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TOWN OF QUEENS RY
• BUILDING . •
REVIEWED r -
DATE _._q.1/4—
NOTES: E of NETy r MAP OF A SURVEY MADE FOR
,.. T3AMETTF 09 .
„ THIS SURVEY WAS PREPARED WITHOUT THE DEED REFERENCE: T ,�' MARY LOU & DAVID E. DUTRA SR.
BENEFIT OF AN ABSTRACT OF TIRE AND IS LEGEND *uy r.JI otM I ,
THEREFORE•SUBJECT TO ANY EASEMENTS, Mary Lou tr David E&RIM S. C r
A STATEMENT OCOVENANTS OR FS FACTS SUCH DOCNS UMENT E11rd Dutra o I R.F. IRON ROD FOUND ��,r yAD r TOWN OF OUEENSBURY,'COUNTY OF WHITEN, STATE OF NEW YORK
WOULD DISCLOSE. Doled Octebr&1999 o I P.F. IRON PIPE FOUND D to \\FO ,�
Libor 1136 Page 230 o I R.S. IRON ROD SET \AND% BOLSTER AND ASSOCIATES
• 2) UNAUTHORIZED A N SURVEYORS
R A SURVEY U UTIUTY POLE '
MAP BEARING OF A UCENSEDIO ,LANDS —DMSON ,OF 1s A . .. op STONE WALL PROFESSIONAL LAND•SURVEYORS
VIOLATION SECTION ATION SUB—DMSION 2,OF THE .we BARBED VANE FENCE - 342 MAIN STREET,HUDSON FALLS,NEW YORK 12839
NEW YORK STATE EDUCATION LAW. -
_ • . PONT • DATE:JULY 25,2006
3) ONLY COPIES FROM THE ORIGINAL OF THIS SURVEY W.F.F. WOOD RICE POST RUSSELL E.NONARD,PLS N.Y.S.UC.N0.50540 REVISED:JULY 31,2006 SCALE 1' 20
—m.— OVERHEAD VANES
MARKED AN ORIGINAL OF THE LAND SURVEYORS • � ' I -
SEAL SHALL BE CONSIDERED TO BE VALID TRUE COPIES. at. ' NOW OR FORMERLY DATE SEALED. REVISED:AUGUST 1,2006 OWC.N0.06118 C
fl OSBY 289.08-1-33
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8/9/2020 Town of Queensbury Interactive Mapper
j flown of Queensbury Logo
Town of Queensbury Interactive Mapper
XY Location-73.668,43.372
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\E11:1:
10 Z020f QuEE1\zsauR:
! / i
S BL:289.6-1-18 F' I `
�_ OWNER:DONNA M HARUBEN
NAGY-DR''.1 SBL•289.6.1-20
'� OWNER:PENNY DANLEY-GRA'JATT
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` c ' _ ` SBL:289.E-1-32 N.
\f Z OWNER:GUY D!MEMMO `1
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SBL 289.6-1-11 1 /
!
OWNER:JEFFREY G GODNICK /
I SBL 289.6-1-33 �'
OWNER:MARYLOU DUTRA l
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I OWNER'REECE RUDOLPH
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file:///User/maryloudutra/Downloadsffown of Queensbury Interactive Mapper.html •
2g-y 6,-f 33 OFFICE USE ONLY % t k I r_.
• TAX:MAP NO. PERMIT NO, -& 7 f PERMIT FEE i )
SEP 2 6 20D6
APPROVALS: ZONING TOWN CLERK . •
•
• Tc`i"::.)-,='•iiW :,--,iln.,
_L$IILH !'.J COD':
APPLICATION FOR SEPTIC DISPOSAL SYSTEM PERMIT:
A PERMIT MUST BE OBTAINED BEFORE WORK BEGINS.APPLICATION IS SUBJECT TO REVIEW BEFORE ISSUANCE OF A VALID
PERMIT.
OWNER:. r�rx o.,(/ i)r i l'f a. INSTALLER: . F I:L'YQ_\\ L] ;
ADDRESS: 02 t1 Na cy 1/I P ADDRESS: 1630z_._ � ,'.-1Ct
PHONE NOS. 5/ff 2 96 t'9 s'Z PHONE NOS. -77 Z—9 2. i-I
LOCATION OF INSTALLATION: `6 .42 is 4- i D C.I. (_, z.—7.6T. — (Q 7Wr2 (k A�F ('11-p.)
/. �'� F+
NO.
YEAR BUILT X COMPUTATION _ TOTAL DAILY,BEDROOMS �
_...__...__.._,:..__.r_
1980 or older _X 150 gallon per bedroom = r Z.0_0 INSTALLED? +tr 1
1981-1991 X 130 allon per bedroom
._�..__�._ ._....._._._...___:._._,_..—.. 9 F __ -SPA OR HOT TUB
1992-present X t 110 gallon per bedroom L I INSTALLED? t✓o
PARCELINFORMATION:
✓ TOPOGRAPHY: FL T ROLLING \ STEEP SLOPE. %SLOPE
✓. SOIL NATURE:SAND LOAM- CLAY OTHER.
✓ GROUNDWATER: AT WHAT DEPTH? BEDROCK/IMPERVIOUS MATERIAL: AT
WHAT DEPTH?
I DOMESTIC WATER SUPLY: MUNICIPAL WELL l . -70 i p f46LR tJ� ow g
13Ei6H x Tv S To.- (4 otDr i.6 TAN)
An)
(IF WELL:WATER SUPPLY FROM ANY SEPTIC-SYSTEM ABSO PTIO I 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 ih 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.
I :SEPTIC TANK GALLON(MIN.SIZE IS 1,000 GAL) TILE FIELD:EACH TRENCH FT.
I TOTAL SYSTEM LENGTH:: FT. SEEPAGE PIT(S)cHOW MANY?
✓ SIZE OF EACH FT.X FT.
. SIZE OF STONE TO BE USED:ft •/DEPTH OR THICKNESS FT.
✓. BED SYSTEM SIZE X
✓ ALTERNATIVE SYSTEM: LENGTH A!p/OR SIZE
S /�/an S 7,-. IS'op GAL Ltxc
✓ HOLDING TANK SYSTEM:(If required)NO.OF TANKS: /SIZE OF EACH 10..3nnr-,a.,at ( -Nt
.GALLONS.,TOTAL.CAPACITYi �� GAL.
NOTE: ALARM SYSTEM AND ASSOCIATED ELECTRICAL WORK MUST BE INSPECTED BY A TOWN
Er 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 Oueensbury,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 knovin 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 QUESTIONS? CALL 781.8258 OR EMAIL
Queensbury Sanitary Sewage Disposal Ordinance. codesAqueensburv.net
VISIT OUR WEBSITE FORMORE INFORMATION
6..,Q lr�—'- Sf a(- vG www.queensburv.net
Signature of Person Responsible Date
01.
: Town of Queensbury•Community.Development Office•742 Bay Road,Queensbury,NY12804
DCKIZACCIt
RESOLUTION SETTING PUBLIC HEARING ON SEWAGE DISPOSAL
VARIANCE APPLICATION OF DAVID DUTRA
RESOLUTION NO.: BOH 19,2006
INTRODUCED BY: Mr.John Strough
WHO MOVED ITS ADOPTION
SECONDED BY: Mr.Tim Brewer
WHEREAS,the Queensbury. Town Board serves as the Town's Local Board of Health and
is authorized by Town Code Chapter 136 to issue variances from the Town's On-Site Sewage
Disposal Ordinance,and
WHEREAS,_David-Dutra lias applied to the Local Board of Health for a variance-from
Chapter 136, §136-11, which requires an applicant to obtain a variance for a holding tank and the
applicant has requested a new,Code-compliant holding tank to replace the existing septic system on
property located at 28 Nacy Road in the Town of Queensbury,
NOW,THEREFORE,BE IT
RESOLVED, that the Town of Queensbury Local Board of Health will hold a public
hearing on Monday, September 25`h, 2006 at 7:00 p.m. at the Queensbury Activities Center, 742
Bay Road, Queensbury, to consider David Dutra's sewage disposal variance application concerning
property located 428 Nacy:Road mthe Town of Queensbury and bearing Tax Map No : 289:6-1
;r33.and at that time all interested persons will be heard,and
BE IT FURTHER,
RESOLVED, that the Local Board of Health authorizes and directs.the•Queensbury Town
Clerk to publish the Notice of Public Hearing presented at this meeting and send a copy-of the
Notice to neighbors located within 500 feet of the property as required bylaw.
Duly adopted this 11°i day of September,2006,by the following vote:
AYES : Mr: Sanford, Mr. Strough,Mr.Brewer,Mr. Stec,Mr. Boor
NOES : None
ABSENT: None
J U e,.
• Septic Ins Report
p Inspection Repo
p
Office No. (518)761-8256 Date Inl �pectiornrequest received:
Queensbury Building&Code Enforcement Arrive: -' am/pm , Depart: am/pm
742 Bay Rd.,Queensbury, NY 12804 Inspector's Initials: ' C.---
NAME: 1.)07/V,Liii
J PERMIT NO.: •
LOCATION: 2- `�all- i-of INSPECT ON:
RECHECK:
Comments and/or diagram
Soil Type: Sand/Loam/Clay
Type of Water: Municipal/Well Water — \> `5
Waterline separation distance ft. o c
i
Well separation distance ft. Re.N5e
Other wells: ft. �G�C� lel7 l�Co Youte
Absorption Field: Total length ft. 0 1
Length of each trench ft.
ft. C�i��l C1la c i
Depth of trenches fC� (-ti S
p
Size of-Stone �L�,SG�b—air
Seepage Pits: NumberA . 1L.)o r C-tL)
Size: x
Stone.Size: AND 1-tC j 7 i ji-'%vv I- i Uo r ).
Piping Size * Type Aerk 0X-17 i
Building to tank
Tank to Distribution Box j�q�. /
Distribution Box to Field/Pit
oil
Opening Sealed: Y/ NI Partial N/taG c�
End Cap
Inlet/Outlet Pipes&Baffles Y_N
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:4
proved..
arbai Approved and needs to be re-inspected, please call the Building"&Codes Office
Disapproved
Last revised 021006
Last revised 1/6/05
Septic Inspection Report s3
Office No. (518)761-8256. Date Inspecti rrk�request received:
Queensbury Building&Code Enforcement Arrive U am/ mom, /Depart: am/pm
742 Bay Rd.,Queensbury, NY 12804 Inspector's I itials:
r /
NAME: •DLf� PERMIT NO.: y
LOCATION: .-7-6 4o /a? INSPECT ON:
RECHECK:
Comments and/or diagram
Soil Type: Sand/Loam/Clay
Type of Water: Municipal/Well Water
Waterline separation distance ft.
Well separation distance ft.
Other wells: ft.
Absorption Field: Total length _ ft.
Length of each trench ft.
Depth of trenches ft.
Size of Stone
Seepage Pits: Number
Size: x
Stone Size:
Piping Size Type
Building to tank
Tank to Distribution Box
Distribution Box to Field/.Pit
Opening Sealed: Y/ N/Partial
End Cap
Inlet/Outlet Pipes&Baffles . _Y N
Location I.Separations
Foundation to tank ft.
Foundation to absorption . ft.
Separation of Pits. ft. (
Conforms as per Plot Plan —Y—N • G 1� `��
Engineer Report and As-Built -Y_N
Location of System on Property: 6'et
Front Rear Left Side Right Side
Middle Front Middle Rear
System Use Statu
Approved
Partial Approved and needs to be re-inspected,please call the Building &Codes Office
Disapproved
Last revised 021006
Last revised 1/6/05
/0
#0 .1,
! r-k- f ‘b +ter ^s
Septic Inspection Report
Office No. (518)761-8256 Date.Inspeefio uest received:
Queensbury Building&Code Enforcement Arrive: /('i U m/ppa' part: am/pm
742 Bay Rd.,Queensbury, NY 12804 Inspectdr~s I itials:
NAME: 2.-D1)'troL__ . � j PERMIT NO.: 234
LOCATION: ,i1Lu c y l INSPECT ON:
RECHECK: /
Comments and/or diagram
Soil Type: Sand/ Loam/Clay
Type of Water: Municipal/Well Water //z,L -06 v5
Waterline separation distance . ft.
Well separation distance ft.
Other wells: ft. ` C_ , IA-�1`�-5
Absorption Field: Total length ft•
Length ^-of each trench ft.
Depth of trenches ft.
Size of Stone. .
Seepage Pits: Number. .
Size: x
Stone Size: AL K\ W Oc`�G✓L (-(u
Piping Size Type O
Building to tank
Tank to Distribution Box
Distribution Box to,Field/ Pit
Opening Sealed: Y/N/ Partial
End Cap
Inlet/Outlet Pipes&Baffles I Y—N I.
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 /�l Ai
Location of System on Property:
Front Rear Left Side Right("-ideR- `�/
!pc--
Middle Front Middle Rear
System Use Status:
/Approved
I Partial Approved and needs to be re-inspected, please call the Building &Codes Office
Disapproved
Last revised 021006
Last revised 1/6/05
. .
Septic Inspection Report
Office No. (518)761-8256 Date Insinctiprvequest received:
Queensbury Building&Code Enforcement Arrive: •-9 am/pm& pe pa rt: am/pm
742 Bay Rd.,Queensbury, NY 12804 Inspector's Initials: \.//4-C--''
NAME: D A- PERMIT NO.: 00--- (p7
LOCATION: .47:/4-c-r INSPECT ON:
RECHECK:
Comments and/or diagram
Soil Type: Sand/ Loam/Clay
Type of Water: Munidpal/Well Water
Waterline separation distance 5 tl
ft. ) /4&12
Well separation distance ft.
Other wells: ft.
Absorption Field Total length _ft 1 500 .
Length of each trench ft.
Depth of trenches ft.
Size of Stone
1-410
Seepage Pits: Number —
Size:
Stone Size:
Piping Size Type
• Building to tank y 47eb
Tank to.Distribution Box
Distribution Box to Field/ Pit
Opening Sealed: Y/Ni Partial
End Cap
Inlet/Outlet Pipes&Baffles \/Y N
Location!Separations
• Foundation to tank• fretit. fiet.../1"
Foundation to absorption ft.
•Separation of Pits ft.
Conforms as per Plot Plan i y N
Engineer Report and As-Built Y-
N
Location of System on Property:
•
Front Rear Left Side Right Side LA.
1<t1.'
Middle Front Front Middle Rear
System Use Status:
• ;proved
'Partial Approved and needs to be re-inspected,please call the Building&Codes Office
Disapproved
• Last revised 021006
Last revised 1/6/05