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2013-566 TOWN OF QUEENSBURY F 742 Bay Road,Qucensbury,NY 12804-5902 (518) 761-8201 Community Development - Building & Codes (518) 761-8256 CERTIFICATE OF COMPLIANCE Permit Number: P20130566 Date Issued: Monday, December 16, 2013 This is to certify that work requested to be done as shown by Permit Number P20130566 has been completed. Tax Map Number: 523400-308-014-0001-068-000-0000 Location: 29 TRIPHAMMER Rd Owner: PHILIP & SANDRA JARROSIAK Applicant: PHILIP & SANDRA JARROSIAK 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 4 property owner of the responsibility for compliance with Site Plan, ,L)j Variance, or other issues and conditions as a result of approvals by the Director of Building& Code nfor 4 cnt Planning Board or Zoning Board of Appeals. 1 ow; TOWN OF QUEENSBURY 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201 Community Development-Building& Codes (518) 761-8256 BUILDING PERMIT Permit Number: P20130566 Application Number: A20130566 Tax Map No: 523400-308-014-0001-068-000-0000 Permission is hereby granted to: PHILIP& SANDRA JARROSIAK For property located at: 29 TRIPHAMMER 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: PHILIP& SANDRA JARROSIAK Septic Alteration Residential 29 TRIPHAMMER Rd Total Value QUEENSBURY,NY 12804 Contractor or Builder's Name/Address Electrical Inspection Agency SANITARY SEWER GEORGE DRELLOS 792-7257 PO BOX 224 GLENS FALLS NY Plans&Specifications 2013-566 Res. Septic Alteration $40.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Wednesday,December 10,2014 (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 nsbu A Tu_ a/ D• .•mber 10,2013 SIGNED BY t for the Town of Queensbury. Director of Building&Code Enforcement { CommunityDevelopment Office ��:`<-_=:-:., p _ Town of Queensbury • 742 Bay Road • Queensbury, New York •12804 ULT' U 201 3 Office Use Only pp TAX MAP NO. 30� ,`y -�-to c� PERMIT NO. /3 — S(OLD PERMIT FEE 4/0 417 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: Q.kik k Ll JGt ('r 0-c INSTALLER: Q�/a"�1 7f ,Jv'�A _fe/',r�i ADDRESS: .7C / r 1 vAO h• M . ' e/ r�' ADDRESS: ° �` z " PHONE NOS. 3-1f 7/ " Z F-2 u PHONE NOS. - 7 -72`f 7 LOCATION OF INSTALLATION: F('42`."'1 y RESIDENCE INFORMATION: YEAR BUILT NO.OF X COMPUTATION = TOTAL DAILY FLOW BEDROOMS (Gallons per bedroom) GARBAGE GRINDER 1980 or older X 150 = INSTALLED? /k 1981 -1991 X 130 = SPA OR HOT TUEt„f 1992-present Y X 110 = yyp INSTALLED? PARCEL INFORMATION: ✓ TOPOGRAPHY: FLAT ROLLING x STEEP SLOPE %SLOPE ✓ SOIL NATURE: SAND ).2 LOAM CLAY OTHER ✓ GROUNDWATER: AT WHAT DEPTH? /1'4 ✓ BEDROCK/IMPERVIOUS MATERIAL: AT WHAT DEPTH? /✓/j- ✓ DOMESTIC WATER SUPLY: MUNICIPAL> WELL (If well:water supply from any septic system absorption is: ft) ✓ PERCOLATION TEST: RATE IS / f 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:/ 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 Bed or other type? 020 >C. Z S' o 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 regulations with respect to this application and agree to abide b + --e and all requirem-nts of the Town of Queensbury QUESTIONS? CALL 761-8256 OR EMAIL Sanit- a po . codesf@queensburv.net ( codes queensbury.net v D• _ L -/ o-r3 Signa ure of Person Responsible Date VISIT OUR WEBSITE FOR MORE INFORMATION ovww.queensbury.net Town of Queensbury Building & Code Enforcement hWiklea \11,3o Office No. (518) 761-8256 Septic Inspection Report Inspection request received: Name: 1_,..1C tt DC7: k6L1S O Inspected on: _ — - i vi Location: C l ‘ � .� �' Arrive: IP' Ar p.m. e Permit No.: /3 - 66or!o Inspector's Initials: Comments and/or diagram Soil Type S�!Clay Type of Water. Munic. lA_Lell Water Waterline separation distance \2--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 ()f5 ft. Length of each trench eft. 1i9 \--c c ' L-- '‘-i'`,)eQ-V---- Depth of trenches Z ft. Size of Stone — _ Seepage Pits: Number Size: x Stone Size: Piping Size Type Building to tank Tank to Distribution Box LV"h ---. 5---- Distribution Distribution Box to Field/Pitv- Vi?----- S-ta4 �-z� "fib ' tA� savT_ Opening Sealed: i�Y_V End Cap _Y/_✓N \ 3"V' L_DID ;-7 Inlet/Outlet Pipes&Baffles t/Y N Manholes 12"or less below grade t [provide extension collar if Yes] _Y_N Location/Separations Foundation to tank ...-",14,61—ft. • Foundation to absorption 'L""j ft. Separation of Pits ft. Conforms as per Plot Plan Y_N Engineer Report and As-Built _Y N ETU Maintenance Contract provided _Y_N Location f-System on Property: - Front R— r Left Side ,. Right Sid . the Front Middle Rear System Use St us: V Approved Partial Approved and needs to be re-inspected, please call the Building&Codes Office Disapproved Septic Inspection Report 6 1° 1 3_ 5-e, (� PEPTIC PLOT PLAN / I HAVE SEEN OR OBSERVED ALL OBJECTS SUCH AS HOUSES, WELLS, TREES, FENCES, ETC , SHOWN ON THIS DOCUMENT.I HAVE PERSONALLY f �f e / MEAS,HE .T SET FO N THIS DIAGRAM. Yr/ /� ..Hr /L—w-i3 / illy SIG. !:T RE DATE i LEO 1 0 2013 - '1/, y_ao fc 1 r \ �� �, i `'1 z s S ae: 1� a s V iL 0 tz 7 )r / /2//I-M M e_ r" CENTER PROJECT SERVICES °13 U�v J 73 Sheridan Street, Glens Falls, NY 12801 Phone-518-796-2515 December 10, 2013 1 �3J�(Q44 Project# 178 George Drellos Sanitary Sewer Services Luzerne Road Queensbury,NY 12804 Re: Proposed Replacement Septic Jarrosiak Residence—29 Triphammer Road, Queensbury,NY Dear George: At your request we have reviewed your proposed replacement septic system design of the existing 4 bedroom house at 29 Triphammer Road 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 and that the owner has agreed to remove the tree in the area of the proposed replacement system. Based upon a design flow rate of 440 GPD and a percolation rate of 1 to 5 minutes, you will need 463 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, 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, Cwt, Thomas R. Center Jr, P.E. Septic Inspection Report Office No. (518) 761-8256 Date Ins ion �y- :ce' -r: Queensbury Building &Code Enforcement Arrive: Iv % s'' . i part: 742 Bay Rd., Queensbury, NY 12804 Ins ...•`�pector's Initials: /' NAME: t I S2 )t \A ")AF�f�J• • • ff NO.: . I---1\.;c)1 t�l� LOCATION: a - K) • PECT ON: \?(c)—13 RECHECK: 798 --aqz‘ Comments and/or diagram Soil Type: Sand/ Loam/ Clay Type of Water: Municipal/ Well Water \ Waterline separation distance ft. ! E '–c\ c_ '5 `� b-N- V\ Well separation distance ft. Other wells: ft. Well Casing Length 50' + / - Y N N/A \ . L�10\) 1� ' \ C-01 1 [150'to well required if NO] Absorption Field: Total length ft. v-c\. c9 S\ol3E 'N--7 Length of each trench ft. Depth of trenches ft. LE A V\ \_ O -- E \ -t Size of Stone Seepage Pits: Number (3.6� --i •ii Size: x Stone Size: Piping Size Tyke 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 Rear Left Side Right Side Middle Front Middle Rear System Use Status: pproved 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