2014-605 TOWN OF QUEENSBURY
FOS
742 Bay Road,Queensbury,NY 12804-5902 (518) 761-8201
Community Development - Building & Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: P20140605 Date Issued: Wednesday, December 03, 2014
This is to certify that work requested to be done as shown by Permit Number P20140605
has been completed.
Tax Map Number: 523400-309-009-0001-067-000-0000
Location: 72 INDIANA Ave
Owner: RAE E. CLARICE
Applicant: RAE E. CLARKE
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, Y�
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.
at TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development-Building& Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20140605 Application Number: A20140605
Tax Map No: 523400-309-009-0001-067-000-0000
Permission is hereby granted to: RAE E. CLARKE
For property located at: 72 INDIANA Ave
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: RAE E. CLARKS
Septic Alteration Residential
PO BOX 523
GLENS FALLS,NY 12801 Total Value
Contractor or Builders Name /Address Electrical Inspection Agency
SANITARY SEWER
GEORGE DRELLOS 792-7257
PO BOX 224
GLENS FALLS NY
Plans&Specifications
2014-605
Res. Septic Alteration
$40.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Friday,November 20,2015
(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 o uee bury; ihunsda November 20,2014
SIGNED BY for the Town of Queensbury.
Director of Building&Code Enforcement
}
r. Office Use Only .
Town of Queensbury Building & Codes
Received: brA4 u 2A I
SEPTIC DISPOSAL PERMIT Tex Map ID r 3 0 S:( -cO 7
A permit must be obtained before beginning construction Perna Fes. $ /47'1001`�
fle //J//� APtaovakpApplicant f iarA- IcelaileriBuiider `1;911-• Je -rc Liv.cYAddress: 4v14/,,, /sty- x2-ve Address M. k air
eensB A.,- /zea/ ( eP1.1 64 lb Ar /Lea el
Phone: Phone 791 - 711-7
Owner. c14-./`c- Location of histaliafion 7z- Avdp. /f re
Address:
Phone
Contact Person for Building&Code Compliance: t ? rj e b e— " Day Phone: 776."57‘
Residence Information: c�
Year Built #of Bedrooms x Gallons per bedroom =Total Daily Flow
1980 or older x 150 = Garbage Grinder installed? ihi0
1981-1991 x 130 = Spa or Hot Tub Installed? No
1992-Present 3 x 110 = 330
Parcel Information:
Topography x-Fatng _Steep Slope _'%Slope
Soil Nature y RoffiSand _Loam _Clay _Other
Groundwater - Atwhatdepth? A/14
BedmddimpeMous Material At what depth? Ni'
Domestic Water Supply be-Municipal _Well(dwell,water supply from any septic system absorption is ft.)
Percolation Test Rate-�per minute per inch(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(mhitmum size 1,000 gallons),add 250 gallons to size of septic tank for each garbage grinder,spa or whirlpool tub
System Type: Absorption Field(wilh#2 stone) Total length ft Each trench ZS' x g3
Seepage Pi S)(with#3 stone) How may? Size?
ahue.5} to Bed or other type? i %e 30 '
Holding Tank System Total required capacity? Tank size? #of tanks?
NOTE: 1)Alarm system and associated electrical work must be Inspected by a Town approved electrical inspection agency Certified Electrical form
an Town websle; 2) Effective as of March 23, 2006 Septic System-As Built Plot PID: The Building Department will no longer allow systems to be
covered until such Imre as an As-Built Plot Plan is received and approved by the Building Inspector. The installed system must match the septic system
layout on file. Them will be no exceptions.
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.
it have read the regulations with respect to this application and agree to abide by these and all requirements of the Town of Oueensbury Sanitary
Sewage Disposal Ordinance.
Print Name: 62oyr' r Dabs: //le //
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i
Signature: - le- Date: // ZO -/ '
Town of Queensbury Buadmg&Codes Septic Disposal Permit 518-761-PQ58
Town of Queensbury Building & Code Enforcement "6,t&.. I t !c30
Office No. (518) 761-8256
Septic Inspection Report
Inspection request received:()art(
Name: (/�Q{r(e Inspected on: /
Location: 1 /1Atoi - a -No a Arrive: al"
..m.
Permit No.: / y -(pp J Inspector'stnitials: 1/
Comments and/or diagram
Soil Type(an. gam/Clay
Type of Water Iwnici.. ' - ater FQa v j ` P R➢
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 rib ft.
Length of each trench aft. C r, f- t�bYEC to'
Depth of trenches 'Z ft
Size of Stone 7
Seepage Pits: Number
Size. x
Stone Size:
Piping Size Type
Building to tank &M IAD
Tank to Distribution Box L,,t, A OR tR
Distribution Box to Field/Pit 11),)0 Q 25 TFL 4"t b0R -- V��@
Opening Sealed:
End Cap ✓Y N •
Inlet/Outlet Pipes&Baffles , N
Manholes 12"or less below grade —lye
[provide extension collar if Yes] Y N
Location/Separations
Foundation to lank 113 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 provided Y N
Location of S stem ot • ..en .Fron Rea_ eft Side •ight Side Middle Front Middle Rear
S stem Use St us:
Approved
Partial Approved and needs to be re-inspected, please call the Building&Codes Office
Disapproved
Septic Inspection Report
P
SEPTIC PLOT PLAN
a l i --10o� I HAVE SEEN OR OBSERVED ALL OBJECTS
SUCH AS HOUSES, WELLS, TREES, FENCES, ETC
SHOWN ON THIS DOCUMENT.I HAVE PERSONALLY
�// MEA.SlJi2EDTHEDISIANC ET T ON THIS DIAGRAM.
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SIGNA'T'URE DATE
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CENTER PROJECT
SERVICES
73 Sheridan Street, Glens Falls,NY 12801
Phone-518-796-2515
November 19, 2014
Project# 205
George Drellos
Sanitary Sewer Services
Luzeme Road
Queensbury,NY 12804
Re: Proposed Replacement Septic
Rae Clarke—72 Indiana Avenue, Queensbury,NY
Dear George:
At your request we have reviewed your proposed replacement septic system design of the
existing 2 bedroom house at 72 Indiana Avenue in Queensbury. As per our conversation the
residence has an existing failed septic system and will be adding and additional bedroom to the
residence.
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 330 GPD and a percolation rate of
1 to 5 minutes, you will need a minimum of 367 sf of absorption area. We recommend using 15
ft wide by 30 ft long absorption bed with 3 - 25 ft long laterals. The absorption system can be
constructed with a new 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,
Thomas R. Center Jr, P.E.