2012-340 ..11101h 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: P20120340 Date Issued: Monday, November 25, 2013
This is to certify that work requested to be done as shown by Permit Number P20120340
has been completed.
Tax Map Number: 523400-315-008-0001-009-000-0000
Location: 130 Eagan Rd
Owner: DAVID & NANCY ARMSTRONG
Applicant: DAVID & NANCY ARMSTRONG
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 ,,,vP
� � f
property owner of the responsibility for compliance with Site Plan, d
Variance, or other issues and conditions as a result of approvals by theDirector of Building& Cod Enfor -mens
Planning Board or Zoning Board of Appeals.
011111k TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
F 417
Community Development-Building& Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20120340 Application Number: A20120340
Tax Map No: 523400-315-008-0001-009-000-0000
Permission is hereby granted to: DAVID &NANCY ARMSTRONG
For property located at: 130 Eagan 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: DAVID&NANCY ARMSTRONG Septic Alteration Residential
115 WEST MT. Rd Total Value
QUEENSBURY,NY 12804
Contractor or Builder's Name/Address Electrical Inspection Agency
Plans&Specifications
2012-340
Residential Septic Alteration
$40.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Wednesday, September 04,2013
(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 Tow o ensb ;4 s u � : - i tember 04, 2012
SIGNED BY for the Town of Queensbury.
Director of Building&Code Enforcement
0 Community Development Office r��12
• - Town of Queensbury • 742 Bay Road • Queensbury, New York •12804 �
Office Use Onlyva
TAX MAP NO. ' Si 8 -1-9
PERMIT NO.J0` 3<lo PERMIT FEE W1 `D
APPROVALS: ZONING TOWN CLERK
APPLICATION FOR SEPTIC DISPOSAL SYSTEM PERMIT: A PERMIT MUST BE OBTAINED
BEFORE WORK BEGINS. APPLICATION IS SUBJECT TO REVIEW BEFORE ISSUANCE OF A VALID PERMIT.
OWNER: DAVE AND NANCY ARMSTRONG INSTALLER:
ADDRESS: ADDRESS:
PHONE NOS. (518) 955-4005 PHONE NOS.
LOCATION OF INSTALLATION: 130 EAGAN ROAD
RESIDENCE INFORMATION:
YEAR BUILT NO.OF X COMPUTATION = TOTAL DAILY FLOW
BEDROOMS (Gallons per bedroom) GARBAGE GRINDER
1980 or older X 150 = INSTALLED? NO
1981 -1991 X 130 = SPA OR HOT TUB
I
1992-present 2 X 110 = 220 INSTALLED? NO
PARCEL INFORMATION:
✓ TOPOGRAPHY: FLAT ROLLING STEEP SLOPE ✓ %SLOPE
✓ SOIL NATURE: SAND ✓ LOAM CLAY OTHER
✓ GROUNDWATER: AT WHAT DEPTH? >48"
✓ BEDROCK/IMPERVIOUS MATERIAL: AT WHAT DEPTH? >48"
✓ DOMESTIC WATER SUPLY: MUNICIPAL WELL ✓ (If well:water supply from any septic system absorption is: 120 h)
✓ PERCOLATION TEST: RATE IS 1:05 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: 1,000 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:
E'ABSORPTION FIELD(WITH NO.2 STONE) Total length 120 ft. Each trench 2 X 40
❑ 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 beh. of an applicant,shall be void.
ave read the regulat 1,ns wi i r--•-.ct to this application and agree to
•de by these and 6•ui -,s � • he To of Queensbury QUESTIONS? CALL 761-8256 OR EMAIL
Sewage Dis•• Or•' ." ) codes@queensburv.net
� 1 di
r• /� / VISIT OUR WEBSITE FOR MORE INFORMATION
�. a of •erson -•s•onsible Dat www.queensburY.net
Septic Inspection Report
Office No. (518) 761-8256 Date Inspection request
Queensbury Building &Code Enforcement Arrive: Z ZD a 4""02 -••i : 'Z. a year
742 Bay Rd., Queensbury, NY 12804 Inspector's Initials:
NAME: rnnS`-1 -D 3-1 e
LOCATION: /3 r)ec n Pd IN•'- ON: -Z-1 c— 1�
RECHECK:
Comments and/or diagram
Soil Type: Sand/ Loam/ Clay
Type of Water: Municipal / Well Water L7.p9`/ /3
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 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
End Cap _Y 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 ' 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 Property:
Front ar Left Side Right Side Middle Front Middle Rear
S stem Use Sta s:
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 Report03 29 10.doc
169 Haviland Road
Queensbury, NY 12804
Hutchins Engineering Phone: (518)745-0307
g g Fax: (518)745-0308
November 8, 2013
Mr. John O'Brien
Town of Queensbury Building and Codes Department
742 Bay Rd
Queensbury, NY 12804
Re: Wastewater System Replacement
Dave Armstrong, 130 Eagan Road
Tax Map# 308-20-1-9
Dear Mr. O'Brien:
Our office prepared a wastewater replacement design for Mr. Armstrong at the above-
referenced property. A representative from our office visited the site during system installation.
Based upon our site inspection and discussions with the installer it is my opinion that the system
was installed in general conformance with the attached record drawing.
Please contact me if you have any questions or if you require additional information.
Best Regards,
rtr Tn
G. Thomas Hutbhins, P.E. E • L ''y `
Enclosure
Cc: Mr. Dave Armstrong
Hutchins Engineering
To: (
Date: 31-1411' Lt bek fent
G.Thomas Hutchins,P.E.
Mount
1
PROPOSED 2'W ABSORPTION
TRENCH, (3) REQUIRED AT
40' LONG EACH
PROPOSED DISTRIBUTION
/ PROPOSED 1000 GAL
\ CONCRETE SEP
1-1,
HAND E
STEE
PROPOSED HOU
PROPOSED EJONE DH071-
PUMP STATION; VERIF
DEPTH PER RELD
EXISTING
BE REMOVED
j
SHOWING BUILDING
IMPROVEMENTS LANDS NOW OR
FORMERLY OF DAVID A. & NANCY J.
ARMSTRONG" BY DARRAH LAND
SURVEYING, PLLC OF GLENS FALLS, NY
DATED FEBRUARY 8, 2012.
2. "MAP MADE FOR DAVID A. & NANCY J.
ARMSTRONG" BY VAN DUSEN &
SIEVES LAND SURVEYORS OF
QUEENSBURY, NY DATED JUNE 6, 2012.
APPROXIM
SYSTEI
0
r
SITE
1 � 4
WASTEWATER SYSTEM PLAN_
SCALE: 1"=30'
I
SUGGESTED: POLYETHYLENE
EXTENSION TO GRADE WITH ,\
TAMPER RESISTANT ACCESS
COVER (NON -TRAFFIC AREAS)
12" MIN. COVER
1.25" HDPE 1 "!
1RANSI110N TO 4" ! I It } If
OUSTSIDE TANK U 16^ I 18"
MIN.
WATERTIGHT SLEEVE
& SEAL (TYI'.)
LIQUID DEPTH
30" MIN.
i.= 60" MAX.
MINIMUM 2X WIDTH
MAXIMUM 4X WIDTH
1/8" PER FOOT 12" MIN. COVER
MIN, SLOPE DISTRIBUTION BOX
BAFFLE IJ--LL�
USE SPEED LEVELERS TO
ASSURE ALL OUTLETS ARE AT
EXACTLY THE SAME ELEVATION
4" PVC SDR -35 SOLID HEADER TO
PERFORATED ABSORPTION TRENCH
PIPING, 1/8" PER FOOT MIN SLOPE
1000 GALLON PRECAST CONCRETE SEPTIC TANK
SEPTIC TANK DETAIL
NTS
HDPE GASKETED LID STRAIN RELIEF CORD
CONNECTOR
GRADE TO DRAIN AWAY
FROM PUMP STATION
ELECTRICAL QUICK _'-I i
DISCONNECT =1! I i-
��liiill.ii{I
QUICK DISCONNECT ASSY.. 11
SS CAST ALL VALVE- - I
1.25" DISCHARGE
I
I
CHECK VALVE - '1
41.6"
DISCHARGE
I
I
AN77-SIPHON 1
VALVE a ii
!!=! 11-11 I=1 I I-
PR07ECTIVE CABLE
I
SHROUD (HDPE)
�_- POWERIALARM CABLE
E10NE EQUALIZER
2"0 INTERNAL WELL VENT
INLET GROMMET TO ACCEPT 4.5"
O.D. PVC HOUSE SEWER
26 -
AL
TPUI 18"
MP ON
14"
10" PUMP OFF
4=4
DUAL WALL CORRUGATED J }' CONCRETE ANCHOR
HDPE TANK
6" MIN. GRAVEL
SEMI -POSITIVE �p 29.5"
DISPLACEMENT TYPE PUMP m 36" -
.91ONE DH071-74 GRINDER PUMP ASSEMBLY DETAIL
NP;
12" MAX
2" MIN.
6-
314- TO 1 1
WASHED CRUSHED SD
SLOPE
6' TYP. TRENCH SPACING
2"MIN.
2" MIN. DROP
BETWEEN INVERTS
WASTEWATER SYSTEM DESIGN
SYSTEM INSTALLATION NOTES
2 BEDROOM RESIDENCE
CONSTRUC71ON SHALL BE AS SHOWN ON THIS DRAWING AND IN ACCORDANCE WI7H
ABSORPTION TRENCH PERFORATED PIPE
THE N.Y.S. DEPARTMENT OF HEALTH INDIVIDUAL HOUSEHOLD SYSTEMS AND ASTM
WATER SAVING FIXTURES (1.6 GPF MAX. FLUSH,
F481 INSTALLATION OF THERMOPLASTIC PIPE AND CORRUGATED TUBING IN SEPTIC
3.0 GPM MAX. FAUCETS)
TANK LEACH FIELDS.
DESIGN FLOW - 110 GPD/BEDROOM
ESTABLISH TURF.
SYSTEM DESIGN FLOW - 220 GPD
AFTER EXCAVATION OF 2' WIDE TRENCH TO THE DEPTHS REQUIRED, THE WALLS AND
1.25" HDPE
FLOOR OF EACH TRENCH SHALL BE CLEANED AND RAKED IN ORDER TO LOOSEN
SEPTIC TANK - 1000 GAL PRECAST CONCRETE
SMEARED SECTIONS OF TRENCH.
LEACH FIELD - PIPE IN STONE ABSORPTION TRENCHES
DESIGN PERCOLATION RATE = 1-5 MIN/IN
PLACEMENT OF CRUSHED STONE, PERFORATED PIPE AND FILTER FABRIC SHALL BE
APPLICA77ON RATE= 1.2 GPD/SF
AS SHOWN, AND CARE SHALL BE EXERCISED TO AVOID INCLUSION OF FINE GRAINED
MINIMUM SLOPE.
SOILS AND WASTE MATERIAL IN THE STONE AND PIPE.
ABSORPTION AREA REQUIRED= 184 SF
FILTER FABRIC
2' WIDE TRENCH LENGTH REQUIRED 92 LF
THE PIPE SHOULD BE LAID AT THE GRADES INDICATED, MAINTAINING STRAIGHT
USE 3 TRENCHES AT 40' LONG (120 LF)
CONTINUOUS GRADES WITHOUT SAGS, HUMPS, SEPARATED JOINTS, OR OTHER
73"
UNSUITABLE CONDITIONS. PIPE SHALL BE LAID WITH HOLES DOWN W ALL CASES.
POTABLE WATER SUPPLY IS ON-SITE WELL
:r':;_,
MAINTAIN 100' SETBACK TO ABSORPTION FIELD
ALL DISPOSAL FIELDS SHALL BE GRADED TO SHED RAINFALL AND DIVERT SURFACE
MAINTAIN 50' SETBACK TO SEPTIC TANK
RUNOFF AWAY FROM THE DISPOSAL FIELD.
DO NOT USE HEAVY EQUIPMENT WITHIN THE ABSORP77ON AREA AFTER PIPING HAS
SITE SOILS DATA
BEEN INSTALLED.
TEST PTTS
THIS SYSTEM IS DESIGNED FOR WATER CONSERVING FIXTURES AND IS NOT DESIGNED
TPI - 6/29/12 BY T. HUTCHINS, P.E.
TO ACCOMODATE EXTREME WATER USE OR EXTREME ORGANIC LOADING DEVICES
0-6" - TOPSOIL
SUCH AS JACUZZI TYPE SPAS OR GARBAGE GRINDERS.
6-22" - YELLOWISH BROWN MEDIUM & FINE SAND
22-48" - MEDIUM BROWN MEDIUM & COARSE
ROOF, FOOTING, GARAGE, CELLAR AND SURFACE WATER DRAINAGE MUST BE
SAND
EXCLUDED FROM THE WASTEWATER SYSTEM.
PERCOLATION TESTS
THIS DESIGN IS SUBJECT TO STATE AND LOCAL APPROVALS.
PT -1 - 6/29/12 BY T. HUTCHINS, P.E.
SYSTEM MATERIAL SPECIFICATIONS
STABILIZED PERCOLATION RATE: 1 MIN. 5 SEC. PER
INCH
ABSORP77ON TRENCH AGGREGATE
SLOPE
STONE IS TO BE 314" TO 1-1/2" WASHED STONE..
GRANULAR BACKFILL FREE OF :-_ DEPTH
TOPSOIL
INLET
ABSORPTION TRENCH PERFORATED PIPE
PARTICLES LARGER THAN 3" * '
UNLESS OTHERWISE SPECIFIED, PERFORATED PIPING TO MEET ASTM F481.
PLACE 4" MINIMUM TOPSOIL OVER ENTIRE BACKFILL AREA. SEED, MULCH, AND
BACKFILL MATERIAL
ESTABLISH TURF.
BACKFILL MATERIAL TO BE GRANULAR BACKFILL MATERIAL WITH
NO PAR77CLES
1.25" HDPE
GREATER THAN 2" (-2).
OVERFILL AND MULCH
EFFLUENT SEWER PIPE
CLOSED CELL PIPE ---'ALL UNITS SHALL COMPLY WITH 774E REQUIREMENTS OF THE NEW YORK STATE
PIPING TO BE 4" SDR -35 OR SCHEDULE 40 PVC. INSTALL WITH
1/8" PER FOOT
INSULATION FOR DEPARTMENT OF HEALTH AND SHALL BE OF PRECAST CONCRETE AS MANUFACTURED
MINIMUM SLOPE.
_ _ _
111=1 ;.III
FILTER FABRIC
II III= `:;?;:`; _:??; '• ` '` '_'. =1� '
FILTER FABRIC TO BE 4.8 OZ SY NON -WOVEN SEPARATION FABRIC,
/
7ENCATE MIRAFI
73"
140N OR EQUIVALENT
:r':;_,
FORCEMAIN
12 ",;.`:::=t' :' it
:.:.•t
PIPING TO BE 1-1/4" SDR -11 HDPE.
HOUSE SEWER PIPE
COINER 18"
TRENCH
PIPING TO BE 4" SDR -35 OR SCHEDULE 40 PVC. INSTALL WITH
1/4" PER FOOT
MINIMUM
36"
GRANULAR BACKFILL FREE OF :-_ DEPTH
TOPSOIL
INLET
PARTICLES LARGER THAN 3" * '
PLACE 4" MINIMUM TOPSOIL OVER ENTIRE BACKFILL AREA. SEED, MULCH, AND
ESTABLISH TURF.
1.25" HDPE
FORCEMAIN SEPTIC TANK NOTES
CLOSED CELL PIPE ---'ALL UNITS SHALL COMPLY WITH 774E REQUIREMENTS OF THE NEW YORK STATE
INSULATION FOR DEPARTMENT OF HEALTH AND SHALL BE OF PRECAST CONCRETE AS MANUFACTURED
DIRECT BURIAL USAGE
BY UTOPIA ENTERPRISES OR EQUIVALENT.
FORCEMAIN TRENCH DETAIL ALL ,RUCTURES SHALL BE PLACED ON FIRM, COMPACT SAND OR GRAVEL BASE.
NTS
TYPICAL PIPE IN STONE ABSORP77ON
TRENCH; (3) REQUIRED AT 40' LONG
EACH (SEE ABSORPTION TRENCH
SEC77ON AND PROFILE FOR DETAILS)
BACKMATERIAL ENCH AGGREGATE
FILETERArn
FABRIC 4" ABSORP77ON PERFORATED PIPE
ABSORPTION FIELD SECTION
NTS
4" MIN TOPSOIL OVER THE ENTIRE ABSORPTION
FIELD; SEED AND ESTABLISH TURF
FILTER FABRIC
MIRAFI 14ON OR EQUIVALENT
4" PERFORATED PVC LATERAL,
SLOPE 1116" - 1132" PER FT.
ABSORPTION TRENCH PROFILE
NTS
6" MIN.
END
4" MIN TOPSOIL OVER THE
ENTIRE ABSORPTION FIELD;
SEED & ESTABLISH TURF
GRANULAR BACKFILL FREE
OF STONES OVER 2" (-2)
FILTER FABRIC
MIRAFI 140N
OR EQUAL
NOTE
INFILTRATOR® QUICK -4 EQUALIZER
36 CHAMBERS MA) BE SUBSTITUTED
FOR PIPE-IN-SIONE TRENCHES.
INSTALL IN CONFORMANCE WITH
MANUFACTURERS INSTRUCTIONS.
2" IN.
6-
2' TRENCH WIDTH
WHERE EXISTING SOIL CONDITIONS ARE UNSUITABLE, CRUSHED STONE SHALL BE
PLACED AS NECESSARY TO ACHIEVE A STABLE BASE.
SEPTIC TANKS INSTALLED IN TRAFFIC AREAS SHALL BE OF EXTRA HEAVY
CONSTRUCTION DESIGNED FOR H-20 WHEEL LOADING.
EXISTING TANKS TO BE REUSED ARE TO BE PUMPED AND VERIFIED THAT ALL
PENETRATIONS AND TANK STRUCTURE ARE WATER TIGHT
ALL JOINTS MUST BE SEALED.
PUMP STATION NOTES
SEAL ALL TANK OPENINGS WATERTIGHT.
PROVIDE AND INSTALL UL LISTED PACKAGED PUMP CONTROL PANEL WITH VISUAL
AND AUDIBLE ALARM. INSTALL CONTROL PANEL INSIDE HOUSE IN ACCESSIBLE
LOCATION.
INSTALL POWER & CONTROL WIRING TO CONTROLLER WITH ALARM IN HOUSE IN
ACCORDANCE WITH NA77ONAL ELECTRIC CODE (N.E.C.) REQUIREMENTS.
SET ALARM LEVEL AS INDICATED.
LIQUID VOLUME BETWEEN "PUMP ON" AND "PUMP OFF" TO BE 8t GALLONS.
PUMP TO BE EJONE DH071-74 GRINDER PUMP.
VERIFY EXISTING ELECTRICAL SERVICE PRIOR TO PURCHASING PUMP.
AN ELECTRICAL INSPECTION BY CERTIFIED ELECTRICAL INSPECTION AGENCY IS
OVERFILL TO ALLOW REQUIRED PRIOR TO START-UP OF PUMP STATION. ELECTRICAL INSPECTION SEAL IS
FOR SETTLEMENT TO BE AFFIXED TO PUMP STATION CONTROL PANEL.
Bull[
6-12"
-4
12" MIN.
'\-314" TO 1-112" WASHED
CRUSHED STONE
ABSORPTION TRENCH SECTION
NTS
Dig Safely.
NewPAYork
1!! Cali Before You Dig
* Wait The Required Time
® confirm Utility Response
* Respect The Marks
® sig With care
800.962-7962
ww Algsefetynewyork.eom
TAX MAP # 308-20-1-9
ALTERATION OF THIS DOCUMENT EXCEPT BY A LICENSED
PROFESSIONAL ENGINEER IS A VIOLATION OF NYS EDUCATION LAW.
Town of Queensbury Building & Code Enforcement
Office No, (518) 761-8256
Septic Inspection Report
Inspection request received:
Name: -4M,SA- 1 G Inspected on: f t
Location: 1.—) +7 6A-€0A-Ki f?S7 Arrive: (1 , 1 a.m.I p.m.
Permit No.: 1 �Zq Inspector's Initials: (
4_.."4" )
/C) "/3<t-17 Comments and/or diagram
Soil Type: Sand I Loam 1 Clay
Type of Water: Municipal I Well Water
Waterline separation distanc- ft.
Well separation distance ft.
1
Other wells: ft.
Well Casing Length 50' /- Y N t/A
[150'to well required if NO
Absorption Field: Total le gth ft.
Length of each trench ft
Depth of trenches .
Size of Stone
Seepage Pits: Number
Size: x
Stone Size:
Piping Size Type
Building to tank
Tank to Distribution Box
Distribution Box to Field I Pit
Opening Sealed: Y_N
End Cap _Y_N
Inlet/Outlet Pipes&Baffles _Y_N
Manholes 12"or less below grade _Y_N
[provide extension collar if Yes] _Y_N
Location 1 Separations
Foundation to tank ft.
Foundation to absorption ft.
Separation of Pits ft.
Conforms as Plet-Plarr----„, N
r Report and As-Built _) Y N
ETU Maintenance Contract provided Y N
Location of System on Property:
Front Re r Left Side Right Side Middle Front Middle Rear
S stem Use Sta s:
Approved
Partial Approved and needs to be re-inspected, please call the Building &Codes Office
Disapproved
Septic Inspection Report
Septic Inspection Report
Office No. (518) 761-8256 Date Inspection request received:
Queensbury Building &Code Enforcement Arrive: am/pm Depart: ,.". = am/pm
742 Bay Rd., Queensbury, NY 12804 Inspector's Initials:C
NAME: ar7--lvl` tom.-%•vim PERMIT N0.: `-�� Z -
LOCATION: /'j ;'- In f"�e4 t �"�►`�{� INSPECT ON: /c /ci I , -a__RECHECK: (
Comments and/or diagram
Soil Type: Sand/ 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 _ 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
End Cap Y N
InletLOutlet 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 absor.tionft.
Separation of Pits ft.
Conforms as per Plot Plan _ Y
ineer'�port rtd As-Built —Y N
ETU Maintenance Contract Y N
provided
Location of System on Property:
Front Rear Left Side Right Side Middle Front Middle Rear
Sy tem Use Status:
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 Repor03 29 10.doc
Septic Inspection Report C
Office No. (518) 761-8256 Date Inspection request received: `—L4'y--
Queensbury Building &Code Enforcement Arrive: am/ m rt• y -"
i4 am/pm
742 Bay Rd., Queensbury, NY 12804 Inspector's Initials:
NAME: tOfl n_' PERMIT NO.:
LOCATION: 13) 2 ;� PCA INSPECT ON:
RECHECK:
Comments and/or diagram
Soil Type: Sand/ Loam / Clay
Type of Water: Municipal/ Well Water I S 0/4'16- iz&74
Waterline separation distance ft.
Well separation distance ft.
Other wells: ft.
Well Casing Length 50' + / - Y N N/A
Absorption Field: Total length _ ft.
Length of each trench ft.
Depth of trenches ft.
Size of Stone
Seepage Pits: Number -
Size: x
Stone Size: 2 \ r►� e4n
Piping Size Type
Building to tank
Tank to Distribution Box
Distribution Box to Field/ Pit ; OL-Y;4\��
Opening Sealed: _Y_N
End Cap Y Nn /
Inlet/Outlet Pipes &Baffles Y— N - -- `'V�`" U4_>,
Location/ Separations
• Foundation to tank ft.
Foundation to absorption ft.
Separation of Pits ft.
Conforms as per Plot Plan Y --
Engineer Report and As-Built Y �
Location of System on Property:
Front Rear Left Side Right Side Middle Front Middle Rear
S s -I Us- . .
Approved
Partial Approved and needs to be re-inspected, please call the Building &Codes Office
Disapproved
Last revised 06/18/07 L:\Building&Codes Forms-OLD\Building&Codes\Inspection Forms\Septic Inspection Report.doc
RX Date/Time 10/02/2012 16:05 518 273 1202 P.002
•45.)- u c f. 2. 2 012�� 4:04 PU v MD[A Watery] . NY J.J.J0 J.J:�J.J•�,�J{J4L.�i•J4J�\ N ;,=,_ •�J P._ 2/2(•;'.'vo.1..ivy
.. MIDDLE DEPARTMENT INSPECTION AGENCY, INC. ` i
o
-,• r . , that the electrical wiring to the electrical equipment listed below has been examined and is approved as •
0�,, 415�
(j being in accord with the National Electrical Code, applicable governmental, utility and Agency rules in effect on the date •iii'
9 noted below and is issued subject to the following conditions. (''r
A) Owner: David Armstrong Date: 09/18/2012 y:�S
<<) Occupant Same Location:Eagan Road li
(`J
(cal Queensbury,Warren Co. NY )
�. Occupancy: Grinder Pump r:'�
0r T .4
t� Applicant:
• David Armstrong _ <.r. �i
C>> 115 W, Mountain Road ,rY..."• f,•,rical •
yVif+'..:... ••4 +1
(e�,) Queensbury, NY 1280,4yv "rt -' '.= •,• ,'r �`
(Cy) a� Y4' �))
<`� L J`
�i) v:-' „'•- -'}' e •
�,
•?,- Joseph A.Holmes. ' ;y:;:-., ,',.;;', :,.::`??• ,".�;.. ,..:k.; f
ley. NO. ," -..i:s" •:...•::!;4?c.•V vy:•;:;:1\. r
3180;141d7.1;,4.7EL��•;;i ;-..:;;. 4w�. I
IQs% ,v):x ,•,,,w�4'• j2"s,`{ .`d;;ti�:f;%a,..1: °.:ii •'T•••• .. `G•1
T'" • ` ;H' 'is Ra ..,;
•
Equipment: 4�}lr` ,. .,r ; :�..•:
t:4 $!1 Pump Grinder: 1 -Control Panel }p' ;•' Fr -:�`-L':�`.."•`- 4.'.,.'
•
(-s' mac.' . ;•,'w�'': ._ l(
``: :•<.�> ori• ,:Y:. •
ria It'r ,:tr:«s. ;t
�
j4;
6 This certificate applies to the electrical wiring to the electrical equipment listed immediately null and void. This certificate applies only to the use.occupancy and y:
(r above and the installation inspected as of the above noted date based on a visual ownership es indicated herein. Upon a change in the use.occupancy or ownership `•
(.0 inspection. No warranty Is expressed or implied as to the mechanical safety.efti- of the property indicated above,this certificate shall be Immediately null and void. `F,•
(F4 ciency or fitness of the equipment for any particular purpose. This certificate shall In the event that this certificate becomes invalid based upon the above conditions, C
be valid for a period of one year from Ma above noted date. Should the electrical this certificate may be revalidated upon retnspectlon Dy Middle Department
t'V system to which this certificate applies be altered in any way,including but not limit- Inspection Agency.Inc. An application for inspection must be submitted to Middle (.)
('4j ed to,the introduction of additional electrical equipment and/or the replacement Of Department Inspection Agency, Inc. to initiate the inspection and revalidation r.(i
g.,, any of the components Installed as of the above noted date,this certificate shell be process. A fee will be charged for this service. /c,.1
rCry :♦:i:'rF:�'�i %i•i::':�i ;:�i;�: �7�Y "`;:�9;?9 �i.�•r;`"`/,•:'%vr/,•`�%;;�9%`:i ':%:::'r;6:r;:�i;:�i •;i::�i::�:; •�' i¢V �:4 5;:;: •n... is.X%; is•r'Tba is \.')
,v S.. ;v v �..•;,. ,� , �. Z. ;FV >�Jr7- r.•,GM.A Y� . , ,. 4.. S. , 5.: Fc-t ,, :t e.<e4t�s
♦✓nom��%✓ ✓�•'! ✓♦✓����-�<♦�.♦�!�:�.v.v4 !.�iG�'i:`!:''i:�:i:�. `.i,`- ` ii is�'C� 3:�✓:��"�`% ✓:✓4`✓:'••:✓i�✓:✓i .J.♦rTG.9i�.�<`J.'i.�:
13 , 14)- 3p