department will no longer allow systems to be
covered until such time as an As-Built Plot Plan is received and approved by the Building Inspector. The installed system must match the septic system
layout on file. There will be no exceptions.
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 the regulations with respect to this application and agree to abide by these and all requirements of the Town of Queensbury Sanitary
Sewage Disposal Ordinance.
Print Name: 0'0' . e 1O - '‘f Date:
Signature: — , -'4z_ Date:
Town of Queensbury Building : Codes Septic Disposal Permit 518-761-8256
Town of Queensbury GIS Viewer Page 1 of 2
Zoom In
Parcel Results: More Info Clear _
FID 10290 le — —
PIN ::: : 880
01000100C , iel
NEWNUMBER -1-BSor _ t — )
GISACRES 0.480961
PRINT KEY 301.13-1-88 s ri a • < [ P
.�Municipal Eoundares
AREA 20950.6478579406 ✓Town END
PERIMETER 584.798582752312 ✓ Roads
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PARCEL_ID 301.13-1-88L✓J Queensbury Parcels
PARCADRNUM 5646
_ U Election Districts
PARCADRNAM West Mountain Rd - ., ,_
LJ Subdivisions
OWNER1 PAUL THOMAS -
ai U Zoning Districts
OWNER2
! .i • U Sea,erlines
►J Waterlines
f U Waterbed es
-/ -- _ r° „:« - L_,Streams
■ " • 'r Flood Zones
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` . _ U Critical Environmental Areas IS
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r L 1•iaPPed APA Wetlands
4- # E 1 t►r- _
A i 4 U NW1 wetlands
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http://toggis.queensbury.net/webmap/workingwebappapri12012TestPage.html?pid=301.13-1-88 5/27/2014
Town of Queensbury Building &Code Enforcement LO Ac ca
Office No. (518) 761-8256
Septic Inspection Report
Inspection request received:
Name: ' -N Inspected on: Lo`5 —/ r
Location: E (.0 .--1 LAD mr1 R61 Arrive:
Arrive: 1 I 5-3S— p.m.
Permit No.: / `-'/ a Inspector's Initials: e_,t
Comments and/or diagram
Soil Type: an /Clay
Type of Water: Municipal/Well Water
Waterline separation distance 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 ft. 1�
Length of each trench 1&`K3S JSe 6�
Depth of trenches ft.
Size of Stone
Seepage Pits: Number
Size: x
Stone Size:
Piping Size Type
Building to tank
Tank to Distribution Box 5 ( ' 1
Distribution Box to Field/Pit ( ��(� � ( j2
Opening Sealed: V14
End Cap N
Inlet/Outlet Pipes&Baffles
Manholes 12"or less below grade Y N
[provide extension collar if Yes] Y N
Location/Separations
Foundation to tank ft.
Foundation to absorption 'L!) ft.
Separation of Pits �' /_- ft.
Conforms as per Plot Plan _
Engineer Report and As-Built Y
ETU Maintenance Contract provided —Y_N
Location of System on Property:
Front Rear Left Side Right Side Middle Front Middle Rear
System Use St. •
A.. ;•—s
Partial Approved and needs to be re-inspected, please call the Building &Codes Office
Disapproved
Septic Inspection Report
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CENTER PROJECT
SERVICES
73 Sheridan Street, Glens Falls, NY 12801
Phone-518-796-2515
May 15, 2014
Project# 186
George Drellos
Sanitary Sewer Services
Luzerne Road
Queensbury, NY 12804
Re: Proposed Replacement Septic
Paul Thomas—564 West Mountain Road, Queensbury, NY
Dear George:
At your request we have reviewed your proposed replacement septic system design of the
existing 4 bedroom house at 564 West Mountain 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. 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 15 ft
wide by 35 ft long absorption bed with 3 — 30 foot long laterals, which will provide 525 sf of
absorptive area. The absorption bed can be constructed with the existing 1,250 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,
Thomas R. Center Jr, P.E.