2004-587 TOWN OF QUEENSBURY
742 Ba Road ueensbu NY 12804-5902 518 761-8201
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Community Development - Building & Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: P20040587 Date Issued: Thursday, August 05, 2004
This is to certify that work requested to be done as shown by Permit Number P20040587
has been completed.
Tax Map Number: 523400-239-008-0001-011-000-0000
Location: 28 BRAYTON Rd
Owner: F. HAGER JOHNSON LE
Applicant: F. HAGER JOHNSON LE
This structure may be occupied as a:
By Order of Town Board
Septic Alteration Residential TOWN OF QUEENSBURY
Director of Building&Code En orcement
TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
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Community Development-Building&Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20040587 Application Number: A20040587
Tax Map No: 523400-239-008-0001-011-000-0000
Permission is hereby granted to: F. HAGER JOHNSON T,E
For property located at: 28 BRAYTON 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: F. HAGER JOHNSON LE
JANE ELRAY LE HOWELL&DUN Totaloic Alteration Residential
Rd Value
BOX 189
CLEVERDALE, NY 12820-0000
Contractor or Builder's Name /Address Electrical Inspection Agency
JAY SWEET
Plans&Specifications
2004-587
Septic Alteration Residential
$25.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Thursday, July 28, 2005
(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 Topf,eens a esda , July 28, 2004
itvSIGNED BY for the Town of Queensbury.
Director of Building&Code Enforcement
31;t) - I - 1I
Application for Permit—Septic Disposal System
Town of Queensbury 742 Bay Road Queensbury,NY 12804 (518) 761-8256
1. OWNER INFORMATION:
Office Use
Location of installation: 2 S /3119 y rc h .2. -e n
t 7-2_ File Permit No. ic(U 1- J°',
Tax Map No. 239,mob/ / / / S
Fee Paid °C)
Owner's Name: /llA1�/}r JAW e
Address: o� a�5 /%'t r-y7011 2 2 €
2. INSTALLER'S NAME : J4 y J wt'f r PHONE NO.
3. RESIDENCE INFORMATION: (circle year of dwelling,indicate#bedroom(s)and multiply# 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 =
1980—1991 x 130 gal/bdrm =
1991—present x 110 gal/bdrm = 2 2 0
p./�'// older r 4r'i''i Ta rode (or0,4/;tv17
Garbage Grinder Installed yes_ / no ?C
Spa or Whirlpool Installed yes— / no )o
4. PARCEL INFORMATION: (circle applicable information&indicate measurements)
Topography Soil Nature Ground Water Bedrock or Impervious Material Domestic Water Supply
sand at what depth at what depth municipal
Rolling 16a feet _ feet well
Steep slope c 3 7 H( ra No if well;water supply
slope% other from any septic-system
depth: 4�" / ' TT/ii) /5�efrG c if o 6 5 Prier f absorption is ft.
p other Lf3/(e
Percolation Test: (To be completed by licensed professional engineer or architect)
Rate: /VA 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.
S Tank: gallon(min. size 1,000 gal.)
Tile Field: each trench . Total System Length:
Seepage Pit(s): number of size of each: . by
Size of Stone to be used: # depth or ' ess feet
Bed System S. • x
've System: length and/or size
6. HOLDING TANK SYSTEM: (if required)
Number of tanks: / Size of each: //00" gallons /TOTAL Capacity:3,0e0 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 the Town of Queensbury Sanitary Sewage Disposal Ordinance.
Signature of responsible pe on Date
COMMONWEALTH ELECTRICAL INSPECTION SERVICE,INC.
Main Office 176 Doe Run Road-Manheim,PA 17545
MUNICIPAL CERTIFICATE - ELECTRICAL APPROVAL
Permit No. Cert. No 75947 Cut-in Card No 1-\
Owner 51 ' $-ttlnt,Z�.�9 —CC) `t'17'"&'4-e ,s�
Location c 2 6""f' y i �'4 ' f ieth-X
Installation Consisting of.... CrLIJ e12-- 77?-4 L5 P vd
Installed By 7Ne SAtti 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 making a.ections at any time, and if its
rules are violated,the Company shall have the right to e e thi irate
Date ¢' 5�V INSPECTOR
Member N.F.P.A.,I.A.E.I.
Septic Inspection Report
Office No. (518) 761-8256 Date Inspection request received:
Queensbury Building&Code Enforcement Arrive: am/p epart: (Dm/pm
742 Bay Rd.,Queensbury,NY 12804 Inspector's Initials:
�Q
NAME: 'r5KN`)as PERMIT NO.: C) — 37
LOCATION: ClatietrO.i R, . 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
ALAK, 4 kJA• I etc
Location/Separations E\Av i —O F F
, c<
Foundation to tank ft.
Foundation to absorption ft.
Separation of Pits ft.
Conforms as per Plot Plan Y N G
Location of System on Property:
Front Rear Left Side Right Side6/510 q
Middle Front Middle Rear
S stem Use Stag •
pproved
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
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Septic Inspection Report v.',-.) ' '2 /N( `]) /
Office No. (518)761-8256 Date Inspection request received: / W i i\sr (a
Queensbury Building&Code Enforcement Arrive: am/ epart:/o•?j 5 am/pm
742 Bay Rd.,Queensbury,NY 12804 Inspector's Initials:
NAME: `l\ ` IN `- c N\r\` ,`Y� PERMIT NO.: . 241*-1 --ST)
LOCATION: d , %IS' C INSPECT ON: `Zc S—C) 1
RECHECK:
Comments and/or diagram
Soil Type: Sand/Loam/Clay
Type of Water: Municipal/Well Water/14a. - ate ��� vS
•
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 Si e Type
Building to tank r 6 , 46
Tank to Diotirl,>•ctierr-$mc-TA,,11L5
N Aw 1"5 zo 1fP/" G
Distribution Box to Field/Pit
Opening Sealed: Y/N/Partial
/3«> Fo,ols(c E - - -
Location/Separations -2 RA/0 ,, •
Foundation to tank ft.
Foundation to absorption ft. ® " 7?5- GkC c(c
Separation of Pits ft.
Conforms as per Plot Plan —Y N
Location of System on Property:
Front Rear Left Side Right Side Rokw, 6 c1,4.
Middle Front Middle Rear
System Use Status.
Approved
Partial Approved and needs to be re-inspected,please call the Building&Codes Office
Disapproved
LASueHemingwayBuilding.Codes.Inspection.FORMS\Septic Inspection Report.doc January 28,2003
53 '
52
MAP REFERENCES: 51 s ,� Q
MAP OF A SUBDIVISION OF THE rm• _�o s�s � �r U 2 IRA BRAYTON FARM (2) NEW 1 ,000 GAL.. rV� � � � 1= U O
DATED: NOVEMBER 1928
Y HOLDING TANKS - r "B : H.D. CHAMBERS
♦ J 't,in � M �, J N W �'
I O Nv
DEED REFERENCE: 1 0 `` .1 '
h 0 rur sad' 160 I � O
PAMELA ANN HOWELLTO
y j�N F. HAGER JOHNSON � 29
+ :
JANE ELRAY JOHNSON
DATED: DECEMBER 28, 1998 �0
0 0
BOOK 1099 PAGE 101 44
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IPF IN CONCRETE q % $ \ N
APPROXIMATE LOCATION OF O A %' ' \ N
U. ABSORPTION PIT * SEPTIC TANK -
2. \\ QI �
INFILL OR REMOVE ALL COMPONENTS >_1 oZ
OF EX. SEPTIC SYSTEM * DISCONNECT C a
FROM HOUSE SEWER o a m z
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LEGEND: 04
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IPF = IRON PIPE FOUND w '
OIRS = IRON ROD SET OM
W � o
= NAIL SET
`x), = UTILITY POLE FINISH GRADE
# = LIGHT POLE AREA OF PARCELa
�HEAVY DUTY MANHOLE FRAME HEAVY DUTY MANHOLE FRAME FINISH GRADE E-,
AND COVER (TYP.) AND COVER (TYP.)
SYRACUSE CASTINGS #13048 OR. EQUAL SYRACUSE CASTINGS #13048 OR EQUAL
CONCRETE EXTENSION RINGS 'v i CONCRETE EXTENSION RINGS
AS REQUIRED (TYP.) a 3 AS REQUIRED (TYP.)PLAN I I L-- I
N
Mril
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Scale: 1"=20' �VPVC 4"PVC 4"PVC p
w FROM EXISTING 1,000 GAL HOLDING TANK e� � 1
E ALARM ~�#2 — VISUAL & AUDIBLE ALARM
IC SYSTEM DESIGN + ACTIVATE SOLENOID TO
: SHUT OFF WATER SUPPLY
DESIGN FLOW - EXISTING 2 BEDROOM HOUSE WITH 1,000 GALLON SEPTIC TANK I w �
AND SEEPAGE PIT. :- � `
ALARM #1 — SIGNAL VISUAL AUDIBLE ALARM SIGNAL AUDIBLE (D
- NEW FIXTURES TO BE INSTALLED IN EXISTING RESIDENCE. M�
- FAILURES OF EXISTING SEEPAGE PITS MAKE � z
EXISTING SYSTEM UNUSABLE. 1,000 SEAMLESS SEPTIC TANK 1,000 SEAMLESS SEPTIC TANK
- DUE TO SITE CONSTRAINTS HOLDING TANK SYSTEM WILL (HO—R20 RATED) FORT EQUAL FORT MILLER OR EQUAL ( H-20 RATED)
BE REQUIRED TO REPLACE EXISTING SYSTEM. MERCURY FLOAT 11-4
SWITCH WITH
WEIGHT (TYP.) O ���r'" r �;,,,__ : {ry'� to�� � r �
T+ Y I 'd �.' }{ss d a�`�6 Iy
NEW HOLDING - USE EXISTING 1 ,000 GAL. SEPTIC TANK AND (2) ��_ � � ,
TANK SYSTEM NEW 1,000 GALLON HOLDING TANKS TO MEET 3,000 �UILDI (; $� .,r a (D
GALLON CAPACITY REQUIRED BY TOWN OF QUEENSBURY
FOR A TWO BEDROOM HOUSE. 00 p000 REVIEWED BY �. I " a
PROVIDE 3 SASID OR —� 0(�0 G PROVIDE 3" SAND OR-----00 00 000000
DATE o—_--
PEA GRAVEL UNDER TANK PEA GRAVEL UNDER TANK I!
ALARM SYSTEM - NEW HOLDING TANK ALARM SYSTEM ,.d
SHALL BE INSTALLED PER TOWN of QUEENSBURY NEW HOLDING TANK #2 NEW HOLDING TANK #3 o
w �
SEWER CODE SECTION 136-11. W
TANK BUOYANCY — TANK BUOYANCY CHECKED ASSUMING 24" BURIAL DEPTH HOLDING TANK SYSTEM _� b
AND MAXIMUM HIGH GROUND WATER 12' BELOW TOP OF TANK.
CONTACT ENGINEER IF CONDITIONS ARE DIFFERENT THAN
w �
ASSUMED. NOTES
x
1. ALL UNITS SHALL COMPLY WITH THE REQUIREMENTS OF THE NEW YORK O Q
STATE DEPARTMENT OF HEALTH AND SHALL BE PRECAST CONCRETE
AS MANUFACTURED BY FORT MILLER OR EQUIVALENT. F+1
2. ALL STRUCTURES To BE PLACED ON FlRM, COMPACT SAND OR L
SOILS DATA GRAVEL FOUNDATION. WHEREVER EXISTING FOUNDATION CONDITIONS
ARE UNSUITABLE, 6 OF CRUSHED STONE SHALL BE PLACED AS
TEST PIT
NECESSARY TO ACHIEVE A STABLE FOUNDATION.
" do Z
3. ALARM COMPONENTS TO BE INSTALLED IN SECOND THIRD TANK. IVE,D
0-11 TOP SOIL RECE
r
11 -37" FINE SILTY SAND SOME CLAY ALARM NOTES
37-48" CLAY WITH FINE SILTY SAND MOIST 2, $ 20pq Date, MAY, 2004 '
1. USE TWO STAGE ALARM SYSTEM: Scale, AS NOTED
THIRD TANK IS HALF FU AL SIGNAL WHEN SECOND TANK IS FULL AND DING AND CODE
MOTTLING A T 3 7 TOWN OF QUEENSBURY
Bull.
— ALARM 2 TO TURN ON AUDIBLE SIGNAL WHEN THIRD TANK IS 95X FULL
NO GROUND WATER OBSERVED AT BOTTOM OF BORING AND TO SHUT OFF SOLENOID VALVE ON WATER SUPPLY.
TEST PIT BY NACE ENGINEERING - 5/26/04 2. ALARM SYSTEM COMPONENTS SHALL COMPLY WITH TOWN OF QUEENSBURY CODE
SECTION 136-11 B— 9, 10, 11, 12, 13, 14, 15, 16, do 17. 49133
SHEET 10F1