2010-467 411" TOWN OFQ UEENSBURY
742 BayRoad,Queensbury,NY 12 4-
� � Qu ry, 80 5902 (518)761-8201
Community Development- Building &Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: P20100467 Date Issued: Thursday, September 30, 2010
This is to certify that work requested to be done as shown by Permit Number P20100467
has been completed.
Tax Map Number. 523400-307-000-0001-037-000-0000
Location: 915 LUZERNE Rd
Owner. SUSAN & WILLIAM COOK
Applicant: SUSAN & WILLIAM COOK
This structure may be occupied as a:
Septic Alteration Residential
Test Pit/Perc Test Review By Order of Town Board
TOWN OF QUEENSBURY
Issuance of this Certificate of Compliance DOES NOT relieve the (— ,‘„P /
4
property owner of the responsibility for compliance with Site Plan,
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
AAT 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development- Building&Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20100467 Application Number. A20100467
Tax Map No: 523400-307-000-0001-037-000-0000
Permission is hereby granted to: SUSAN &WILLIAM COOK
For property located at: 915 LUZERNE 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: SUSAN &WILLIAM COOK
915 LUZERNE Rd Septic Alteration Residential
QUEENSBURY, NY 12804 Test Pit/Perc Test Review
Total Value
Contractor or Builder's Name/Address Electrical Inspection Agency
QUEENSBURY SEWER
JAY SWEET
Plans &Specifications
2010-467
deep hole/perc test& septic alteration
$225.00 PERMIT FEE PAID- THIS PERMIT EXPIRES: Wednesday, September 28,2011
(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 fQu b ty; / I .y, September 28, 2010
SIGNED BY for the Town of Queensbury.
Director of Building&Code Enforcement
� �� _--- OFFICE USE ONLY
MAP NO. 2 .�_--
�C _ PERMIT NO. PERMIT FEE__
APPROVALS: SEP 2 4 2010
- TOWN CLERK
'T, WN OF QU -GOIDE --
,
APPLICATION FOR SEPTIC ,�`-_`_____________________ ___. �It�N�&��_.-.,
A PERMIT MUST BE OBTAINED BEFORE WORK BEGINS.DISPOSAL SYSTEM PERMIT:
PERMIT. APPLICATION IS SUBJECT TO REVIEW BEFORE ISSUANCE OF A VALID
OWNER: 4 ' C 00 eINSTALLER: roc /
ADDRESS: ir 10� /.lI
`, ' `, ADDRESS: a
PHON- OS.
PHONE NOS. ✓C / s-3
LOCATION OF INSTALLATION:
YEAR BUILT NO.OF
BEDROOMS X COMPUTATION= = TOTAL DAILY FLOW RESIDENCE INFORMATION:
1980 or older X 150 gallon per bedroom
1981 •1991 = �l a GARAAGE GRIND
X 130 gallon per bedroom INSTALLED? / _
SPA OR HOT
1992 .T
-present X 110 gallon per bedroom =
T
PARCEL INFORMATION: INSTALLED?
✓ TOPOGRAPHY:
Flat rolling_ Steep slope o
✓ SOIL NATURE: �oSlope_
Sand Loam Clay______
Other
✓ GROUNDWATER:
At what depth?
✓ BEDROCK/IMPERVIOUS MATERIAL: At what depth?
✓ DOMESTIC WATER SUPL_
Municipal Well
l__ (Ifxwell: Water supply from any septic
✓ PERCOLATION TEST: Rate is /— '` �, - 16 Sc_ system absorption is�ft.)
r- per minute per inch.
(Test to be completed by a licensed professional engineer or architect.
PROPOSED SYSTEM FOR NEW CONSTRUCTION: All individual sewage disposal }
g p sal systems must be designed by
a licensed professional engineer or architect(unless installed in a Planning Board
TANK l approved subdivision).
GALLON (MIN. SIZE IS 1,000 GAL.) Add 250 gallons to the '
each garbage grinder, spa or whirlpool tub. size of the septic tank for
SYSTEM TYPE:
❑ ABSORPTION FIELD (WITH NO. 2 STONE) Total length �' a f
0 SEEPAGE PIT(S) (WITH NO. 3 STONE) How --'t' Each trench X_�_
many?
❑ ALTERNATIVE SYSTEM BSize?
Bed or other type? l e f ,g
❑ HOLDING TANK SYSTEM q Be�
Total required capacity?
Tank size?
Number of tanks?
1 APPROV ALARM SYSTEM AND ASSOCIATED ELECTRICAL
:.,.:.:.,:.:::::::,.,.:.,,,.,.:.,.,.:.,.:...,.:...:.:.:.:.:.,.:::,:.:.:..
..........
INSPECTED
BY A TAT..:...:...........:.::::.
ELECTRICAL INSPECTION AGENCY. PLEASE EV EW LIST PROVIDED.
For ::..::.::...::.:....:.. :
•
•
your protection, please note that pursuant to Section 136-29 of the Code of the Town of QuAAnh...,, ,._..
permit or approval granted which is based UDOn nr lc n.,.,.,.., ,_ ._ ..
f211ltrq to r„ .I, - __ . . .
//—/ /1 o v
Septic Inspection Report
Office No. (518) 761-8256 Date Ins req ;•• rece
Queensbury Building&Code Enforcement Arrive: " 5U a • J - : "b a rt
742 Bay Rd., Queensb ry, NY 12804 Inspector's Initials•
NAME: 1() RMIT NO.:
LOCATION: �' i.i'('r rte ,� . INSPECT ON: .>�`�Ci
RECHECK:
Comments and/or diagram
Soil TypeC m. .Clay.`
T of Water: Munia•• Well Water
Waterline separa•.- :' •- ft.
Well separation distance 1 C)(F3
Other wells: I I 0 ft.÷--
Well Casing Length 50' +/- Y N N/A
[150'to well required if NO]
Absorption Field: Total length ft.
Length of each trench ft.
Depth of trenches
Size of Stone
Seepage Pits: Number
Size:
Stone Size:
Piping Size Type
Building to tank I t�7'i i
Tank to Distribution Box 1-4 " ',iv_ 3 lc-
Distribution Box to Field/ Pit A 7b0 a., 3 c' T'O Q -
Opening Sealed: %/S1, N
End Cap •—�—N
Inlet/Outlet Pipes&Baffles ✓Y N
Manholes 12"or less below grade %A _N
[provide extension collar if Yes] Y N
Location/ Separations
Foundation to tank 17.— ft. E-)C-i A
Foundation to absorption 5Z—ft.
Separation of Pits
Conforms as per Plot Plan �N
Engineer Report and As-Built Y_N
ETU Maintenance Contract _Y N
provided
Location of System on Property:
Front Rear -ft Side Right Side Middle Front Middle Rear
em . - S_
Approved
Partial Approved and needs to be re-inspected, please call the Building&Codes Office
Disapproved
L:1Pam Whiting120101Building Codes Fom s\Inspection Forms\Septic Inspection Report_03 29 10.doc
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NACE ENGINEERING, P.C.
169 Haviland Road, Queensbury, NY 12804
Phone- 518-745-4400 Fax -518-792-851
September 23, 2010
Project #49323
Dave Hatin
Code Enforcement Officer
Town of Queensbury
742 Bay Road
Queensbury, NY 12804
Re: Cook—915 Luzerne Road— Replacement Septic System
Dear Dave:
On September 23, 2010, we performed a deep soil test pit and percolation test at the Cook residence
located at 915 Luzerne Road in Queensbury. The tests were performed to the east of the existing
residence in the location where construction of a replacement leach field is proposed. The current
residence has an existing failed septic system which will be decommissioned upon completion and
certification of the replacement system.
The results of the testing are as follows:
Test Pit Percolation Test
0 —4" Tosoil Stabilization percolation rate - 1" in 3 min., 16 sec.
4 —24" Loamy Fine Sand w/gravel
24 —60" Medium Fine Sand w/gravel & boulders
Compact @ 30"
No Mottling observed.
No Groundwater observed.
The 18 inch deep hole was presoaked and the test was run 5 times; at a depth of 12 inches, until it
stabilized with three consecutive runs of 2:51, 3:15 and 3:16 respectively.
The design flow for this 3 bedroom residence at 110 gpd per bedroom (330 gpd design flow),
requires 347 sf of absorption bed. The replacement absorption system should be constructed as a
shallow bed system and shall be no deeper than 12 inches into the existing soil. The absorption
system will consist of the existing 1,000 gallon septic tank, a new distribution box and 20 ft wide by
20 ft long absorption bed with 4 — 15 foot long absorption laterals located to the east of the existing
residence.
Please call me if you have any questions.
Sincerely, /7
Thomas R. Center Jr, P.E.
•
Town of Queensbury• Building&Codes Enforcement Office•742 Bay Road• itIn r. V ¶► o \V1 ;-�
±fg 1
DEEP HOLE/PERC TEST a 1�;
; ,
Request for Town Engineer RevieWi
YO a OI--15-LIEtNSBUP's,
Property Owner: (T CODES
p rty lJ ���`gpto jJo /1 Phone: CODES
Property Owner's / ��,
Address: //5 L C� 7 (� //4 "rd
Location of Test: it r 6' r� /!�;"e ,sem r,: i S),5rrf,, Tax ID#: j�' ', /- 3 7
*Applicant's Engineer: A 4 j-C ��,h t'y•� Phone:
7�F z S/5
Applicant's Agent: /U/-77(rj i jet- Phone:
Additional Notes:
1. Reason for Request? New Septic System X10-Replacement Septic System -X Failed Septic System
Subdivision Site Plan Review
2.Are Wetlands present? YES Fl NO UNKNOWN
'"Note: Applicant is required to engage an engineer for design and testing of the system. The Town
Engineer's responsibility is to witness system testing only.
PLOT PLAN: Plot plan, to scale, to be submitted with application
FEE SCHEDULE:
a. $200 Flat Fee Date Paid: )! A`
•
Check No.: "� _
b. OR Fee to be determined during To Be Determined:
Site Plan/Subdivision review process
SIGNATURE:
In carrying out the provisions of Article IV, the Local Board of Health or the enforcement officer may
engage the services of a qualified professional consultant for expert review and recommendation arising
from the carrying out of the provisions of Art. IV, including but not limited to the review of plans,
specifications and reports, attendance at inspections, dye tests, deep hole test pits, septic related deep
hole and percolation tests, system installations, and any other aspect of any matter contained in this Art.
IV, and any costs incurred in such review shall be paid to the Town by the owner of the property before
any approval can be granted under this Art. IV shall become effective within 30 days of presentment of an
invoice for same, whichever is sooner. Such costs shall not exceed $1,500 without prior written notice to
the party to be charged with same.
My signature below indicates I have thoroughly read and understand the instructions, agree to the
submission requirements and have completed the application. I also fully understand that additional
engineering fees may be necessary per Town of Queensbury Local Law 136-14D.
SIGNATURE OF APPLICANT: Date: c�
SIGNATURE OF AGENT: >, Date: //�//er
Original (B&C File) Canary(Planning) Pink(Applicant) Gold (Town Clerk)
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Map Produced by Warren County Spatial Data Viewer-www.co.warren ny us/gis
data sources parcels-Warren County Real Property Tax 2009 Tentative Roll
aerial photography-NYS CSC IC.flown in April,2008 it-foot coke)
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