2009-176 TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development- Building&Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20090176 Application Number. A20090176
Tax Map No: 523400-309-018-0001-011-000-0000
Permission is hereby granted to: LOU ANNE HOWES
For property located at: 4 EAST BRANCH Dr
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: LOU ANNE HOWES
4 EAST BRANCH Dr Septic Alteration Residential
QUEENSBURY,NY Total value
Contractor or Builder's Name/Address Electrical Inspection Agency
Plans &Specifications
2009-176
septic alteration residential
$25.00 PERMIT FEE PAID- THIS PERMIT EXPIRES: Tuesday,May 11, 2010
(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 To Queens ry;� f1Vo day,May 11,2009
6
SIGNED BY for the Town of Queensbury.
Director of Building Code nforcement
TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development- Building &Codes (518) 761-8256
CERTIFICATE (31'r` COMPLIANCE
Permit Number. P20090176 Date Issued: Monday, November 29, 2010
This is to certify that work requested to be done as shown by Pen-nit Number P20090176
has been completed.
Tax Map Number. 523400-309-018-0001-011-000-0000
Location: 4 EAST BRANCH Dr
Owner. LOU ANNE HOWES
Applicant: LOU ANNE HOWES
This structure maybe occupied as a:
Septic Alteration Residential
By Order of Town Board
TOWN OF QUEENSBURY
Issuance of this Certificate of Compliance DOES NOT relieve the l ,��
property owner of the responsibility for compliance with Site Plan, J ,<S'
= V -
Variance, or other issues and conditions as a result of approvals by the Director of Building&Co a Enfo ement
Planning Board or Zoning Board of Appeals.
OFFICE USE ONLY
TAX MAP NO. '
PERMIT NO. PERMIT FEE
APPROVALS: ZONING TOWN CLERK MAY 07 2009
' '
__.____ __[ .Q,QIJ e
APPLICATION FOR SEPTIC DISPOSAL SYSTE BUILDING & CODES�
A PERMIT MUST BE OBTAINED BEFORE WORK BEGINS.APPLICATION IS SUBJEC TO REVIEW BEFORE ISSUANCE OF A VALID
PERMIT.
OWNER: tom: `�%PUS INSTALLER:
r
ADDRESS:-
ADDRESS:
PHONE NOS. , / 6 PHONE NOS. 7 / v — v 0-
LOCATION OF INSTALLATION: kr
YEAR BUILT NO.OF X COMPUTATION= RESIDENCE INFORMATION:
BEDROOMS = TOTAL DAILY FLOW
1980 or older X 150 gallon per bedroom = GARBAGE GRINDER
1981 -1991 INSTALLED? c7
X 130 gallon per bedroom =
1992-present X 110 gallon per bedroom = SPA OR HOT TUB
INSTALLED? NJ
PARCEL INFORMATION:
TOPOGRAPHY: Flat rolling Steepslo e
P %Slope
✓ SOIL NATURE: Sand Loam
Clay Other
✓ GROUNDWATER: At what depth?
✓ BEDROCK/IMPERVIOUS MATERIAL: At wh epth?
✓ DOMESTIC WATER "FLY: Municipal Well (If well: Water supply from any septic
system absorption is ft.)
✓ PERCOLATION TEST: Rate is
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: ��� 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? -Bc4 �Z;" x `
❑ 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 the regulations with respect to this application and
agree to abide by these and all requirements of the Town bf (4i4g
1-8256 OR EMAIL
Queensbury Sanitary Sewage Disposal Ordinance. codes@Queensbury.net
ORE INFORMATION
.6 Dbury.net
nature of Person Responsible Date
Town of Queensbury • Community Development Office - 742 Bay Road, Queensbury, NY 12804
3 7C�
Septic Inspection Report
Office No. (518) 761-8256 Date Inspection request received:
Queensbury Building &Code Enforcement Arrive: am/pm Depart: am/pm
742 Bay Rd., Queen , NY 12804 Inspector's Initials:&�
NAME: . PERMIT NO..
LOCATION: _ INSPECT ON:
RECHECK:
Comments and/or diagram
Soil Type Loam J Clay
Type of Water: u ci Well Water
Waterline separation distance
Well separation distance ft. `
Other wells: ft.
Well Casing Length 50' + / - Y ot N N/A
Absorption Field: Total length V ft.
Length of each trench ft.
Depth of trenches ft.
Size of Stone
Seepage Pits: Number
Size: &1= x
I , t L
Stone Size:
Piping Size Type
Building to tank Uk il A&IIL-
Tank to Distribution Box i' t
Distribution Box to Field/ Pit
Opening Sealed: Y N
End Ca _N _
Inlet/Outlet Pipes&Baffles _ _N .1
Location Separations
Foundation to tank ft.
Foundation to absorption ft. j
Separation of Pits
Conforms as per Plot Plan _Y_N
Engineer Report and As-Built Y N
Location of System on Property: _
Front Re Left Side Right Side Middle Front Middle Rear
S st m Use S s:
Approved
Partial Approved and needs to be re-inspected, please call the Building &Codes Office
Disapproved
Last revised 06/18/07 L:\Building&Codes Forms-OLD\Building&Codes\Inspection Forms\Septic Inspection Report.doc
NACE ENGINEERING, P.C.
169 Haviland Road, Queensbury, NY 12804
Phone-518-745-4400 Fax -518-792-8511
May 6, 2009
Project # 49291
Mr. Dan Drellos
Sanitary Sewer Services
Queensbury,NY 12804
Re: Proposed Replacement Septic System
Rice Residence—4 East Branch Drive, Queensbury,NY
Dear Dan:
At your request we have reviewed your proposed replacement septic system design at the site of
the existing 3 bedroom house of Steve Rice at 4 East Branch Drive in Queensbury. As per our
conversation the residence has an existing failed septic systems.
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 330 GPD and a percolation rate of
1 to 5 minutes, you will need 348 square feet of absorptive area. We recommend using a 20 ft
wide by 20 ft long absorption bed with 3 — 15 foot long laterals, which will provide 400 sf of
absorptive area. The absorption bed should be constructed with a new distribution box, 4 inch
diameter perforated pipe and stone.
Please call me if you have any questions.
Sncerely,
r`
Thomas R. Center Jr., PE
Cc: Dave Hatin, Town of Queensbury Qj
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Septic Inspection Rep
P
Office No. (518) 761-8256 Date Inspection requ ec ved:
Queensbury Building &Code Enforcement Arrive: �am Depart: 7.�iZ art}
742 Bay Rd., Queensbury, NY 12804 Inspector's Initials:
NAME: "T'E j E 1 PE r NO.: VF ei)N tJ� 0
LOCATION: L4 E �� Pik-JC� INS EST ON: ) - 'A —bq
RECHECK:
Comments and/or diagram
Soil Type: Sand/ Loam/ Clay
Type of Water: Municipal/ Well Water
Waterline separation distance ft. r
Well separation distance ft.
�� AD�
Other wells: ft.
Well Casing Length 50' + / - Y N N/A
Absorption Field: Total length ft. _
Length of each trench ft. �``
Depth of trenches
Size of Stone
Seepage Pits: Number
Size: x ---_-t--- `
Stone Size: �' S!i r, C ...v
1
Piping Size Type
Building to tank _ ;
Tank to Distribution Boxes',
Distribution Box to Field J Pit
Opening Sealed: Y N 19,
F N �t't.
End Cap —Y—N
Inlet/Outlet Pipes&Baffles _Y
C-
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
Location of System on Property:
Front Rear Left Side Right Side Middle Front Middle Rear
System Use Status:
Approved
Partial Approved and needs to be re-inspected, please call the Building &Codes Office
Disapproved
Last revised 06/18/07 U\Building&Codes Forms-01-1)\Building&Codes\Inspection Forms\Septic Inspection Report.doc