2002-425 TOWN OF QUEENSBURY
7 2 B R n NY 12 4-5902 518 761-8201
ow 4 ay oad,Quee sbury, 80 ( )
Community Development - Building & Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: P20020425 Date Issued: Monday, August 18, 2003
This is to certify that work requested to be done as shown by Permit Number P20020425
has been completed.
Tax Map Number: 523400-289-007-0002-006-000-0000
Location: 674 MOON HILL Rd
Owner: KRIS ERCEG
Applicant: KRIS ERCEG
This structure may be occupied as a:
By Order of Town Board
Septic Alteration Residential TOWN OF QUEENSBURY
("Da4IP 4 kil."1
Director of Building&Code Enforcement
TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
FON
Community Development-Building& Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20020425 Application Number: A20020425
Tax Map No: 523400-289-007-0002-006-000-0000
Permission is hereby granted to: KRIS ERCEG
For property located at: 674 MOON HILL 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: KRIS ERCEG
674 MOON HILL Rd Septic Alteration Residential
Total Value
LAKE GEORGE,NY 12845
Contractor or Builder's Name /Address Electrical Inspection Agency
Plans&Specifications
2002-425
SEPTIC ALTERATION AS PER PLOT PLAN SPECIFICATIONS
$25.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Wednesday,May 28,2003
(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 f Quee b4r; •sd. ,May 28,2002
dr'.
SIGNED BY for the Town of Queensbury.
Director of Building&Code Enforcement
Application for Permit-Septic Disposal System
Town of Queensbury 742 Bay Road Queensbury,NY 12804 (518) 761-8256
1. OWNER INFORMATION: _ _ �--
Location of installation: �� 0 0 /� ��( it
r) Office Use
File Permit No.Q= f -L/ 5
Tax Map No. / /
Fee Paid
Owner's Name: Kr- Eacci
Address: Y 7N„
2. INSTALLER'S NAME : ( /3. S. 5c,r/ PHONE NO. trt4Y 2a
3. RESIDENCE INFORMATION: (circle year of dwelling,indicate#bedroom(s) and mul •st _ 2
bedrooms with applicable gallons per bedroom to equal totals,y`lt .. '� ;v' G•
Year of House: No. of Bedrooms x Computation = Total Daily Flow
1980 or older 3 x 150 gal/bdrm = ys
1980-1991 x 130 gal/bdrm =
1991 -present xg� 110 gal/bdrm =
Garbage Grinder Installed yes_ / no tl
Spa or Whirlpool Installed yes_ / no K
4. PARCEL INFORMATION: (circle applicable information&indicate measurements)
Tip graphy re Ground Water Bedrock or Impervious Material Domestic Water Supply
Flat s•,..#, at whet depth at what depth i'cipal
oiling •• 3 feet feet
Steep slope c ay if well;water supply
_%slope other from any septic-system
depth: absorption is/ ft.
other
Percolation Test: (To be completed by licensed professional engineer or architect)
Rate: minute per inch
5. 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 Tank: l & t gallon(min. size 1,000 gal)
Tile Field: each trench ft. Total System Length: ft
Seepage Pit(s): number of size of each: ft. by ft
Size of Stone to be used: # / depth or thickness feet
Bed System Size: x i A./dl rc-f/ ''
Alternative System: length and/or size )-
6.
HOLDING TANK SYSTEM: (if required)
Number of tanks: / Size of each: gallons /TOTAL Capacity: gallons
Note: Alarm System and associated electrical work must be inspected by a Town approved
electrical inspection agency.
7. SIGNATURE &INFORMATION FOR RESPONSIBLE PERSON(please read)
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 th own of Queensb Sanitary Sewage Disposal Ordinance.
C.- 1—)4' )0d 61
Signature of responsible person Date
Septic Inspection Report
Office No. (518) 761-8256 Date Inspection reque,t re ived:
Queensbury Building&Code Enforcement Arrive: am/I epart: �I am/pm
742 BayRd.,Queensbury,NY 12804 Inspector's
Q ury, Inspector s Initials: •.•
PERMIT NO.: 6
LOCATION: ? MOO KILL— 4). INSPECT ON: 7/L/11 .•
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
Location/Separations
Foundation to tank ft.
Foundation to absorption ft. g/f
QSeparation of Pits ft. /7'{/4-U
Conforms as per Plot Plan Y N
C6q5
Location of System on Property:
Front Rear Left Side Right Side
Middle Front Middle Rear
S stem Use Status.
Approved
Partial Approved and needs to be re-inspected,please call the Building&Codes Office
Disapproved
L:\SueHemingway\Building.Codes.Inspection.FORMS\Septic Inspection Report.doc January 28,2003
COMMONWEALTH ELECTRICAL INSPECTION SERVICE,INC.
Main Office 176 Doe Run Road-Manheim,PA 17545
MUNICIPAL CERTIFICATE - ELECTRICAL APPROVAL
Permit No. Cert. O 81407 Cut-in Card No.
!.\...
Owner C -ee •
Location 674 00 0 4) AI( , 0. .62I-€_ ( r
Installation Consisting of. ze-b49 CQA-)T/
Installed By se S / - e Lic.No.
The conditions following governed the issuance of this certificate,and any certificate previously issued is
cancelled:-
This certificate only covers the electrical equipment and installation conditions as of date. Upon the
introduction of additional equipment or alterations,application shall be promptly made for inspection.
Inspectors of this Company shall have the privilege of ma spections at any time, and if its
rules are violated,the Company shall have the right t r v e ific f.
Date /z_U� INSPECTOR
Member N.F.P.A.,I.A.E.1.
Septic Inspection Report
Office No. (518) 761-8256 Date Inspection request received: /S
Queensbury Building&Code Enforcement Arrive: a Depart: C b,, am/pm
742 Bay Rd., Queensbury,NY 12804 Inspector's Initials
NAME: _ r cj PERMIT NO.: 0 —9- ' --S
LOCATION: `\C,. g. INSPECT ON: 03
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: i x
Stone Size: t
Piping Size ype
Building to tank ,�/��� FI EC CC.
Tank to Distribution Box /V
Distribution Box to Field/Pit 1/V,�P -� C (-
Q 5
Opening Sealed: Y/N/Partial `� [ �'
0VT l,C--g %1
Location/Separations
Foundation to tank ft.
Foundation to absorption ft.
Separation of Pits ft.
Conforms as per Plot Plan Y N
Location of System on Property:
Front Rear Left Side Right Side
Middle Front Middle Rear
System Use Status:
roved
artial Approved and needs to be re-inspected,please call the Building&Codes Office
Disapproved
L:\SueHemingway'Building.Codes.Inspection.FORMS\Septic Inspection Report.doc January 28,2003
TOWN OF QUEENSBURY
BUILDING & CODE ENFORCEMENT
742 Bay Road
Queensbury NY 12804
(518) 761-8256
SEPTIC DISPOSAL SYSTEM INSPECTION
Names ER?Ce
Loc 1i� n ToJA/ lb/ cJ-
Date P rmit # ®`Z`
SOIL TYP : Sand-Loam- lay-
Results of Percolation Test-
(if applicable) Rate-Minute/Inch
TYPE OF SYSTEM: '` r
ABSORPTION FIELD: Total Length U5/
Length of each trench 2..4
Depth of trenches /
Size of stone CJ/Ci-4J
SEEPAGE PITS: Number-
Size - ft. x ft.
Stone size
PIPING: ize Type
Bldg. to Tank
Tank to Dist. Box `
Dist. Box to Field/Pi ^5C2
Openings Sealed? Yes No Partin
LOCATION/SEPARATIONS:
Foundation to Tank feet
Foundation to Absorption feet
Separation of Pits -
eet
Conforms as per Plot Plan s No
LOCATION OF SYSTEM ON PROPERT
(circle one)
Front - Rear - Left Sided Right Sid
Middle S:
/Ei4 /4—
a
COMM�MENNTS
7d 4 LA SAP. —47(L
•
A% &Awl) ,4l" /rl/1 ///e(
SYSTEM USE APPROVED: YES NO,
Arrived:
Departed:
Building Inspector
4'- 6' TOPSOIL 4"- 6' TOPSOIL
FIN GRADE FIN GRADE FIN GRADE ELEV 99.00 (TOP)
—7 INSTALL CONTROL PANEL INDOORS. MAKE ALL
i ��- i i i �/ ELECTRICAL CONNECTIONS OUTSIDE PUMP CHAMBER.
s— 77
LOAMY BACKFILL —s 4' PERFORATED CLEAN. MED-COARSE 4' PERFORATED PANEL BOX SHALL HAVE A WARNING LIGHT AND
PVC PIPE CONCRETE SAND <-- LOAMY BACKFILL ON PVC PIPE so LOAMY BACKFILL No AUDIBLE ALARM. SEAL CONDUIT AND AIR PASSAGES
BANDING STRAPS GEOTEXTILE ,1 BANDING STRAPS PROVIDE 4" PVC PUMP CHAMBER VENT.
'IN-DRAIN' UNIT o GEOTEXTILE 'IN-DRAIN' UNIT' CONCRETE SAND MED-COARSE LOCATE SCREENED OPENING AS FAR AS FROM PUMP CHAMBER WITH SEAL- TIGHT FITTINGS AND/OR
PRACTICABLE FROM RESIDENCES. NON-SHRINK GROUT TO PREVENT OUTFLOW OF GASES.
rz
CLEAN. MED-COARSE
L T-DUTY MH
CONCRETE SAND z z
D •;' cp
FRAME & COVER
FINISHED GRADE PROVIDE A DISCHARGE BALL
s" 36' OIL 00 s" 'L 36• L 24- �I 3 L�6' � 24' ?•I� 36" WL 12" / / / / / / / / / / / / / / / / / / VALVE FOR THROTTLING
4'- 0'
,• • • • • CONDUIT TO PANEL BOX
SECTION GRAB BAR
PART - SECTIONl I/2" "BA KER" OR
"MARTINSON" PITLESS l 1/2" SWING CHECK
SINGLE "IN-DRAIN' MODULE "IN-DRAIN" ABSORPTION SYSTEM ADAPTER
GRADE 4" SCH 40 PVC INLET l 1/2" PVC FORCE MAIN
;/1110 FROM SEPTIC TANK: POWER
•
DARK SEAL WALL PENE TRA T LEAD PENETRATIONS l 1/2 " GAL V. STEEL PIPE
5ANDY-11XAM 500-GALLON ALARM
1.5 PRECAST H YDR OMA 'TIC EFFL UEN T
SEPTIC TANK •• PUMP - MODEL OSP33 PUMP START
S TA B/L IZED PER COLA TION FINE TAN SAND PUMP STOP
TEST RATE, AFTER PRESOAK. TERMITE BL K
•
SE T CA S TING ON 12"
IS 20 MIN / INCH !*/-). • • COMPA C TED CRUSHED ROCK
DESIGN IS BASED ON 20 MINUTE 3.0' GROUNDWATER _ " " , , - , • -
• . .
RATE APPLIED FOR IN-DRAIN ABS. • • . • , s ,
S YS TEM A S PER MANUFA C TURER. - . • ' - . ' - .
4.0' DETAIL
501L, BOG EFFL UENT LIFT STA T/ON
NTy
51' EGIFIGAT10N5
36" x 48" x7"
4" PERFORA TED IN-DRAIN UNI T-
VEN T PVC LATERAL 2/ UNITS REQUIRED BED FORCE MAIN AT A DEPTH OF 5 FEET BELOW GRADE.
MOON HILL ROAD 34' 15'
11/2" DIAM. FORCE MAIN SHALL BE PRESSURE RA TED A T /00 PSI MIN.
EDGE OF PAVEMENT INCREASE l I/2" FORCE MAIN DIAMETER TO 4" DIAMETER l0 FEET AHEAD
CONC OF DISTRIBUTION BOX.
PROTECTIVE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . SAND
_. R-O-W LINE_ . . __ __•' -1 _F_ENCX_EEFFLUENT
' _ . EFFL UEN T PUMP SHALL BE SOE 'H YDROMA TlC OSP 33" CAP
ABLE A BLE OF
X X DELIVERING 20 GPM AGAINST A TOTAL HEAD OF 22 FEET.
p2 �— —MAC. D/S T PROVIDE A THROTTLING BALL VALVE ON THE PUMP DISCHARGE LINE.
\ X ' PORCH BOX
t�
P SET CONCRETE CASTINGS DEAD LEVEL ON I2" COMPA C TED CRUSHED ROCK.
Irk - -
X `• —
��� oA THE EL GEN TYPE-B 'IN-DRAIN' MODULAR SYSTEM IS DESIGNED AND MANU-
I FACTORED BY ELJEN CORP.. 15 WESTWOOD ROAD. STORRS. CT 06268.
��� EFFL UEN T /2" B NUT X _j 3-,qEDROom HOUSE 4" PVC--a► U
lO" B'SPRUCE �_ 28 PREPARE IN-DRAIN ABSORPTION SYSTEM BY PLACING MEDIUM CONCRETE SAND
ABS. SYSTEM �' SO THAT IN-DRAIN UNITS WILL LIE STRAIGHT AND DEAD LEVEL.
WELL TOP FIN. GR. ...................... ...... ... .. .... ��, .- 30'
ELEV 9 9.0 0 4• SCHED INSTALL IN-DRAIN UNITS EXACTLY A S RECOMMENDED B Y THE MANUFACTURER.
TBM TOP CAP 40 PVC PLAN GEOTEXTILE SHALL BE SOE l8ON NONWOVEN NEEDLE-PUNCHED M/RAFI
• FORCE FILTER FABRIC" MANUFACTURED BY M/RAFI GEOSYNTHET/C PRODUCTS.
ELEV /OO.oO "IN-DRAIN' ABSORPT/ON SYSTEM MAIN 3500 PARKWAY LANE. NORCROSS. GEORGIA 30092.
.... ..... ... ... BECK NEW.
SAP TIC VENT L IF r STATION AND ABSORPTION SYSTEM TO ATMOSPHERE AS SHOWN.
gg ........ LIFT TANK
s TA rioly DISTRIBUTION BOX SHALL BE 18" WIDE BY 30" LONG MINIMUM. PROVIDE
GARAGE OUTLET FLOW LEVELERS FOR EQUAL DISTRIBUTION.
g� FO.R.CE in
MAIN NO TICE TO CON TRA C TOR � yo
THE IN-DRAIN ABSORPTION SYSTEM SHALL BE RAISED CODE GOMFIIANGE . �IW D
' ...... ABOVE EXISTING GRADE A MINIMUM OF LO FT. TOP OFM4y 2 4 2702
. - ABSORPTION SYSTEM FINISHED GRADE ELEVATION SHALL CONTRACTOR SHALL COMPLY WITH ALL REQUIREMENTS OF THE TOWN F r�w���
P1+'r r„ rC` Div e1[JRII
BE 99.00 RELA T/VE TO ELEV 100.00 ON THE WELL CAP. QUEENSBURY AND THE NA TONAL ELECTRIC CODE. -- -
o-,,
g6 THE ABSORPTION SYSTEM MUST BE PRO TEC TED FROM
TRAFFIC. A PRO TEC TI VE FENCE IS REQUIRED AS SHOWN. �r�+ +i^ u�Eu �Rr aL it►�JG�'EF/1R'ME"JT
Bo:aed on our limited examination, Seen or Qh
compliance vvith our comments shall , p^ serJe�, or believe I saw evidence of
g� not be construed as indicating the ' ' ' ' �s t'?t!ses, wells trees,
, fences ete
plans and specifications are in full , Um?�n
t. l also re,,)resent that l h
compliance with the cod �� 'V s+ : � t? e �`e
_ ,., � istances set forth on the diagram.,,
g� . KRIS ER
674 MOON HIL L R OA D
g� QUEENSBURY. NEW YORK 12804
g� �� •h WTI S TE WA TER S YS TE
SI TE PL A N z a �P
� AUGUST 200/ / 20
��� t SCUDDER ASSOC/A TES TOWN OF QUEE.tv�BU
" 20ale CONSUL TING ENGINEERS y
f � .
TAX ID 12 8 9. 07-2- 61 CHARDS Vt SCUDDER P.o. BOX 79z BUILDING &
GLENS FALLS. NY 'I280/
REVIEWED
t DATE Z T.
o L—