SEP-0800-2018
TOWN OF QUEENSBURY
742 Bay Road, Queensbury, NY 12804-5904 (518) 761-8201
Community Development - Building & Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: SEP-0800-2018Date Issued: Monday, December 31, 2018
This is to certify that work requested to be done as shown by Permit Number
SEP-0800-2018
has been completed.
301.12-1-13
Tax Map Number:
6 HELEN DR
Location:
Glen Anderson
Owner:
Drew Stevens
Applicant:
This structure may be occupied as a: Residential Septic Alteration
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
Director of Building & Code Enforcement
Planning Board or Zoning Board of Appeals.
TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5904 (518)761-8201
Community Development- Building& Codes (518) 761-8256
BUILDING PERMIT
Permit Number: SEP-0800-2018
Tax Map No: 301.12-1-13
Permission is hereby granted to: Glen Anderson
For property located at: 6 HELEN DR
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
Owner Name: Glen Anderson Septic Disposal-Residential $0.00
Owner Address: 6 Helen DR Total Value $0.00
Queensbury,NY 12804
Contractor or Builder's Name/Address Electrical Inspection Agency
Plans&Specifications
Residential Septic Alteration
$ 75.00 PERMIT FEE PAID -THIS PERMIT EXPIRES: Thursday,December 26, 2019
(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; Wednesday,December 26, 2018
SIGNED BY: 2)a04 for the Town of Queensbury.
Director of Building&Code Enforcement
fitSEPTIC DISPOSAL PERMIT AP ATION Office Use Only
742 Bay Road,Queensbury, NY 12804 �i /y� �o �/
rok7i of Quccnsbun P:518 7fi1 8256 www. ueensbur .n t D Permit#:i i `:i �_ 0 G' , 0
Tax Map ID#: 70 l 2-- ( 3 I DEC 19 :liit'F e fs'-b .U0; Invoice#: 1 13 7
Project Location: //E� wee (1 U a N OF ticvariance2
Cl7 Yes No
Owner(s) 6 '7J 25�, B 'WING&t;OD :
Primary �� I-�------�...,�ou-
Mailing Address 6 kictrAi
-DiZ\Ve
Phone & Email 5) 3.220 ggCJ 2
Installer/Builder Ls(C .c,ccaek „)
Mailing Address
Phone & Email
Engineer
Mailing Address
Phone & Email Contact Person for Building&Code Compliance: C/2.2 A 1 r3 d._ Phone: 3 3 F- 9Y5
RESIDENCE INFORMATION:
Year Built Gallons #of bedrooms X gallons per =total daily flow
per day bedroom Garbage Grinder Yes
1980 or older 150 / 6>o e Installed? (circle one) _
1981 1991 130 Spa or Hot Tub Yes c
Installed? (circle one)
1992-Present 110
PARCEL INFORMATION:
Topography X Flat Rolling Steep Slope %Slope
Soil Nature )( Sand Loam Clay Other
Groundwater At what depth? A/q
Bedrock/Impervious material At what depth? /OA
Domestic Water Supply Municipal _Well (if well, water supply from any septic system absorption is ft.)
Percolation Test Rate: per minute per inch (test to be completed by licensed engineer/architect)
PROPOSED SYSTEM FOR NEW CONSTRUCTION:
Tank size •Srya)l'igillons (min. size 1,000 gallons, add 250 gallons for each garbage cylinder or spa/hot tub
System Absorption field with #2 stone Total length ft.; Each Trench ft.
Seepage Pit with #3 stone How many: 'Z ; Size: )(0
Alternative System Bed or other type:
Holding Tank System Total required capacity? ; tank size ; #of tanks
NOTES: 1.Alarm system & associated electrical work must be inspected by a Town approved electrical inspection
agency; 2. We will no longer allow systems to be covered until such time as an as-built plan is received and approved.
The installed system must match the septic layout on file—no exceptions.
Declaration: Any permit or approval granted which is based upon or is granted in reliance upon any material
representation or failure to make a material fact or circumstance known by or on behalf of an applicant, shall be void. I
have read the regulations and agree to abide by these and all requirements of the Town of Queensbury Sanitary Sewage
Disposal Ordinance.
PRINT NAME ) P 6/.k.s / QbtJ DATE: Z / I
SIGNATURE DATE: I2//0(3
Town of Queensbury Building&Code Enforcement Revised March 2018
INSPECTION WORKSHEET (SEP-009053-2018)
Town of Queensbury - Building and Codes - Fire Marshal
742 Bay Road - (518) 761-8256 Building (518) 761-8206 Fire Marshal
SEP-0800-2018Permit
Case Number:Case Module:
Fri Dec 28, 2018Passed
Inspection Date:Inspection Status:
John O'BrienSeptic
Inspector:Inspection Type:
6 HELEN DR301.12-1-13
Job Address:Parcel Number:
Queensbury, NY 12804
Contact TypeCompany NameName
Primary OwnerAnderson, Glen
ContractorGalusha & Sons LLCGalusha, Dan
ApplicantStevens, Drew
Granted PermissionAnderson, Glen
Checklist ItemPassedComments
Building Inspector NotesYESOk to issue permit
12/28/18 Septic System Approved
Type of Water: Municipal / Well WaterYESMunicipal
Waterline separation distanceYES10' from each pit
Seepage Pits: NumberYES2
Size:YES8'x10'
Stone Size:YES#3
Building to TankYESExisting 4" sch40 pvc
Dec 28, 2018Page (1)
INSPECTION WORKSHEET (SEP-009053-2018)
Checklist ItemPassedComments
Tank to Distribution BoxYES4" pvc
Distribution box to Field / PitYES4" pvc to each pit
Foundation to AbsorptionYES22'
Separation of PitsYES24'
Location of system on propertyYESMiddle Front
System Use StatusYES12/28/18 Septic System Approved
O'Brien, John (Inspector)
Dec 28, 2018Page (2)
PALLETTE STONE CORP.
Precast Product Division 1 373 Washington Street, Saratoga Springs, New York 12866
Phone: (518) 584-5891 1 Fax (518) 584-2622 1 www.dacollins.com
8'-0" O.D. DRYWELL
NOTES:
CONCRETE: 4000 PSI U
REINFORCEMENT: GR 60 STANDARD 22"O u_
ENTRAINED AIR: 5.0% - 9.0% CONCENTRIC PLUG OTHER U <
IX
AASHTO H-20 LL SIZES/ORIENTATIONS 1
AVAILABLE - / H z0
THICKNESSES: Z
WALLS - 4" 1--1 00 zo
ROOF SLAB - 8" H2O LL
ROOF SLAB - 6" NON-TRAFFIC (300 PSF)
A
i
WEIGHTS: c==1O O A
4' HIGH BARREL SECTION - 4800 LB
2' HIGH BARREL SECTION - 2400 LB ( i o c
TRAFFIC TOP - 5050 LB I) ® ® ® � q
0
-
NON-TRAFFIC TOP - 3800 LB
1" x 6" TAPERED HOLES (91)
PER 4' SECTION I: ] II ® V
k--, „._______11 11
0
O R ® 4"
® —�
0 0 0 0 0 a
' 0 0 0 0 0 0 0 0
14"0 x 3"0 TAPERED HOLES ' 0 0 0 0 0 0 0 '
(185) PER 4' SECTION O O O J
(74) PER 2 SECTION I �0 0 0° 0 @° ®° °� °0 ® 0� I b Q Q
IO�O ® 00000 ® 001 0 <
® 0 000 C) ® ° I a
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ELEVATION
PALLETTE STONE CORP.
Precast Product Division 1 373 Washington Street, Saratoga Springs, New York 12866
Phone: (518) 584-589I 1 Fax (518) 584-2622 1 www.dacollins.com
6 HOLE DISTRIBUTION BOX
CONCRETE: 4000 PSI PLASTIC KNOCKOUT PIPE SEALS
MESH REIN.: ASTM A185 GR65 TYPICAL AT INLET AND OUTLETS
NON-TRAFFIC LOADING
2' MAX EARTH COVER (6) SPEED LEVELERS INCLUDED
1 1/2" ROOF THICKNESS
1 1/2" WALL THICKNESS
1 1/2" FLOOR THICKNESS
BOTTOM SECTION - ±100LBS
TOP SECTION - 35LBS
OUTLET
(6) TYP.
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g
INLET
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T L —L17 — <>
11-10"
PLAN VIEW
`21(`' INLET �I �
ao I O 011 OUTLETS
_
SIDE ELEVATION