2014-239 ,� TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518) 761-8201
Community Development - Building & Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: P20140239 Date Issued: Monday, June 30, 2014
This is to certify that work requested to be done as shown by Permit Number P20140239
has been completed.
Tax Map Number: 523400-301-017-0001-012-000-0000
Location: 535 WEST MT. Rd
Owner: GORDON & BEVERLY KILTS
Applicant: AMBER PATTEE
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 /)�
property owner of the responsibility for compliance with Site Plan, Gf/
Variance, or other issues and conditions as a result of approvals by the Director of Building&C n cement
Planning Board or Zoning Board of Appeals.
TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
14
Community Development- Building& Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20140239 Application Number: A20140239
Tax Map No: 523400-301-017-0001-012-000-0000
Permission is hereby granted to: GORDON & BEVERLY KILTS
For property located at: 535 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: GORDON & BEVERLY KILTS
535 WEST MT. Rd Septic Alteration Residential
QUEENSBURY,NY 12804-0000 Total Value
Contractor or Builders Name /Address Electrical Inspection Agency
SANITARY SEWER
GEORGE DRELLOS 792-7257
PO BOX 224
GLENS FALLS NY
Plans&Specifications
2014-239
Res. Septic Alteration
$40.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Friday,June 19,2015
(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 bury 4Th. .d . : :a 19,2014
SIGNED BY -1'- \ for the Town of Queensbury.
Director of Building& Code Enforcement
•
5 m— Office Use Only
Town of Queensbury.Building & Codes h
a Received:
L)) r Tax Map ID:
SEPTIC DISPOSIL PERMIT "
li o ll t Permit ��
A permit must be obtained before f egin{3iitt cangru?i }f} permit Fee: $ o r o
ITOWN OF QUEENSBURY Approvals:/� BUILDING&CODES
Applicant: IQiyi. e'r� PA f t et Installer/Builder 5ANv4A-r §w ea_ Se/gel/cc
Address: 53S ttt.<S* mi--. Ron1 Address Po . €0.,e tizzy
ificteers!!(..,-,-),_ 6'/en lam-/!r XIV /reoy
Phone: Phone 792 -725-7 CZ••'- 796-796-376.0G'
Owner: Location of Installation 5;3r est-/n1. Ed
Address:
Phone /n1 �� /f/ yc�
Contact Person for Building&Code Compliance: (9eOCyC a5"�`•«J Day Phone: 7$6 3760
Residence Information:
Year Built #of Bedrooms x Gallons per bedroom =Total Daily Flow
1980 or older x 150 = Garbage Grinder installed? /110
1981-1991 x 130 = 5642
Spa or Hot Tub Installed? NZ)
1992–Present 5 x 110 =
Parcel Information:
Topography DC Flat Rolling _Steep Slope %Slope
Soil Nature Sand Loam Clay _Other
Groundwater At what depth? Na
Bedrock/Impervious Material At what depth? N el
Domestic Water Supply k Municipal Well(if well,water supply from any septic system absorption is ft.)
Percolation Test Rate- /`S 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 Plpgning Board approved subdivision).
Tank size d/ 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?)
temative System Bed or other type?fO X ZS
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. /6
Print Name: t7 ebre-11-7 Date: p4/- //!�
Signature: .se, Date:
Town of Queensbury Building&Codes Septic Disposal Permit 518-761-8256
J
Town of Queensbury Building & Code Enforcement I /leg M id
Office No. (518) 761-8256 ( i 11 3°?)
Septic Inspection Report /
Inspection request received:
Name: I Q4te CK I -1-g ; ) Inspected on:
Location: 535 Aq/ 111 Arrive:
01•• a.m.1 p.m.
Permit No.: I i —.9) 39 Inspector's Initials: .—
Comments andlor diagram
Soil Type. San /Ly
Type of WWell er' unicip 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 a ft.
Length of each trench ft. Y .CV)
Depth of trenches j $' ft.
Size of Stone
Seepage Pits: Number
Size.
Stone Size:
Piping Size Type
Building to tank N_. A (7t3 —
Tank to Distribution Box
Distribution Box to Field/Pit rt r �r�I) 3 C Ply
Opening Sealed: Y .
JJ
End Cap
Inlet/Outlet Pipes&Bathes —fj✓
Manholes 12"or less below grade _Y ✓ r
[provide extension collar if Yes]
Location/Separations
Foundation to tankft. i
Foundation to absorption S. ft.
Separation of Pits
Conforms as per Plot PO r N
Engineer Report and s-Bu _N
ETU Maintenance Contract provided Y N
Location of S ste •n • o'e :
Front Left Side Right Side Middle Front Middle Rear
S stem Use Sta . :
Approved
Partial Approved and needs to be re-inspected, please call the Building&Codes Office
Disapproved
Septic Inspection Report
ursialy 1 -3
Foundation Inspection Report
Office No. (518) 761-8256 Date Inspection request received:
Queensbury Building&Code Enforcement Arrive: am/pm Depart: / lram/pm
742 Bay Rd., Queensbury,NY 12804 Inspector's Initials: # c "`/�IIIIj
NAME: 4 I m PERMIT#: I J a 3 /
LOCATION: /023 C ^ INSPECT ON: 9-a-e4-144
TYPE OF STRUCTURE: tee!
Comments
N N/A
`Footings=—=-
__1
Piers
Monolithic Slab
Reinforcement in Place
The contractor is responsible for
providing protection from freezing
for 48 hours following the placement
of the concrete.
Materials for this purpose on site.
Foundation/Wallpour
Reinforcement in Place
Footing Dowels or Keyway in place
Foundation Dampproofing
Foundation Waterproofing
Footing Drain Daylight or Sump
Footing Drain Stone:
12 inch width
6 inches above footing
6 mil poly for wet areas under slab
Backfill Approval
Plumbing Under Slab
PVC/Cast/Copper
Foundation Insulation Interior/Exterior
R-
Rough Grade 6 inch drop within 10 ft.
L:\Building &Codes Forms\Building &Codes\Inspection Forms Foundation Inspection Report.doc
Last printed 12/18/2013 2:44:00 PM
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I HAVE SEEN OR OBSERVED ALL OBJECTS
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CENTER PROJECT
SERVICESsm,a3'9
73 Sheridan Street, Glens Falls,NY 12801
Phone-518-796-2515
June 13,2014
Project# 188
George Drellos
Sanitary Sewer Services
Luzeme Road
Queensbury,NY 12804
Re: Proposed Replacement Septic
Amber Patte—535 West Mt. Road, Queensbury,NY
Dear George:
At your request we have reviewed your proposed replacement septic system design of the
existing 3 bedroom house at 535 West Mt. 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 450 GPD and a percolation rate of
I to 5 minutes, you will need 500 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 a new 1,250 gallon septic tank, new
distribution box, and 4 inch diameter perforated pipe and stone. The replacement system has
been designed to accommodate a future additional bedroom as long as all fixtures are upgraded
to water saving devices.
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.