2005-726 TOWN OF QUEENSBURY
*Ivo 742 Bay Road,Queensbury,NY 12804-5902 (518) 761-8201
Community Development- Building & Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: P20050726 Date Issued: Wednesday, September 14, 2005
This is to certify that work requested to be done as shown by Permit Number P20050726
has been completed.
Tax Map Number:
523400-227-010-0001-010-000-0000
Location: 43 BEAN Rd
Owner: CAROLYN TIPPETT
Applicant
CAROLYN TIPPETT
This structure may be 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, ( j#i
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.
Application for Permit— Septic Disposal System
Town of Queensbury 742 Bay Road Queensbury, NY 12804 (518) 761-8256
•
1. OWNER INFORMATION:
/5
AetrA, Office Use
Location of installation:
File Permit No. 65 7a
Tax Map No.
Fee Paid c9-5
Owner's Name: , / l y.Q7
Address: 6 g 10.X �• O'~ I l V
s?J
. 2. INSTALLER'S NAME : pin (� .mil PHONE NO. G23o r
3. RESIDENCE INFORMATION: (circle year of dwelling, i dicate#bedroom(s) and multiply#
g p Y of
bedrooms with applicable gallons per bedroom to equal total daily flow)
Year of House: No. of Bedrooms x Computation = Total Daily Flow
1980 or older x 150 gal/bdrm =
1980iQ 1 x 130 gal/bdrm = •
1991 —prese x 110 gal/bdrm = G,�
Garbage Grinder Installed yes_ / no
Spa or Hot Tub Installed yes_ / SEP 1 2 2005
4. PARCEL INFORMATION: (circle applicable information&indicate measure ts�Cr QuEE(�!SL�1JJE Y
;���_. �,,�IC�,P,!_i CODE:
T..ography Soil Nature Ground Water Bedrock or Impervious Material Domestic Water Supply
san at what depth at what depth municipal
Rolling oam • feet feet wel
.12
Steep slope clay if well; water supply
%slope other from any septic-system
depth: absorption is ft.
• other,/70
Percolation Test: (To be completed by licensed_professional engineer_or--ar-chitect)-- - --- —
Rate: ' 141A'' minute per inch
/aa
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: /QC) gallon (min. size 1,000 gal.) 7 p L'l 1 QZ i'j'n S t f
Tile Field: each trench (..5-0 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
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)
Town of Queensbury
Sewers and Sewage Disposal Chapter
Appendix C
ABSORPTION FIELD
SEPARATION REQUIREMENTS
,,,,.... 400
46
\ ../rf_____POND
4',ffLti nu ?4<T R- r LeA
moon. cots r -' .-
c•ctikAE 19d" C�t*S e.
40,
.a, I
Absokt� rtic .
• tLioz
v.
Appendix C
ABSORPTION FIELD
SEPARATION REQUIREMENTS
poN
'Li!A'1842.'1ixii.1I
r t
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SeEPAipa
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Septic Inspection Report
Office No. (518)761-8256 Date Inspection request received:
Queensbury Building&Code Enforcement Arrive: am/p i2 ep:art: ill .- m/pm
742 Bay Rd., Queensbury,NY 12804 Inspector's Initials: V/���
NAME: W\,C ; 1 g _1 �' PERMIT NO.: ' 05— �`�
LOCATION: /.� `j P\ . INSPECT ON: ng --
RECHECK:
M Comments and/or diagram
Soil T e: Sand/L Clay
Type of Water: Municipal/Well Water
Waterline separation distance ft.
Well separation distance r ft.
Other wells: _ ft.
Absorption Field: Total length ft.
Length of each trench ft.
Depth of trenches 2--- ft.
Size of Stone I�,le/L-rv2 ,-- MZ S." .
Seepage Pits: Number
Size: x
Stone Size:
Piping Siz Type
o
Building to tank 6.ev ®
Tank to /va,,%:? 4,4 44
Pow,.P ft. Distribution Box -, - i U_ pg®�" �'` 5� �3s s af tee.
Opening Sealed:a N/Partial dv
End Caps
Location/Separations
Foundation to tank iD,
ft.
Foundation to absorption R,Rt.
Separation of Pits _��_ft.
Conforms as per Plot Plan dY N
Engineer Report and As-Built Y N
Location of Syste 1: on Property: ��,JA-L- (L e--<. _ 0 i-<
Front Left Side Right Side qi4(105---
15
Middle Front Middle Rear
System Use Stateg
/" Approved
Partial Approved and needs to be re-inspected,please call the Building&Codes Office
Disapproved
Last revised 1/6/05
NACE ENGINEERING, P.C.
169 Haviland Road, Queensbury,NY 12804
Phone-518-745-4400 Fax -518-792-8511
August 17, 2005
Project#49181
Mr. Jay Sweet
Queensbury Septic
PO Box 4283 R ECL.0 702
Bay Road VI D
Lake George,NY 12845
SE P 1 2 2005
Re: Percolation Test TOtWUPJ OF OUEENSURY
Tippett Residence—43 Bean Road, Queensbury,NY jJ !'f GT i' i�`ODE
Dear Jay:
At your request, on August 17, 2005, I performed a percolation test at the Tippett residence
located at 43 Bean Road in Queensbury. The test was performed to the northeast of the existing
residence in the location where construction of a replacement leach field is proposed.
The results of the testing are as follows:
Percolation Test
• Stabilization percolation rate- 1" in 3 minute, 10 seconds
The test was run in the native sand at a depth of 24 inches in a 30 inch deep hole. The hole was
presoaked and the test was run 5 times until it stabilized with three consecutive runs of 3:00, 3:09
and 3:10 respectively.
The design flow for this 3 bedroom residence at 110 gpd per bedroom requires 138 if of
absorption trench. The replacement system for this residence should consist of a pump station
and 4—50 ft long laterals (200 if).
Please call me if you have any questions.
Sincerely,
Thomas R. Center Jr., PE
Cc: Dave Hatin, Town of Queensbury
•
COMMONWEALTH ELECTRICAL INSPECTION SERVICE,INC.0�
Main Office 176 Doe Run Road-Manheim,PA 17545
MUNICIPAL CERTIFICATE - ELECTRICAL APPROVAL
89928
Permit No. Cert. A Cut-in Card No
Owner A < a fic1
Location 7 M21.41r) v ",
Installation Consisting of...off--e 1 va f144 /J V,e'
Installed By A, ." 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 ' inspections at any time, and if its
rules are violated,the Company shall have the right t r oke t is title e.
Date 9/ INSPECTOR i
Member N.F.P.A.,I.A.E.I.