2005-841 TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518) 761-8201
Community Development- Building & Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: P20050841 Date Issued: Thursday, November 10, 2005
This is to certify that work requested to be done as shown by Permit Number P20050841
has been completed.
Tax Map Number: 523400-295-015-0001-045-000-0000
Location: 16 MOORWOOD Dr
Owner: LEESA STILLER
Applicant: LEESA STILLER
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, 1�3 2
Variance, or other issues and conditions as a result of approvals by the Director of Building&Code KnforceNent
Planning Board or Zoning Board of Appeals.
TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development-Building&Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20050841 Application Number: A20050841
Tax Map No: 523400-295-015-0001-045-000-0000
Permission is hereby granted to: 1,F,F,SA STI J F,R
For property located at: 16 MOORWOOD Dr
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. Tyne of Construction Value
Owner Address: LEESA STILLER
16 MOORWOOD Dr Septic Alteration Residential
Total Value
QUEENSBURY, NY 12804-0000
Contractor or Builder's Name /Address Electrical Inspection Agency
OTTEENSBITRY SEWER
JAY SWEET
Plans&Specifications
2005-841
SEPTIC ALTERATION
$25.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Tuesday, October 24, 2006
(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 Town Queensb- ; October 24, 2005
SIGNED BY for the Town of Queensbury.
Director of Building 0-'ode Enforcement
Application for Permit— Septic Disposal System
Town of Queensbury 742 Bay Road Queensbui�� NY 12804 (518) 761-8256
IOWNER INFORMATION: ................................................ .............................. ..................
Office Use
Location of installation:
File Permit No 0
Tax Map No.
Fee Paid
Owner's Name:
.........................................................................................................................
Address:
2. INSTALLER'S NAME 9--:)c 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 galfbdrm =
x 130 gal/bdrm = r
— 9-91 —present x <:,Zaal/bdrm =
Garbage Grinder Installed yes no UT 21 Z005
Spa or Hot Tub Installed yes no , - - - i -
4. PARCEL INFORMATION: (circle applicable information& indicate measurements)
Topography Soil Nature Ground Water Bedrock or Impervious Material Domestic Water Supply
(f 5
at what d feet feet well
at what depth munici�: ECE�
Rolling loam
— 17
Steep slope clay if well; water supply
%slope other from any septic-system
depth: absorption is
other
Percolation Test: (To be completed by licensed professional engineer or architect)
Rate: 57 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 gallon (min. size 1,000 gal.)
Tile Field: each trench ft. Total System Length:
Seepage Pit(s): number of size of each: _ft. by_ft.
Size of Stone to be used: # 2 depth or thickness 67
Bed System Size: X 2 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 & IN-FORMATION 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 know�i 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.
NOV /4 —
Sign u of espoinsi �Iee-pjerson-,. Date
I'
Town of Queensbury
Sewers and Sewage Disposal Chapter
Appendix C
ABSORPTION FIELD
SEPARATION REQUIREMENTS
POND
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Appendix C
ABSORPTION FIELD
SEPARATION REQUIREMENTS
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NACE
ENGINEERING, 1
169 Haviland Road, Queensbury,NY 12804
Phone-518-745-4400 Fax -518-792-8511
October 14, 2005
Project#49196
Mr. Jay Sweet
Queensbury.Septic
PO Box 4283 2 2005
Bay Road }
Lake George,NY 12845
Re: Replacement Septic System j
Stiller Residence— 16 Morwood Drive, Queensbury,NY
Dear Jay:
At your request we have reviewed your proposed replacement septic system design at the site of
the existing 3 bedroom house of Leesa Stiller at 16 Morwood Drive in Queensbury. As per our
conversation the residence has an existing failed septic systems.
We have reviewed the proposed replacement septic system design and we agree that a standard
absorption bed is acceptable. Based upon a design flow rate of 330 GPD and a percolation rate of
1 to 5 minutes, you will need 350 square feet of absorptive area. We recommend using a 15 ft
wide by 25 ft long absorption bed with 3 — 20 foot long laterals, which will provide 375 sf of
absorptive area.
Please call me if you have any questions.
Sincerely,
Thomas R. Center, PE
Septic Inspection Report
Office No. (518) 761-8256 Date Inspection request eceived:
Queensbury Building&Code Enforcement Arrive: am/pnDepart: am/ m
742 Bay Rd., Queensbury,NY 12804 Inspector's Initials:
NAME: PERMIT NO.:
LOCATION: INSPECT ON:
RECHECK:
Comments and/or diagram
Soil Type(San lay
Type of a er: unicipa'/Well Water
Waterline separaftmrthtTance _$.
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 Caps
Location/Separations
Foundation to tank eft.
Foundation to absorption ft.
Separation of Pits ft.
Conforms as per Plot Plan VY N
Engineer Report and As-Built Y N
Location of System on Property:
Front Rear Left Side Cightide'Middle row MiddleRea
System Use-Stat s:
Approved
Partial Approved and needs to be re-inspected, please call the Building&Codes Office
Disapproved
Last revised 1/6/05
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TOWN OF QUEENSIBURY OWING DEPARTMENT � —�a- _ :zs
Based on our iim6ted examination, .. ..;
Comppliance with our comments shall
not b2 construed as indicating the
plans and specifications are in full
compliance with the Building Codes
of New VO4 Stag:. ti
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TOWN OF OUEENBBURY
BUILDING & G T.
REVIEWED BY
DATE
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TOWN OF QUEENSBURY BUILDING DEPARTMENT G` �
Based on oor limbd examination,
compiianrewlmc�urcommentsshall
not be mn& as incmH9 the
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bMVbn va ft Building Code j
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TOWN OF QUEBNBBURY
BUILDING & D T.
REVIEWED BY , -'
DATE ��