2005-422 TOWN OF QUEENSBURY
Fir* 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development - Building & Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: P20050422 Date Issued: Wednesday, October 19, 2005
This is to certify that work requested to be done as shown by Permit Number P20050422
has been completed.
Tax Map Number: 523400-289-013-0001-054-000-0000
Location: 10 BENMOST BUR Ln
Owner: ROBERT & ANNA CLARK
Applicant: ROBERT & ANNA CLARK
This structure may be occupied as a:
Septic Alteration Residential
By Order of Town Board
TOWN OF QUEENSBURY
l
Issuance of this Certificate of Compliance DOES NOT relieve the t
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: P20050422 Application Number: A20050422
Tax Map No: 523400-289-013-0001-054-000-0000
Permission is hereby granted to: ROBERT & ANNA CLARK
For property located at: 10 BENMOST BUR Ln
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 & ANNA CLARK
10 BENMOST BUR Ln Septic Alteration Residential
Total Value
LAKE GEORGE, NY 12845
Contractor or Builder's Name /Address Electrical Inspection Agency
OITEENSBITRY SEWER
JAY SWEET
Plans&Specifications
2005-422
SEPTIC ALTERATION
$25.00 PERMIT FEE PAID -THIS PERMIT EXPIRES: Wednesday, June 14, 2006
(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 of Que sbury; T esday, June 14, 2005
SIGNED BY for the Town of Queensbury.
Director of Buildi g&C e Enforcement
o'er'- I j - / — =�`f
Application for Permit- Septic Disposal System
Town of Queensbury 742 Bay Road Queensbury, NY 12804 (518) 761-8256
1. OWNER INFORMATION:
Office Use
Location of installation: / 0 --e /? YY\CST gce r c
File Permit No. tW- £�
Tax Map No.
/ Fee Paid c25
Owner's Nan:PO ter r C ' a /-
Address: / d .c/ /71 O.ST Bit r 1/6 -
NAME : Sec,? -/ PHONE NO.? ` �26/
2. INSTALLER'S AM -r+..�S +�
3. RESIDENCE INFORMATION: (circle year of dwelling, indicate#bedroom(s) and multiply #of
bedrooms with applicable gallons per bedroom to equal total daily flow)
Year of House: No. of Bedrooms x Computation = Total Daily Flow
� x 150 gal/bdrm = L�"s1v
1980- 1991 x 130 gal/bdrm = om?, f �/��
1991 -present x 110 gal/bdrm = T d D
JUN
Garbage Grinder Installed yes / no 0
Spa or Hot Tub Installed yes / no
T r � lUS
ZONIN Q QFILEENSBUR,,
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4. PARCEL INFORMATION: (circle applicable information& indicate measurements)
To.ography Soil Nature Ground Water Bedrock or Impervious Material Domestic Water Supply
Flat sand at what depth at what depth municipal
o ing loam feet feet
Steep slope clay if well; water supply
_%slope other from any septic-system
depth: absorption is/d Z..Jt.
other /SU `
Percolation est: (To com I ed by licensed professional engineer or architect)
Rate: e mute per inch
5. 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). Add 250 gallons to the size
of the septic tank and leach field for each Garbage Grinder, Spa or Whirlpool Tub.
Septic Tank/Freer) gallon (min. size 1,000 gal.)
Tile Field: each trench ft. Total System Length: f t.
Seepage Pit(s): number of size of each: ft. by ft.
Size of Stone to be used: # / depth or thickness feet
Bed System Size: � x
Alternative System: c length and/or size
6. HOLDING TANK SYSTEM: (if required)
Number of tanks: / Size of each: gallons /TOTAL Capacity: gallons
Note: Alarm System and associated electrical work must be inspected by a Town approved
electrical inspection agency.
7. SIGNATURE &INFORMATION FOR RESPONSIBLE PERSON(please read)
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 Queensbury Sanitary Sewage Disposal Ordinance.
Effe � r
Signature ofiresponsible person Date
Town of Queensbury
Sewers and Sewage Disposal Chapter
Appendix C
ABSORPTION FIELD
SEPARATION REQUIREMENTS
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Appendix C
ABSORPTION FIELD
SEPARATION REQUIREMENTS
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Septic Inspection Report
Office No. (518) 761-8256 Date Inspection request received:
Queensbury Building&.Code Enforcement Arrive: amw/p`mIn Depart: //"" am/pm
742 Bay Rd., Q sbury,NY 1 804 ; ' Inspector's Initials: (--- -
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NAME: � - PERMIT NO.:
LOCATION: ' 21 MOSt t) r ^,7 INSPECT ON:
RECHECK:
Comments and/or diagram
Soil Type: San Loam/Cl�a,�`Type of Wa : Municipal dell Wat
Waterline separation distan i ft.
Well separation distance ft.
Other wells: ft.
Absorption Field: Total length _ ft.
Length of each trench 0 ft.
Depth of trenches ft.
Size of Stone C-i._ N 6 r
Seepage Pits: Number
Size: x
Stone Size:
Piping — Siz Type
Building to tank ! /r cjtO
Tank to Distribution Box u ,p2e___
Distribution Box to Field/Pit �r� .4
Opening Sealed: Y/N/Partial
End Caps
Location/Separations _
Foundation to tank ft.
Foundation to absorption ft.
Separation of Pits / ft.
Conforms as per Plot Plan tIY N OPP I>
Engineer Report and As-Built _ Y N F j V RG"S - „_
LocationSystem on Property:
Front Rear Left Side Right Side
c
Middle Front Middle Rear
System Use Statu
proved
artial Approved and needs to be re-inspected, please call the Building& Codes Office
Disapproved
Last revised 1/6/05
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TOWN OF QUEENSBURY BUILDING DEPARTMENT }
Based on otir limited examinatid n,
campliance'with our comments shall
not be construed as indicating t le S-'`i d
plans and specifications are in fill `}-,
compliance with the Building Cod)s E E��ED -r ,
of New York State.
R
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QuEENSBURY '� F
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BUILDING & 6 •
REVIEWED BY
DATE �D
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NACE ENGINEERING, P.C.
169 Haviland Road, Queensbury,NY 12804
Phone-518-745-4400 Fax -518-792-8511
November 1, 2004
c ,"�` Project# 49151
Mr. Jay Sweet
Queensbury Septic
PO Box 4283
Bay Road
Lake George,NY 12845
Re: Percolation Test
Robert Clark—10 BenMost-Bur Lane, Lake George ,NY
Dear Jay:
At your request, on October 29,2004, I performed a percolation test at the Clark residence located
at 10 BenMost-Bur Lane. The test was performed to the west of the existing residence in the
location where construction of a replacement leach field is proposed.
The results of the testing are as follows:
Percolation Test
Stabilization percolation rate - 1" in 4 minute, 50 seconds
The test was run in the native sand and gravel at a depth of 24 inches in a 30 inch deep hole. The
hole was presoaked with 6 gallons of water and the test was run 6 times until it stabilized with
three consecutive runs of 4:46, 4:48 and 4:50 respectively.
The replacement absorption bed for this 3 bedroom residence requires a minimum of 10 Eljen In
Drain Units in a 10 ft wide by 22 ft long absorption bed. Also, all fixtures in the residence shall
be replaced with new code compliant water saving fixtures.
Please call me if you have any questions.
Foy
Sincerely, > T ✓(/� 1
- L 't'x'� ' OwN O,c
Thomas R. Center Jr., EI 20N/N GOpp Sao,
CF Y