2012-565 TOWN OFQ UEENSBURY
742 BayRoad,Queensbury,NY 12804-5902 (518) 761-8201
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Community Development - Building & Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: P20120565 Date Issued: Monday, December 10, 2012
This is to certify that work requested to be done as shown by Permit Number P20120565
has been completed.
Tax Map Number: 523400-301-012-0002-058-000-0000
Location: 4 HEINRICK Cir
Owner: ROBERT & KIM GRUGLE
Applicant: ROBERT & KIM GRUGLE
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
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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
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development-Building&Codes (518)761-8256
BUILDING PERMIT
Permit Number: P20120565 Application Number: A20120565
Tax Map No: 523400-301-012-0002-058-000-0000
Permission is hereby granted to: ROBERT&KIM GRUGLE
For property located at: 4 HEINRICK Cir
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: ROBERT& KIM GRUGLE
Septic Alteration Residential
4 HEINRICK Cir
QUEENSBURY,NY 12804-0000 Total value
Contractor or Builders Name/Address Electrical Inspection Agency
SANITARY SEWER
GEORGE DRELLOS 792-7257
PO BOX 224
GLENS FALLS NY
Plans&Specifications
2012-565
Res. Septic Alteration
$40.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Saturday,November 30,2013
(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 Queensbury; Friday,November 30,2012
SIGNED BY for the Town of Queensbury.
Director of Building&Code Enforcement
�� NTh'Community Development Office 2 9 2012
q-4 `, Town of Queensbury • 742 Bay Road • Queensbury, New York •12804
Office Use Only c.M.,
TAX MAP NO.2OL_IK_ "S b PERMIT NO._L �*---J105 PERMIT FEE_!__a_
APPROVALS: ZONING ____ _
____ ___ TOWN CLERK_______
APPLICATION FOR SEPTIC DISPOSAL SYSTE ERMIT: A PERMIT MUST BE OBTAINED
BEFORERFS BEGINS./APPPLICATION IS SUBJECT TO REVIE B FORE ISSUA E OF ASV D PERMIT.
OWNER: �(,/, INSTALLER 11E_C11 - _ .Gi/'E� rV ems'_Vl c.-e_
ADDRESS: __ _et /g1j2 242Gt✓L ADDRESS:_ 0 —2 9 ' 2. C F
PHONE NOS. 7(4:5 ,' 73 _ PHONE NOS. 796.1 - e .5-0
LOCATION OF INSTALLATION:iE./girl? _Cfhc,4--L
RESIDENCE INFORMATION:
YEAR BUILT NO.OF X COMPUTATION = TOTAL DAILY FLOW
BEDROOMS (Gallons per bedroom) GARBAGE GRI
1980 or older K X 150 = 5--'61 INSTALLED?
1981 -1991 X 130
SPA OR HOT TUB c,,
1992-present X 110 = INSTALLED?____ILIV
PARCEL INFORMATION:
✓ TOPOGRAPHY: FLAT ROLLING STEEP SLOPE %SLOPE
/o
/ SOIL NATURE: SAND LOAMCLAY OTHER_____
✓ GROUNDWATER: AT WHAT DEPTH?
✓ BEDROCK/IMPERVIOUS MATERIAL: AT WHAT DEPTH?
✓ DOMESTIC WATER SUPLY: MUNICIPAL_ ELL (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:(Qa __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 e or other type? a `_, _c)
❑ HOLDING TANK SYSTE� tal 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 eg. -tions with respe t to this application and agree to
____af id- z., these a�• . •quiremen �. the Town of ueen ury QUESTIONS? CALL 761-8256 OR EMAIL
Sewa.: D.po�:lOrdi �e. 2 codes(a�queensburv.net
I r" ` �� VISIT OUR WEBSITE FOR MORE INFORMATION
'• !net re o Pers. esponsible Date www.queensburv.net
h,rs cl,, 1--3 Cip ,)
Septic Inspection Re•ort
Office No. (518) 761-8256 Date Inspection equest-r-c: -•: f
/pmt
Queensbury Building &Code Enforcement Arrive: y--
- _• ia •-••rt: ,"- i r- a
742 Bay Rd., Queensbury, NY 12804 Inspector's Initial. A T
/
NAME: ()-1-1L4 9‘ ERMIT NO.: / s."3-(95
LOCATION: `/ -/J-Pr n('i C C t`r INSPECT ON: \7.- l Z_-
RECHECK:
----N Comments and/or diagram
Soil Ty a----S am/ Clay
Type of Wat : Mum! ell 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 °Vi ft.
Length of each trench 4 ft. N( \QbTRILNC.-),7
Depth of trenches _ '77 _IA.ft. • 7(
Size of Stone -
Seep Pits:<Number
Size: -2.-0.' x .ti LE_; .\ : ,
Stone Size:
Piping Size Type
Building to tank /2Ci-I Liz__
Tank to Distribution Box �. I h`�-��' j
1
Distribution Box to Field/ Pit `' ', D �� IL S ^-}
Opening Sealed: N `cC2-F
End Cap _ _ N
Inlet/Outlet Pipes&Baffles .N �
Manholes 12"or less below grade • _ N
[provide extension collar if Yes] _• _ N
Location / Separations
Foundation to tank TL ft.
Foundation to absorption _ ,(v ft. 1-1--
Separation
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 Re. - : ide `Right Side j ' die 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 Report 03 29 10.doc
SEPTIC PLOT PLAN
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SU HAS • 4ES,WELL*, REES, FENCES, ETC
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Community Development Office
..� i�,e Town of Queensbury•742 Bay Road • Queensbury, New York•12804
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BUILDING 8c OE _._ . r.
Reviewed By.
CENTER PROJECT
SERVICES
73 Sheridan Street,Glens Falls,NY 12801
Phone-518-796-2515
November 28,2012
Project# 166
Dan Drellos
Sanitary Sewer Services
Luzerne Road
Queensbury,NY 12804
Re: Proposed Replacement Septic
NOV 2 9 2012
Grugle Residence—4 Heinrick Circle, Queensbury, NY
Dear Dan:
At your request we have reviewed your proposed replacement septic system design at the site of
the existing 3 bedroom house of at 4 Heinrick Circle 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 450 GPD and a percolation rate of
1 to 5 minutes, you will need 500 square feet of absorptive area. We recommend using a 20 ft
wide by 25 ft long absorption bed with 4 — 20 foot long laterals, which will provide 500 sf of
absorptive area.The absorption bed can be constructed with the existing 1,000 gallon septic tank,
new distribution box, 4 inch diameter perforated pipe and stone and a 4"diameter vent due to the
depth of the existing septic tank.
Please feel free to contact me at 796-2515 if you have any questions and that you for your
assistance with this request.
Sincerely.
Thomas R. Center Jr, P.E.