2011-187 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: P20110187 Date Issued: Tuesday,June 21, 2011
This is to certify that work requested to be done as shown by Permit Number P20110187
has been completed.
Tax Map Number: 523400-296-014-0001-060-000-0000
Location: 11 ORCHARD Dr
Owner: TONY POULOS
Applicant: TONY POULOS
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 , 3�
property owner of the responsibility for compliance with Site Plan, '' r
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:
TOWN OF QUEENSBURY ,
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development-Building&Codes (518)761-8256
BUILDING PERMIT
Permit Number: P20110187 Application Number: A20110187
Tax,Map No: 523400-296-014-0001-060-000-0000
Permission is hereby granted to: TONY POULOS
'For property located at. 11 ORCHARD 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: TONY POULOS Septic Alteration Residential
11 ORCHARD Dr Total Value
QUEENSBURY,NY 12804-0000
Contractor or Builder's Name/Address Electrical Inspection Agency
Plans&Specifications
2011-181
septic alteration residential
$40.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Friday,May 11,2012
(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 Towr of Que sb ; W� n eS ysMay 11,2011
SIGNED BY h for the Town of Queensbury.
Director of Building&Code Enforcement
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Community Development Office PLAY 0 9 2p11
Town of Queensbury • 742 Bay Road • Queensbury, New Y rk
A CODE,
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Office Use Only -
TAX MAP NO. �.� PERMIT NO. A PER
FEE
9
APPROVALS: ZONING TOWN CLERK
APPLICATION FOR SEPTIC DISPOSAL SYSTEM PERMIT: A PERMIT MUST BE OBTAINED
BEFORE WORK BEGINS.APPLICATION IS SUBJECT TO REVIEW FORE ISSUANCE OF A VAL PERMIT.
OWNER: O �Q �S INSTALLER: / /��'� e(2 6 Cj
ADDRESS:I I ��� kI'dZ 7 b 41 V'q_ ADDRESS:
PHONE NOS. PHONE NOS. 7 76
LOCATION OF INSTALLATION: �d���.A-/I^a a 1'V�
RESIDENCE INFORMATION:
YEAR BUILT NO.OF X COMPUTATION = TOTAL DAILY FLOW
BEDROOMS Gallons per bedroom GARBAGE GRINDER
1980 or older X 150 = 6 CO INSTALLED? 1,10
1981-1991 X 130 = SPA OR HOT TUB h j 0
1992-present X 110 = INSTALLED?
PARCEL INFORMATION:
✓ TOPOGRAPHY: FLAT ROLLIN -STEEP SLOPE %SLOPE
✓ SOIL NATURE: SAND LOAM CLAY OTHER_
✓ GROUNDWATER: AT WHAT DEPTH?
✓ BEDROCK/IMPERVIOUS MATERIAL: AT WHAT EPTH?
✓ DOMESTIC WATER SUPLY: MUNICIPAL y WELL (If well:water supply from any septic system absorption is: ft)
✓ PERCOLATION TEST: RATE IS PER MIINUTE PER INCH[mpi] (Test to be completed by a licensed professional
engineer or architect)
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).
TANK SIZE: il GALLON(MIN.SIZE IS 1,000 GAL.)Add 250 gallons to the size of the septic tank for each garbage grinder,
spa or whirlpool tub.
SYSTEM TYPE:
❑ABSORPTION FIELD(WITH NO.2 STONE) Total length ft. Each trench X
❑SEEPAGE PIT(S)(WITH NO.3 STONE) How many? Size?
(ALTERNATIVE SYSTEM ed r other type?
❑ HOLDING TANK SYSTEM Total required capacity? Tank size? Number of tanks?
NOTE: ALARM SYSTEM AND ASSOCIATED ELECTRICAL WORK MUST BE INSPECTED BY A TOWN APPROVED ELECTRICAL
INSPECTION AGENCY. PLEASE REVIEW LIST PROVIDED.
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.
read the regulations with respect to this application and agree to
ide y these and equiremen f the Town of Queensbury QUESTIONS? CALL 761-8256 OR EMAIL
ani ry Sewage i. o al Ordi e. codes(dgueensburv.net
VISIT OUR WEBSITE FOR MORE INFORMATION
ignature of Perso esponsible Date www.aueensbury.net
r-
V E V
73 Sheridan Street, Glens Falls,NY 12801 MAY 0 9 2 111
Phone-518-796-2515
TOWN OF QUEENSBURY
BUILDI 8< O
Project# 140
Dan Drellos
Sanitary Sewer Services
Luzerue Road
Queensbury,NY 12804
Re: Proposed Replacement Septic
Poulos Residence— 11 Orchard Drive, Queensbury,NY
Dear Dan:
At your request we have reviewed your proposed replacement septic system design at the site of
the existing 4 bedroom house of at 11 Orchard Drive in Queensbury. As per our conversation the
residence has`an existing failed septic system.
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 600 GPD and a percolation rate of
1 to 5 minutes, you will need 631 square feet of absorptive area. We recommend using a 12 ft
wide by 55 ft long absorption bed with 2 — 50 foot long laterals, which will provide 660 sf of
absorptive area. The absorption bed should be constructed with the existing 1,000 gallon septic
tank,new distribution box,4 inch diameter perforated pipe and stone.
Please feel free to contact me at 796-2515 if you have any questions and that you for your
assistance with this request.
Sincerely,
JG
Thomas R. Center Jr, P.E.
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Septic Inspection Report
Office No. (518)761-8256 Date Ins on uest received:
Queensbury Building&Code Enforcement Arrive: _T• am/Qm Depart: am/pm
742 Bay Rd., Queensz NY 1 804 Inspecto s In 'als: 1
NAME: PERMIT NO.:
LOCATION: - INSPECT ON:
RECHECK:
Comments and/or diagram
Soil Type: / Loam/Clay
Type of Water:Municihal Well Water
Water hi e aration distance ft.
Well separation distance ft.
Other wells: ft.
Well Casing Length 50'+/- Y N N/A
150'to well required If NO
Absorption Field: Total length
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 la -11)2 3
Distribution Box to Field/ Pit �!
Opening Sealed: N
End Ca Y N
Inletjoutlet Pipes&BafFles N
Manholes 12"or less below grade Y_
[provide extension collar if Yes Y N
Location I Separations
Foundation to tank ft.
Foundation to absorption ft.
Separation of Pits ft.
Conforms as per Plot Plan Y N
Engineer Report and As-Built Y N
ETU Maintenance Contract Y_N
provided
Location of System on Prope :
Front Rear Left Side Right Side Middle Front Middle Rear
stem Use Stat
Approved
Partial Approved and needs to be re-inspected, please call the Building &Codes Office
Disapproved
U\Pam Whiting\2010\13uilding Codes Forms\Inspection Forms\Septic Inspection ReporL03 2910.doc