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
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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
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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.