98-698 CEI�TIFIC.ATE O! COIV.�PLI,A.NCE
TOWN OF QUEENSBURY
WARREN COUNTY, NEW YORK
Date November 5 19 98
98698
This is to certify that work requested to be done as shown by Permit No.
has been completed.
SEPTIC ALTERATION
• . This structure may be used as a
Location 60 BEAN RD.
EPWORTH, ROGER W.
Owner
•
TAX MAP NO. 152 . -1-9 By Order of Town Board
TOWN OF QUEENSBURY
Director of Building & Code Enforcement
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BUILDING PERMIT
VALUE $ 0 TOWN OF QUEENSBURY No. 98698
TAX MAP NO. 152 . —1-9 WARREN COUNTY,NEW YORK
PERMISSION is hereby granted to EPWORTH, ROGER W_
OWNER of property located at 60 BEAN RD. Street,Road or Ave.
in the Town of Oueensbury,To Construct or place a SEPTIC ALTF.QATTON
at the above location in accordance to application together with plot plans and other information hereto filed and
approved and in compliance with the Town of Queensbury Building and Zoning Ordinance.
I. owly2E MERKINs DR.
PERRINEVILLE, NJ 08535
2. CONTRACTOR or BUILDERS Name
QUEENSBURY SEWER
3. CON.ZRACTD.f3�t_B_111LDERS Address
J0 SNNtt��EETT
4. ARCHITECT'S Name
5. ARCHITECTS Address
6. TYPE of Construction—(Please indicate by X1 SEPTIC
1 1 Wood Frame 1 I Masonry ( I Steel 1 1
7. PLANS and Specifications
SEPTIC ALTERATION AS PER PLOT PLAN SPECIFICATIONS
8. Proposed Use
SEPTIC ALTERATION
25 November 2 2000
$ PERMIT FEE PAID —THIS PERMIT EXPIRES 19
(If a longer period is required an application for an extension must be made to the Building and Zoning inspector of the
town of Oueensbury before the expiration date.)
2 November 1998
Dated at the Town of Queensbury this Day of 19
SIGNED BY for the Town of Queensbury
Building and Zoni impactor
Application for SEPTIC DISPOSAL PERMIT
Town of Queensbury "bW
Permit No.
Dept. of Community Development
Building &Codes Office 0 al to`10 Ca
742 Bay Road Fee Paid $
AS
Queensbury, NY 12804
d'I 3
Location of property for insta11ati4. (�/k �� ep. Ph / 7,7,,0 4--
Property Owner's Name: R�1 cj = v -�1 tyr-// '`l
Property Owner's Mailing Address: ( 0 d - rt-,-,i/.ii
Installer's Name: 62 ,Ug` 6Li er'.---1 t=c ,,r Phone # -77-- a2;5 k, /d
Number of bedrooms (if residential): 3 Total daily flow: <-3
(residential - compute @ 150 gal./bdrm.)
Topography: A. flat, rolling, steep slope % of slope
Soil Nature: A__
sand, loam, clay, other /depth:
Ground water: at what depth? feet / Bedrock or Impervious Material: at what depth? _ feet
Percolation test: not required, required [ rate /0 min. per inch ]
Domestic water supply: municipal, well, other L a ‘6:-_,,e-v-7-e,
If domestic water supply is a WELL, water supply from any septic absorption is `C0 feet.
PROPOSED SYSTEM
Septic tanl t)gallon (minimum size: 1,000 gal.) ' p (4 KIS
Tile field: each trench feet / Total system length: feet
Seepage pit(s): number of / size each: ft. by ft.
Size of stone to be used: # / depth or thickness feet
HOLDING TANK SYSTEM: (if required)
Number of tanks: Size of each: gallons
Alarm system and associated electrical work to be inspected by a certified agency.9
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 of
Queensbury Sanitary Sewage Disposal ce. �j
Signature of responsible person: - - •�•-k.�i - Date: ! 2 /
�r
/ ,' CbMW(ONWEALTH ELECTRICAL INSPECTION SERVICE,INC. (
Main Office 176 Doe Run Road-Manheim,PA 17545 cp.,9
MUNICIPAL CERTIFICATE - ELECTRICAL APPROVAL
ane oard No Cert.N2 66672 Cut-in Card No. (P
)wner 4)6 oz. 6711 to 0/2_7-i_i--
ocation ,
z f stallation Consisting of ' T7C- 74761-92"f 1° cc'4J ! i2 i
c tilt V.
lstalled By 17 '-C' " 7-+ Lic.No.
The conditions following governed the issuance of this certificate,and any certificate previously issued is
ancelled:-
This certificate only covers the electrical equipment and installation conditions as of date. Upon the
itroduction of additional equipment or alterations,application shall be promptly made for inspection.
Inspectors of this Company shall have the privilege of maki inspections at any time, and if its
Iles are violated,the Company shall have the right t r oke.t 40if{icc��te.
)ate / / S - { INSPECTOR I ��r ��
Member N.F.P.A.,
TOWN OF QUEENSBURY
BUILDING b CODE ENFORCEMENT
742 Bay Road
Queensbury NY 12804
(518) 761-8256
SEPTIC DISPOSAL SYSTEM INSPECTION
Name 1.1 )OS(4 \
Location (l' �3Oôs --ri
I 401 IV
—Date O Permit # (r)
SOIL TYPE- Sa ►oamJClay-
Results of Percolation Test-
(if applicable) Rate-Minute/Inch
TYPE OF SYSTEM: �3EEQ
ABSORPTION FIELD: Totat'Len'
Length of each trench
Depth of trenches ALIA
Size of stone
SEEPAGE PITS: N
Size -
Stone size
PIPING: Size Type
Bldg. to ank p .41p
Tat , - '=- -- - 4" 3LN L
)-Dist Box o f el d/Pit i'gc.t\Rio - o D-P,c)-
Ope ings Sealed? Partial y'%Wg_F-
LOCATION/SEPARATI
Foundation to Tank \p feet
Foundation to Absorption Zp feet
Separation of Pits feet
Conforms as per Plot Plan 41111110No
LOCATION OF SYSTEM ON PROPER :
(circle one)
Front - Rear - Left Side - Right Side
Middle Front - Middle Rear
COMMENTS:
- 6 ��-T"A►� 50` FPS t-\
Flebb4)T'icir 'BED 100' \ c* J E
SYSTEM USE APPROVED: YES 00 7)
Arrived:
Depa
uildin I e or
j f
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�QQ� V/7�r t '1 ���. • +FT �"w • .� � �+ i� drt► ,'£�'° �t� d�' �♦ �s d�`�r \\
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r� ,
y.. O
ppp
Ir X97_,��
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t �'y r,
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Jr plye_ have seen or observed, or believe I saw evlde
T� — all objects such as houses, wells, trees, fences, etc„
Shown on this document. I also represent that i have
x S / / liy measured th races forth on the diagram" ,
�r C/7
!
�� t - - �lf'�L`•' /g '/ tGMATUR� D� � �
D e4:,, �
IS 0 T E ----$ �
I _ Two t 2 ) percolation tests ( holes 24" deep ) averaged a perc
rate of 10 min . /inch . Soil was brown sandy loam- No deep
test hole was dug since it was determined , by hand-digging,
g f that ground water was 38'' below the ground surfseP -
/ i 2 . A 3-bedroom residence with a soil perc rate of 10_ min . /inch
requires 25Uft _ of absorption trench OR 645 sq . ft _ of
absorption bed ( at . 7 GPU/sq . ft . application rate ) . A
i V is 15ft . x45ft . bed area has been configured for this 3-bedroom
� � + �, residence with 'older style" plumbing fixtures .
3 . Bottom of bed must be no closer than 24" above the ground
_ water. Top of new bed fill to be seeded to grass . N-o
'O �/O,y �� � heavy taf f i:c or other loading to be allowed on the bed . �
4 . This residence and close neighbors obtain their potable
`J water from the lake . Closest residential well is . over
200ft . from this new absorption bed system.
! ► 5 . The 1 000 gallon septic tank will be of - lowboy type" to
g p y y P
fit the area and sub-surface ' conditions . Pump and pump
tank to have an alarm to indicate failure of pump or '' high
1 pump tank . Pump line to "D" box to slope back to
level" in ;
j pump tank so that line will drain empty after pump cycle
f and not freeze . This residence is only used as a seasonal
dwelling, which will enhance the operation of the septic
Ilk
disposal system .
f
h . All separation distances shown on the plot plan shall be
maintained .
CT�� f/1/10S 7 . Septic tank shall be pumped-out at optimum intervals to
prevent carry-over of solids to the absorption area .
lip
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