SEP-000623-2017 TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5904 (518)761-8201
--- Community Development-Building&Codes (518)761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: SEP-000623-2017 Date Issued: Thursday, October 12, 2017
This is to certify that work requested to be done as shown by Permit Number SEP-000623-2017
has been completed.
Tax Map Number: 302.17-1-38
Location: 33 WINTERGREEN RD
Owner: David Reed
Applicant: Sanitary Sewer Service
This structure may be occupied as a: Residential Septic Alteration
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,
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.
�'_ TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5904 (518)761-8201
Community Development-Building&Codes (518)761-8256
BUILDING PERMIT
Permit Number: SEP-000623-2017
Tax Map No: 302.17-1-38
Permission is hereby granted to: Sanitary Sewer Service
For property located at: 33 WINTERGREEN 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
Tyne of Construction
Owner Name: David Reed Septic Disposal-Residential $0.00
Owner Address: 33 Wintergreen RD Total Value $0.00
Queensbury,NY 12804
Contractor or Builder's Name/Address Electrical Inspection Agency
Sanitary Sewer Service
PO Box 224
Glens Falls,NY 12801
Plans&Specifications
Residential Septic Alteration
$40.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Wednesday,October 3,2018
(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 ex ' ation date.)
Dated at the Town of ueensb kes a tober 3,2017
SIGNED BY: for the Town of Queensbury.
Director of Building&Code Enforcement
SEPTIC DISPOSAL PERMIT APPLICATION Office Use Oniv
742 Bay Road,Queensbury,NY 1
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Tax Map ID#: OZ- • - /' 3U P i F e: $ � ; Invoice#: 9ol/
201
Project Location- s iance? Yes No
Primary Owner(s) rke
URY
Mailing Address 33 ,,�61-c, re e ,Q
Phone & Email
Installer/Builder /,,
Mailing Address S '�- ZZ y
Phone & Email
Engineer N
Mailing Address
Phone & Email
Contact Person for Building&Code Compliance: 'Ze / Phone:_Ps - ;71� � ��66
RESIDENCE INFORMATION:
Year Built #of bedrooms X gallons per bedroom =total daily flow Garbage Grinder Yes N
1980 or older Installed? (circle one)
1981-1991Spa or Hot Tub Yes No
�1C7 �® Installed? (circle one)
1992-Present
PARCEL INFORMATION:
Topography Flat Rolling Steep Slope %Slope
Soil Nature Sand Loam Clay Other
Groundwater At what depth? N
Bedrock/Impervious material At what 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 licensed engineer/architect)
PROPOSED SYSTEM FOR NEW CONSTRUCTION:
Tank size d gallons (min. size 1,000 gallons, add 250 gallons for each garbage cylinder or spa/hot tub
System Absorption field with#2 stone Total length ft.; Each Trench ft.
Seepage Pit with#3 stone How many: • Size:
Alternative System Bed or other type: de ,e
Holding Tank System Total required capacity? ;tank size ;#of tanks
NOTES: 1.Alarm system &associated electrical work must be inspected by a Town approved electrical inspection
agency; 2.We will no longer allow systems to be covered until such time as an as-built plan is received and approved.
The installed system must match the septic layout on file—no exceptions.
Declaration:Any permit or approval granted which is based upon or is granted in reliance upon any material
representation 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 and agree to abide by these and all requirements of the Town of Queensbury Sanitary Sewage
Disposal Ordinance.
PRINT NAME: (/� e'e, " S DATE: A7
SIGNATURE: �'? DATE: /a - Z - 12
Town of Queensbury Building&Code Enforcement Revised February 2017
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CENTER PROJECT
SERVICES
73 Sheridan Street, Glens Falls,NY 12801
Phone-518-796-2515
D E re E OW September 30, 2017
Project#262
George Drellos OCT 0 3 201
Sanitary Sewer Service
Queensbury,NY 12804 TOWN OF QUEENSBURY
BUILDING&CODES
Re: Proposed Replacement Septic
33 Wintergreen Road, Queensbury,NY
Dear George:
At your request, we have reviewed your proposed replacement septic system design of the
existing 4-bedroom house at 33 Wintergreen 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 a minimum of 464 sf of absorption area. We recommend using 20
ft wide by 30 ft long absorption bed with 4 - 25 ft long laterals. The absorption system 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,
Thomas R. Center Jr, P.E.
302.17-1-38 SEP-000623-2017
Reed, Dave
33 Wintergreen Road
Residential Septic Alteration