2007-420 (2) TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518) 761-8201
4z Community Development- Building &Codes (518) 761-8256
CE R TIFICATE OF COMPLIANCE
Permit Number. P20070420 Date Issued: Wednesday, January 09, 2008
This is to certify that work requested to be done as shown by Permit Number P20070420
has been completed.
Tax Map Number. 523400-309-013-0001-072-000-0000
Location: 4 INDIANA Ave
Owner.. JOHN & LINDA WINSLOW
Applicant: JOHN & LINDA WINSLOW
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
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 12804-5902 (518)761-8201
Community Development- Building&Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20070420 Application Number. A20070420
Tax Map No: 523400-309-013-0001-072-000-0000
Permission is hereby granted to: JOHN &LINDA WINSLOW
For property located at: 4 INDIANA Ave
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: JOHN &LINDA WINSLOW
233 LUZERNE Rd Septic Alteration Residential
QUEENSBURY,NY 12804 Total value
Contractor or Builder's Name/Address Electrical Inspection Agency
Plans &Specifications
2007-420
septic alteration residential
$25.00 PERMIT FEE PAID- THIS PERMIT EXPIRES: Wednesday,July 09, 2008
(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 T
y 09, 2007
SIGNED BYo ® Qe y
for the Town of Queensbury.
Director of Building&Code Enforcement
- OFFICE USE ONLY ;
r �
;
TAX MAP Nb. � � PERMIT N0. /�V ERM1T FEE
APPROVALS: ZONING TOWN CLERK
APPLICATION FOR SEPTIC DISPOSAL SYSTEM PERMIT:
A PERMIT MUST BE OBTAINED BEFORE WORK BEGINS.APPLICATION IS SUBJEC 0 REVIEW BEFORE 7ANCE OF A VALID
PERMIT.
OWNER:c 0 l/� s t�1 Jr`-'uW INSTALLER e_"
ADDRESS: 1 df s✓1 -- ADDRESS: X � 6 j
PHONE NOS. " 9(0 PHONE NOS, / 9
LOCATION OF INSTALLATION:
_..............................................................................................}...........................,..........................................,...............r.........................................................................,.,..........: RESIDENCE INFORMATION:
NO.OF 4 =YEAR BUILT X � COMPUTATIONS TOTAL DAILY FLOW
BE ROOMS
w y..........i•............'1•'y�' i
1980 or alder X 150 gallon per bedroom i � i —(�// � NSTALLOEDG?
........,...-........�......-..._.................................................................................. ...............................................,.' i ....................... ,.........................
}
1981 1991 X 130 gallon per bedroom t....�................
SPA OR HOT TUB
.................................................................................. INSTALLED?
}} ...1992-present...'...........................................L..X...i.......110 gallon per bedroom.,. S _ `
k...............-............_..-.....-....A..............................................i,...........i......................................................................................................................................................
........
PARCEL INFORMATION:
✓ TOPOGRAPHY: FLAILING STEEP SLOPE %SLOPE
✓ SOIL NAME: SAND LOAM CLAY OTHER
✓ GROUNDWATER: AT WHAT DEPTH? BEDROCKAM PERVIOUS MATERIAL: AT
WHAT DEPTH?
✓ DOMESTIC WATER SUPLY: MUNICIPAL WELL
(IF WELL: WATER SUPPLY FROM ANY SEPTIC-SYSTEM ABSORPTION IS FT.-)
✓ PERCOLATION TEST: RATE IS PER MIINUTE 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). Add 250
gallons to the size of the septic tank and leach field for each garbage grinder, spa or whirlpool tub.
✓ SEPTIC TANK100D GALLON (MIN. SIZE IS 1,000 GAL.) TILE FIELD: EACH TRENCH FT.
✓ TOTAL SYSTEM LENGTH: FT. SEEPAGE PIT(S): HOW MANY?
✓ SIZE OF EACH FT. X___,____FT.
✓ SIZE OF STONE TO BE USED: # /DEPTH OR THICKNESS FT.
✓ BED SYSTEM SIZE: A-U X
✓ ALTERNATIVE SYSTEM: LENGTH AND/OR SIZE
✓ HOLDING TANK SYSTEM:(If required) NO. OF TANKS: I SIZE OF EACH
✓ GALLONS.Il-OTAL CAPACITY GAL.
NOTE. ALARM SYSTEM AND ASSOCIATED ELECTRICAL WORK MUST BE INSPECTED BY A TOWN
is 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 equirements of the Town of QUESTIONS? CALL sbury. OR EMAIL
codesf¢7aueensbur .net
nsbu anitary Sewage DI osal Ordincpce.
f � VISIT OUR WEBSITE FOR MORE INFORMATION
www.aueensbury.net
S n re of Person Resp'ortilble Date
,`44 Town of Queensbury ■ Community Development Office • 742 Bay Road, Queensbury, NY 12804
A 620, oc) /0 DA-Ayla
Septic Inspection Report
Office No. (518) 761-8256 Date In n nest received:
Queensbury Building&Code Enforcement Arrive: m part: am/pm
742 Bay Rd., Queensbury, NY 12804 Ins s7 als:
NAME: i "--Sk ('j _ PERMIT NO.:
LOCATION: 41 INSPECT ON:
RECHECK:
Comments and/or diagram
Soil T
T of Water: Muni Well Water
Waterline se ration distance ft.
Well separation distance ft.
Other wells: ft,
-Absorption Field: Total lengthft,
Length of each trench
--Depth of trenches
Size of Stone y
Seepage Pits: Number
Size: x
Stone Size:
Piping Size Type
Building to tank
Tank to Distribution Box JL
Distribution Box to Field Pit ►^
O ni Sealed: Y N Partial
End Ca 6Ajb6
In( Outlet Pipes&Baffles Y N
Location Se rations
Foundation to tank
Foundation to absorption
Separation of Pits ft.
Conforms as per Plot Plan Y N
Engineer Report and As-Built Y N
Location of System on Pro
Front Rear eft Si Right Side
Middle Front Middle Rear
Approved
Partial Approved and needs to be re-inspected, please call the Building &Codes Office
Disapproved
Last revised 021006
Last revised 1/6/05
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169 Haviland Road, Queensbury, NY 12804
Phone-518-745-4400 Fax -518-792-8511
July 8, 2007
Project#49251
Mr. Dan Drellos '"P C
Sanitary Sewer Service /
Luzurne Road
Queensbury, NY 12804
Re: Replacement Septic System
Winslow Residence—4 Indiana Avenue, Queensbury, NY
Dear Dan:
At your request we have reviewed your proposed replacement septic system design at the site of
the existing 4 bedroom house of John Winslow at 4 Indiana Avenue 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 with a new 1,000 gallon septic tank is acceptable. Based upon a design flow rate
of 600 GPD and a percolation rate of 1 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.
Please call me if you have any questions.
Sincerely,
Thomas R. Center Jr., PE