2009-141 TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development- Building&Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20090141 Application Number. A20090141
Tax Map No: 523400-302-017-0002-015-000-0000
Permission is hereby granted to: PHILIP & KAREN CAMP
For property located at: 16 ARBUTUS Dr
in the Town of Queensbury,to construct or place
at the above location in accordance with application together with plot plans and other infonnation hereto filed
and approved and in compliance with the NYS Uniform Building Codes and the QueensburyZoning
Ordinance. Type of Construction Value
Owner Address: PHILIP &KAREN CAMP
16 ARBUTUS Dr Septic Alteration Residential
QUEENSBURY,NY 12804 Total value
Contractor or Builder's Name/Address Electrical Inspection Agency
Plans &Specifications
2009-141
septic alteration residential
$25.00 PERMIT FEE PAID- THIS PERMIT EXPIRES: Saturday,April 24, 2010
(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 TF1 of,19uee fury April 24, 2009
SIGNED BY �' for the Town of Queensbury.
Director of Building&Code Enforcement
TOVN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development- Building &Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Pernut Number. P20090141 Date Issued: Thursday, August 26, 2010
This is to certify that work requested to be done as shown by Permit Number P20090141
has been completed.
Tax Map Number. 523400-302-017-0002-015-000-0000
Location: 16 ARBUTUS Dr
Owner. PHILIP & KAREN CAMP
Applicant: PHILIP & KAREN CAMP
This structure maybe occupied as a:
Septic Alteration Residential
By Ogler 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, f
Variance, or other issues and conditions as a result of approvals by the
Direc ing Co nfo ment
Planning Board or Zoning Board of Appeals.
OFFICE USE ONLY n
TAX MAP txv
N0. PERMIT NO. PERMIT FEE '
APR 2 2009
APPROVALS: ZONING TOWN CLERK 1
11 0
APPLICATION FOR SEPTIC DISPOSAL SYSTEM PE utL°1 cooEs
_ RM
A PERMIT MUST BE OBTAINED BEFORE WORK BEGINS.APPLICATION IS SUBJECT TO REVIEW BEFORE ISSUANCE OF A VALID
PERMIT.
OWNER: f,!� '�i 1 ! C 4 /1 INSTALLER:
ADDRESS: / �` ( G IUD Cc'
ADDRESS:
PHONE NOS. PHONE NOS. � /S S
LOCATION OF INSTALLATION:
YEAR BUILT NO.OF OMPUTATION= RESIDENCE INFORMATION:
X C
BEDROOMS = TOTAL DAILY FLOW
1980 or older ''' X 150 gallon per bedroom = / GARBAGE GRINDER
1981 -1991 INSTALLED?
X 130 gallon per bedroom =
1992-present X 110 gallon per bedroom = SPA HOT TUB
INSTALLED?
PARCEL INFORMATION:
✓ TOPOGRAPHY: Flat rolling Steep
slope_ %Slope
✓ SOIL NATURE: Sand
___)�___ Loam Clay Other
✓ GROUNDWATER: At what depth?
✓ BEDROCK"MPERVIOUS MATERIAL: At what depth?
✓ DOMESTIC WATER SUPLY: Municipal-_ Well
(If well: Water supply from any septic
system absorption is ft.)
minutes✓ PERCOLATION TEST: Rate is
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 profsional engineer or architect(unless installed in a Planning Board approved subdivision).
TANK SIZP � ��G
,f � ALLON (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
;XALTERNATIVE'SYSTEM
AGE PIS) (WITH NO. 3 STONE) How many? Size?
Bed or other type? E
❑ 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 the regulations with respect to this application and
agree to abide by these and all requirements of the Town of QUESTIONS? CALL 761-8256 OR EMAIL
Queensbury Sanitary Sewage Disposal Ordinance. codes pueensbury net
VISIT OUR WEBSITE FOR MORE INFORMATION
www.queensbury.net
Sigt�atur of erson Responsible Date
° a Town of Queensbury • Community Development Office • 742 Bay Road, Queensbury, NY 12804
B 5-LGL 6/06
{ _ _a= 30
Septic Inspection Report
Office No. (518) 761-8256 Date Ins ction r t ec ed:
Queensbury Building &Code Enforcement Arrive: a '"
742 Bay Rd., Queensbury, NY 12804 Inspector's Initials:
NAME: �� P NO.:
LOCATION: �IIM) O t E INSPECT ON:
RECHECK:
Comments and/or diagram
Soil Ty Clay
Type of Water: nisi ell Water
Wate ' ration distance ft.
Well separation distance ft.
Other wells: ft.
Well Casing Length 50' + / - Y N N/A
Absorption Field: Total length Z- ft.
Length of each trench = ft. ��► ot= +_cc�'Etj ��
Depth of trenches 'Z ft. ��► �E � 6
Size of Stone
Seepage Pits: Number
Size: x
Stone Size:
Piping Size Type
Building to tank 41,
Tank to Distribution Box 14 0 ,
Distribution Box to Field/ Pit 41A
Opening Sealed: N
End Cap N
Inlet/Outlet Pipes&Baffles Y N
Location Separations �f
Foundation to tank 1 .
Foundation to absorption ft. \-\V-V
Separation of Pits ft.
Conforms as per Plot Plan Y_N V
Engineer Report and As-Built _Y_N
Location of System on Prope
rant Rear Left Middle Front Mi a Rear
e s:
roved
petted, please call the Building &Codes Office
iEp v
Last revised 06/18/07 L:\Building&Codes Forms-OLD\Building&Codes\Inspection Forms\Septic Inspection Report.doc
t
l
;.'' ved, or believe I saw evidence of,
1 J ;'OUSes, Wells, trees, fences, etc.,
jM'; s document. I aisc represent that I have
<.; dy m asared the distances set f^rth on the diagrarn.." 4
_._(. S GNATURE DATE
` rvr 07-
IZO
NACE ENGINEERING, P.C.
169 Haviland Road, Queensbury, NY 12804
Phone-518-745-4400 Fax -518-792-8511
April 22, 2009
Project#49288
Mr. Jay Sweet
Queensbury Septic
Queensbury,NY 12804
Re: Percolation Test
Camp Residence— 16 Arbutus Drive, Queensbury,NY
Dear Jay:
At your request we have reviewed your proposed replacement septic system design at the site of
the existing 3 bedroom house of Phil Camp at 16 Arbutus in Queensbury. As per our
conversation the residence has an existing failed septic systems.
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 348 square feet of absorptive area. We recommend using a 15 ft
wide by 25 ft long absorption bed with 3 — 20 foot long laterals, which will provide 375 sf of
absorptive area. The absorption bed should be constructed with a new distribution box, 4 inch
diameter perforated pipe and stone.
Please call me if you have any questions.
Sincerely,
11
Thomas R. Center Jr., PE
Cc: Dave Hatin, Town of Queensbury