2003-979 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: P20030979 Date Issued: Tuesday, December 02, 2003
— This is to-certify that work requested to be done as shown by Permit Number - P20030979
has been completed.
Tax Map Number: 523400-296-014-0001-076-000-0000
Location: 21 WINCREST Dr
Owner: CHRISTOPHER& GINELLE JONES
Applicant: CHRISTOPHER& GINELLE JONES
This structure may be occupied as a:
By Order of Town Board
Septic Alteration Residential TOWN OF QUEENSBURY
Director of Building&Code Enforcement
TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development-Building&Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20030979 Application Number: A20030979
Tax Map No: 523400-296-014-0001-076-000-0000
Permission is hereby granted to: CHRTSTOPHF.R & CTTNF,T,T,F,TONF,Q
For property located at: 21 VWINCREST 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. Type of Construction Value
Owner Address: CHRISTOPHER& GINELLE JONE
21"WINCREST Dr Septic Alteration Residential
Total Value
QUEENSBURY, NY 12804
Contractor or Builder's Name /Address Electrical Inspection Agency
T.B.S. SEPTIC
2 LOWER WARREN STREET
OT JEENSBI TRY. NY
Plans&Specifications
2003-979
SEPTIC ALTERATION AS PER PLOT PLAN SPECIFICATIONS
$25.00' PERMIT FEE PAID-THIS PERMIT EXPIRES: Thursday, December 02, 2004
(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 th o f Qu a sb ; y, December 02, 2003
SIGNED BY t, "' for the Town of Queensbury.
Director of Building&Code Enforcement
Applibation for Permit"Septic Disposal System
Town of Queensbury 742 Bay Road Queensbury,NY 12804 (518) 761-8256
1. OWNER INFORMATION:
Office Use
Location of installatio
n:
File Permit No.
Tax Map No.
Owner's Name:
5 -76 A/C Fee Paid
.......................................................................... ................................... ...........
Address: At^
2. INSTALLER'S NAME
f �rI2Ti PHONE NO. 7)PFI
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. =
Garbage Grinder Installed yes no' e'(-
Spa or Hot Tub Installed yes— '/ no
4.' PARCEL INFORMATION: (circle applicable information&indicate measurements)
T65-wraDhv SuflNature Ground Water Bedrock or Lnpervious Material Domestic Water Slipply.
,Iflat) - at ph depth . at what depth municipal
Q?eding (1� feet /1A feet well
Steep slope clay 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 L
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: 4LT
/0-0-0—gallon (min. size 1,000 gal)
Tile Field: each trench .5-0 ft. Total System Length: POO
Seepage Pit(s): number of. size of each:
—ft, by_ft.
Of'
Size of Stone to be used: #2V--WrC,(/'
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)
For your protection,please note that pursuant to Section 13 6-29 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.
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SIGNATURE DATE
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Fill COPY
Septic Inspection Report
Office No. (518)761-8256 Date Inspection r uest ece' ed-
Queensbury Building&Code Enforcement Arrive: am/p art: a a
742 Bay Rd., Queensbury,NY 1,2804 Inspector's Init als:
\
NAME: 1 I,�)/��_ IT NO.: �— J < 9
LOCATION: SPECT ON:
RECHECK:
Comments and/or diagram
Soil T e: an oa /
Type of r: I al/Well WateAV
Waterline separation distan ft.
Well separation distance
Other wells:
Absorption Field: Total length o ft.
Length of each trench ft.
Depth of trenches ft.
Size of Stone �y
Seepage Pits: Number
Size: x
Stone Size:
Piping Size Type
Building to tank
Tank to Distribution Box tA 11
Distribution Box t iel Pit
Opening Sealed /Partial
Location/Separations
Foundation to tank p ft.
Foundation to absorption
Separation of Pits
Conforms as per Plot Plan Y N
Location of System on Property:
Fro Left Side., Right Side
fiddle Fro iddle Rear eo
S ste e 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
STATE OF NEW Y O R K -�-
DEPARTMENT OF HEALTH
Flanigan Square, 547 River Street, Troy, New York 12180-2216
Antonia C. Novello,M.D.,M.P.H., Dr.P.H, Dennis P.Whalen
Commissioner Executive Deputy Commissioner
June 1, 2004
Mr.H. Thomas Jarrett, P.E.
Jarrett-Martin Engineers, PLLC
12 East Washington Street
Glens Falls,NY 12801
RE: Onsite Wastewater Treatment Systems (OWTS)
Stonehurst Subdivision
(T) Queensbury, Warren County
Dear Mr. Jarrett:
This letter is in response to your letter dated May 18, 2004, concerning Lot#31 in the
NYSDOH approved Stonehurst Subdivision located in the Town of Queensbury. As presented in
your letter, the approved Stonehurst Realty Subdivision OWTS design plans call for"stone-and-pipe"
trenches and you would like to substitute Infiltrator's "Equalizer 24" gravelless chambers in lieu of
the stone-and-pipe. It is acceptable to substitute the specified gravelless chambers in the trenches in
lieu of stone-and-pipe on a one-to-one linear foot basis. All other aspects of the approved OWTS
design must be adhered to.
Please provide a copy of the"as-built" OWTS system to the homeowner and the Town of
Queensbury's Code Enforcement Officer(CEO)CIn general,the substitution of NYSDO.H approved`
gravelless chamber systems in lieu of stone-and-pzpe trenches is acceptabl6 as long as the total"linear' -t
rlfeet of trenches is not reduced and all other aspects of the OWTS design are not modified. j
If you have any questions please call me at (518) 402-7650.
S
' rel ,
awes R. Meacham, P.E.
Senior San_itary_Engineer
cc: Ben Pierson,BWSP
Anita Gabalsld, GFDO
(T) Queensbury—Code Enforcement
Septic Inspection Report
Office No. (518)761-8256 Date Inspection request received:
Queensbury Building&Code Enforcement Arrive: am/ '�0epart: am/pm
'D
742 Bay Rd., Queensbuly,NY 12804 Inspector's Initials: iP
r
NAME: Q,f/ PERMIT NO.:
LOCATION: INSPECT ON: Z L G
RECHECK:
Comments andlor diagram
Soil T e: Clay
Type of Water: unicip /Well Water
Waterline separa ' stance 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 /L 0
Seepage Pits: Number
Size: x
Stone Size:
Piping Size Type
Building to tank SJ
Tank to Distribution Box g2
Distribution Box to Field/Pit pl <<
Opening Sealed: Y/N/Partial
Location/Separations
Foundation to tank ft.
Foundation to absorption 8 ft.
Separation of Pits ft.
Conforms as per Plot Plan VY N
Location of System on Property:
Front Rear Left Side Right Side
Middle Front Middle Rear
System Use Stat
Approved
Partial Approved and needs to be re-inspected,please call the Building&Codes Office
Disapproved
L:1.SueHemingway\Building.Codes.Inspection.FORMS\Septic Inspection Report.doc January 28,2003