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2008-171 TOWN OF QUEENSBURY 742 Bay Road,Queensbury,NY 12804-5902 (518) 761-8201 Community Development- Building &Codes (518) 761-8256 CERTIFICATE (31.U` COMPLIANCE Pen-nit Number. P20080171 Date Issued: Monday, May 19, 2008 This is to certify that work requested to be done as shown by Permit Number P20080171 has been completed. Tax Map Number. 523400-279-015-0001-049-000-0000 Location: 140 JENKINSVILLE Rd Owner. THEODORE & JENNA GALICKI Applicant: THEODORE & JENNA GALICKI 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 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: P20080171 Application Number. A20080171 Tax Map No: 523400-279-015-0001-049-000-0000 Permission is hereby granted to: THEODORE &JENNA GALICKI For property located at: 140 JENKINS VILLE 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: THEODORE &JENNA GALICKI 140 JENKINSVILLE Rd Septic Alteration Residential QUEENSBURY, NY 12804-0000 Total value Contractor or Builders Name/Address Electrical Inspection Agency Plans &Specifications 2008-171 septi alteration residential $25.00 PERMIT FEE PAID- THIS PERMIT EXPIRES: Tuesday, May 05,2009 (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 Quee ury� day, May 05,2008 SIGNED BY for the Town of Queensbury. Director of Building&Code Enforcement ' OFFICE USE ONLY C �I � 1 TAX MAP NO. -'�/ PERMIT NO. � PERMIT FEE__,L�✓. ' LILIDING A'� 0 APPROVALS: ZONING TOWN CLERK _____________________________________________________________ _____ E3i'4l�EENS8t11RY., APPLICATION FOR SEPTIC DISPOSAL SYSTEM PE `cos . A PERMIT MUST BE OBTAINED BEFORE WORK BEGINS.APPLICATION IS SUBJECT TO REVIEW BEFORE ISSUANCE OF A VALID PERMIT. OWNER: �e�n� ,3 i� " g"'�/��� INSTALLER: ADDRESS: f jD j`n ��Sy ADDRESS: .V1: /s:;L PHONE NOS. PHONE NOS. 514:2- LOCATION OF INSTALLATION: Py0 RESIDENCE INFORMATION: YEAR BUILT NO.OF X COMPUTATION= = TOTAL DAILY FLOW BEDROOMS GARBAGE GRINDER 1980 or older X 150 gallon per bedroom = 300 INSTALLED? 1VQ._ 1981 -1991 X 130 gallon per bedroom = SPA OR HOT TUP�., 1992-present X 110 gallon per bedroom = INSTALLED? � PARCEL INFORMATION: ✓ TOPOGRAPHY: Flat rolling Z Steep slope %Slope ✓ SOIL NATURE: Sand_ Loam Clay Other ✓ GROUNDWATER: At what depth? .5-61 ✓ BEDROCK/IMPERVIOUS MATERIAL: At what depth? ✓ DOMESTIC WATER SUPLY: Municipal Well (If well: Water supply from any septic system absorption is ft.) ✓ PERCOLATION TEST: Rate is 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: t 00 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? / l Size? C A TERNATIVE SYSTEM Bed or other type? ❑ 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@gueensburv.net VISIT OUR WEBSITE FOR MORE INFORMATION www.ciueensbury.net Signature of Person Responsible Date a Town of Queensbury • Community Development Office • 742 Bay Road, Queensbury,NY 12804 B 5-LGL 6/06 LA fi GAt, i a L,ZC It floo co ( xuu�j Septic Inspection Report Office No. (518) 761-8256 Date Ins request received: Queensbury Building&Code Enforcement Arrive: am�part: am/pm 742 Bay Rd., Queensbury, NY 128 Ins s Initials: NAME: PERMIT NO.: --,��,,T / 7 LOCATION: ARO RECHECK: INSPECT ON: Comments and/or diagramSol!T Sa Loam C! Type of Water: Municipal j Well Water Waterline separation distance Well separation distance Z _ft, Other wells: , Absorption Field: Total length / ft. Length of each trench ft, Depth of trenches Size of Stone r l c See Pits: Number Size: x Stone Size: -Piping Sizea Type Building to tank d Tank to Distribution Box Distribution Box to Field Pit c t r r Opening Sealed: Y N Partial End Ca Inlet/Outlet Pipes&Baffles Y N Location Se rations Foundation to tank ft. Foundation to absorption za ft. Separation of Pits ft. Conforms as per Plot Plan Y N Engineer Report and As-Built Y N Location of System on Property: Front ear Left Side Right Side Middle Fron Middle Rear 5ysWrn Use Approved Partial Approved and needs to be re-inspected, please call the Building &Codes Office Disapproved Last revised 021006 Last revised 1/6/05 169 Haviland Road Queensbury, NY 12804 Hutchins Engineering Phone: (518)745-0307 Fax: (518)745-0308 April 24, 2008 Mr. Scott Boucher Boucher & Son Excavation C 7935 State Route 40 eV4 Hartford, NY 12838 Reference: 140 Jenkinsville Road, Queensbury (T), Theodore Galickie Replacement Wastewater System Dear Mr. Boucher: On April 23, 2008, l conducted a site evaluation at the referenced residence in preparation for a replacement on-site wastewater system. Percolation test results and deep test hole logs are as follows: Percolation Test 24" depth, Stabilized Percolation Rate= 2 minutes, 45 seconds per inch Test Hole Log 0-8" Topsoil 8-40" Light Brown Very Fine Sand, Trace Silt 40-72 Light Brown Very Fine Sand, Some Silt, Some Coarse Sand Pockets Moist @ 48" Mottling @ 50" Water Seepage @ 58" Presumed Seasonal High Groundwater Table @ 50" A conventional absorption field is appropriate for this application. For the two bedroom residence (300 GPD basis) in the observed soils criteria, a minimum of 138 LF of conventional pipe in stone absorption trench (or equivalent chambers) is required. Should you wish to size to three bedroom criteria to enable some future expansion, a minimum of 187 LF of trench is required. It is suggested that three or four absorption trenches each 50' long be installed for a total of 150' (two bedroom basis) or 200' (three bedroom basis). The trenches should be installed to maintain 100' min. from this well and any adjoining wells, 20' from the house, and 10' from any property lines. A minimum 2' vertical separation is required from the BOTTOM of the absorption trench excavation to seasonal high groundwater level, determined at 50" depth at the test hole location. G.Thomas Hutchins,P.E. The septic tank should be a minimum of 1000 gallon capacity, and should be of precast concrete construction. The house sewer should be 4" Schedule 40 or SDR 35 PVC installed at a minimum slope of W per foot. From the septic tank to the distribution box, a 4" PVC effluent sewer line should be installed at 1/8" per foot minimum slope. System components should be as follows: Septic Tank— 1000 Gat — precast concrete, per detail Distribution Box— Precast concrete or polyethylene, use speed levelers Absorption Trenches— 3 at 50' long, 150' total (2 bedroom) 4 at 50' long, 200' total (3 bedroom) Pipe in Stone Absorption Trenches As we discussed I personally prefer pipe-in stone to infiltration chambers, however equivalent sized infiltration chambers are generally considered acceptable by NYS and Queensbury standards when installed in accordance with manufacturers instructions. This summary is intended to provide you with site soils information and does not all information necessary to install a compliant system. A permit is required from Queensbury along with multiple inspections during installation. Should you wish to discuss or you require additional information, please contact me. Regards, G. Thomas Hutchins, P.E.