2012-097 .•11,0) 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: P20120097 Date Issued: Monday, October 21, 2013
This is to certify that work requested to be done as shown by Permit Number P20120097
has been completed.
Tax Map Number: 523400-302-014-0001-029-000-0000
Location: 106 DIXON Rd
Owner: MICHELLE DE LONG
Applicant: MICHELLE DE LONG
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,
Variance, or other issues and conditions as a result of approvals by the
& '
I
Dirc t i o iiildin "o�! 1 • rcement
Planning Board or Zoning Board of Appeals.
01/1k4 TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development-Building&Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20120097 Application Number: A20120097
Tax Map No: 523400-302-014-0001-029-000-0000
Permission is hereby granted to: MICHELLE DE LONG
For property located at: 106 DIXON 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: MICHELLE DE LONG Septic Alteration Residential
106 DIXON Rd Total Value
QUEENSBURY,NY 12804-0000
Contractor or Builder's Name/Address Electrical Inspection Agency
Plans&Specifications
septic alteration
$40.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Tuesday, March 26, 2013
(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 of Quee bull; ,� • - , March 26, 2012
SIGNED BY ` /' �, . \ for the Town of Queensbury.
Director of Building&Code Enforcement
J.
Community Development Office r: ;' < `:').
Town of Queensbury • 742 Bay Road • Queensbury, New York •12.8l
12.8 L____�
TOWN OF QUEENSBURY
Office Use Only p BUILDING & CODES
TAX MAP NO3O, , s A' -.1-6" I PERMIT NO._JZ I> PERMIT FEE
APPROVALS: ZONING TOWN CLERK
APPLICATION FOR SEPTIC DISPOSAL SYSTEM ERMIT: A PERMIT MUST BE OBTAINED
BEFORE WORK BEGINS. APPLICATION IS SUBJECT TO REVIEW ORE ISSUANCE rA VALI/ 2cic)ERMIT.
OWNER: 1 CLL.-ELL (F— Q CoA __ INSTALLER: ' N!i A127 J-f'�z
ADDRESS: G 0 (P— 1 j k c7 ,(`-.1r C.) --3 ADDRESS: r 0 )C -2 L( 7'/ C
.• t�
PHONE NOS. 7 7 V 3 / PHONE NOS.•7 7 C — 0 Y s- u
LOCATION OF INSTALLATION: 1 L ID / _ /.-) (Z)
RESIDENCE INFORMATION:
NO.OF COMPUTATION
YEAR BUILT BEDROOMS X (Gallons per bedroom) = TOTAL DAILY FLOW GARBAGE GRI D
1 1980 or older X 150 = d c7 INSTALLED?
1981-1991 X 130 = SPA OR HOT TUB `-'1 -,
1992-present X 110 =
INSTALLED? L.
PARCEL INFORMATION: f
✓ TOPOGRAPHY: FLAT ROLLING" STEEP SLOPE %SLOPE
✓ SOIL NATURE: SAND '"-- LOAM CLAY OTHER
✓ GROUNDWATER: AT WHAT DEPTH?
✓ BEDROCK/IMPERVIOUS MATERIAL: AT WHAT DEPTH?
✓ DOMESTIC WATER SUPLY: MUNICIPAL_"WELL
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:,000 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: f
ABSORPTION FIELD (WITH NO.2 STONE) Total length ' 3 J ft. Each trench 2 X r )
❑SEEPAGE PIT(S) (WITH NO.3 STONE) How many? Size?
❑ALTERNATIVE SYSTEM Bed or 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.
I have read the ;•ulations with respect to this application and agree to
abide these an a -•uirements •f e Town ofQueensbury QUESTIONS? CALL 761-8256 OR EMAIL
( S Hilary ewage iQu
s•osa •rdina ,% codesqueensburv.net
-- i1 (r Z
S gnature of Person, _ .onsible Date VISIT OUR WEBSITE FOR MORE INFORMATION
www.queensburv.net
_ I II iI I I I
■M■■■ I ��■■ 1111■ ■ MIN 1111111111111111111•11► ■■■■fIJQI ■IZ9■ I 1
1I ► Milo i iii.
1 1 I I MS 4 ' ; I I
II— I I I I lifli -
T 1 1 I 1111■■1111 - y� Mgr `l'
I I I I ��,�' I 1101
i
I IH■ ' 2sgtlites
I I •• • I I
_1 I
MIME= i I I_ 1111■■1111 UU Imo■
1111■ I ■ 111■■■■ ■NNE
f`° r N !LI
_— 1 I 1 —■■■IMS,., 1°4 11=2
I ■ -n I I ■M■■iIlL 1 N
I ■■■Ij 11111101111q1
_I ■ I 11111121411 N, - -
1 1 _._I X g
I EllI ! f 1 T. I _ ■E
■ I M I i I I '°II 1 I I I I I ILtaEI. ;, I
1��aa I I 1 `I . , ,_.
M ■ I_ I I o ,s,,,,-,I I 4 ail -l I
I I .?J_ . x ►1_■■�►
_L_ ■ I ■ ■ice. I I I I I �..wv■■
_I I 1111E I : II■ 1111 I ■■M ■■
II rots=E _ �I ' ' ,_
■ II
■1111 1_ 3 ys' . ■M ■ I I
I■■■ _ _L , ..1..r.... I
_!- I , I - •IIU ' 1 Num. ,
Imo -i= ■ ■ NI1 I I
III1LLiIrHjjjIj...jip t i l
_! ■ M ■■■ II ■ 1... _ 111 I■ ■
,_ 11IU I1 1111■
E ■ EN■i OF c UE .,r lel
1NG & • t ,�.IMM M. Mr f
_ ■ 1111■ ■MM�IIi�' - " -d�-BY ,��,• `®�
t
,- •� ■ II II 11 30 i i t - I
Ill IU II I - II
HIIII II 1 I I I I II
M■■ IMEM= i ! 1111■ L I I I I I
1 MEM I I■ ■■ ■E■ -- I- III
■I11 11■■■ v 1 I-I- I 11111
■ I I_ ■ 1
III iIIi - -- ■11ir ' L'!=' � - - Marla
■M I III 1 1 I l l
11M 1111■ I11111
1 I II 1H
I 1111■■■■•■ ■ ■ I ■ I �■�
c ( cU
Septic Inspection Report Office No. (518)761-8256 Date Inspection request received: L IL//I 2--
Queensbury Building &Code Enforcement Arrive: am/ m Depart:/Lam/pm
742 Bay Rd., Queensbury, NY 12804 Inspector's Initials:C
NAME: 0� 1 Un 61 PERMIT NO.:
LOCATION: / (3(q !°),//ice. —E' . INSPECT ON: FV/2—
RECHECK:RECHECK:
Comments and/or diagram
Soil Type: (ilbet Loam / Clay
Type of Water: Municipal / Well Water
Waterline separation 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 -ft.
Length of each trench ft.
Depth of trenches ' �Z_�_ft.
Size of Stone
Seepage Pits: Number 0. --_--�--
Size: I"
Stone Size:
Piping Size Type i �
Building to tank O '—' `7`tZ �i
Tank to Distribution Box 51 --
Distribution Box to Field / Pit
Opening Sealed: N
End Cap X N
Inlet/Outlet Pipes&Baffles ✓Y—N
Manholes 12"or less below grade _Y N
[provide extension collar if Yes] ,�Y— N
Location/ Separations
Foundation to tank ft. — \ '
Foundation to absorption 'z_ ft.
Separation of Pits .
Conforms as per Plot Plan Y �
Engineer Report and As-Built Y 3/N
ETU Maintenance Contract _Y_ N
provided
Location of System on Property:
Front Rear Left Side Right Side Middle Front Middle Rear
System Use Sta :
Approved
Partial Approved and needs to be re-inspected, please call the Building &Codes Office
Disapproved
L:\Pam Whiting\2010\Building Codes Forms\Inspection Forms\Septic Inspection Report_03 29 10.doc
D E c I E
CENTER PROJECT �' .
SERVICES TOWN O- O1°-
73 Sheridan Street, Glens Falls,NY 12801 BUILDING CODES
Phone-518-796-2515
March 23,2012
Project# 152
Dan Drellos
Sanitary Sewer Services
Luzerne Road
Queensbury,NY 12804
Re: Proposed Replacement Septic
DeLong Residence— 106 Dixon Road, Queensbury,NY
Dear Dan:
At your request we have reviewed your proposed replacement septic system design at the site of
the existing 2 bedroom house of Michelle DeLong at 106 Dixon Road in Queensbury. As per our
conversation the residence has an existing failed septic system.
A deep soil test pit was performed at the request of the Town of Queensbury Building
department. The test pit results were:
0— 12 inches-Topsoil
12—28 inches-Loamy Medium Coarse Sand
28—72 inches - Medium Coarse Sand
Mottling observed at 54 inches
Water observed at 72 inches
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 220 GPD and a percolation rate of
1 to 5 minutes, you will need 100 linear feet of absorptive laterals are required. We recommend
using 3 — 45ft long absorption laterals, which will provide 135 if of absorptive laterals. The
absorption system should be constructed with the existing 1,000 gallon septic tank, new
distribution box, and 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,
41/119, 4T___
Thomas R. Center Jr,P.E.