2008-645 TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development - Building& Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: P20080645 Date Issued: Wednesday, March 30, 2011
This is to certify that work requested to be done as shown by Permit Number P20080645
has been completed.
Tax Map Number: 523400-302-019-0001-015-000-0000
Location: 8 AMES P1
Owner: MATTHEW LEVIN
Applicant: MATTHEW LEVIN
This structure may be occupied as a:
Septic Alteration Residential
Test Pit/Perc Test Review By Order of Town Board
TOWN OF QUEENSBURY
Issuance of this Certificate of Compliance DOES NOT relieve the a
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
(2t Community Development- Building&Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20080645 Application Number. A20080645
Tax Map No: 523400-302-019-0001-015-000-0000
Permission is hereby granted to: MATTHEW LEVIN
For property located at: 8 AMES PI
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: MATTHEW LEVIN
ALLISON NORTH Septic Alteration Residential
Test Pit/Perc Test Review
8 AMES PI
QUEENSBURY,NY 12804-0000 Total value
Contractor or Builders Name/ Address Electrical Inspection Agency
SANITARY SEWER
DAN DRELLOS
PO BOX 224
GLENS FALLS NY
Plans &Specifications
2008-645
DEEP HOLE/PERC TEST
Septic Alteration Residential
$225.00 PERMIT FEE PAID- THIS PERMIT EXPIRES: Saturday,December 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 tht o ori
busy; F 'day,December 05, 2008
SIGNED BY for the Town of Queensbury.
Director of Building&Code Enforcement
----------------
OFFICE USE ONLY
01 TAX MAP NO. PERMIT NO. �-(i--'`� PERMIT FEE _`',1 � '
r
'
0 APPROVALS: ZONING TOWN CLERK ;
' r r
0____________________________________________________________________'. r_.____.______.____._..
APPLICATION FOR SEPTIC DISPOSAL SYSTEM PERMIT:
A PERMIT MUST BE OBTAINED BEFORE WORK BEGINS.APPLICATION IS SUBJEC TO REVIEW BEFORE ISSUANCE OF A VALID
PERMIT. � ; -� n,
OWNER: 1 v�A 4'{ `� — Le `)f /0 INSTALLER: cl
ADDRESS: y-'x pt-'4c-'a ADDRESS: NO- y
PHONE NOS. ���� 7 1 PHONE NOS, 7 j � '�`�
LOCATION OF INSTALLATION:
RESIDENCE INFORMATION:
YEAR BUILT NO.OF X COMPUTATION= = TOTAL DAILY FLOW
BEDROOMS GARBAGE GRIND P,
1980 or older S-,t_ =L X 150 gallon per bedroom = INSTALLED? _
1981 -1991 X 130 gallon per bedroom = SPA OR HOT TUB
1992-present X 110 gallon per bedroom = INSTALLED?_
PARCEL INFORMATION:
✓ TOPOGRAPHY: Flat rolling Steep slope %Slope
✓ SOIL NATURE: Sand Loam Clay Other
✓ GROUNDWATER: At what depth?
✓ BEDROCK/IMPERVIOUS MATERIAL: At w depth?
✓ DOMESTIC WATER SUPLY: Municipal Well (If well: Water supply from any septic
See p L AYJ system absorption is fit.)
t
✓ 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: 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? Size?
� ! f
141-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 ouesTloNs? CALL OR EMAIL
Queensbury Sanitary Sewage Disposal Ordinance. codes@aueenaburv-net sbur
VISIT OUR WEBSITE FOR MORE INFORMATION
www.aueensbury.net
Signature of Person Responsible Date
Town of Queensbury • Community Development Office • 742 Bay Road, Queensbury, NY 12804
-'�k . / �.
Septic Inspection Report
Office No. (518)761-8256 Date Inspection req
Queensbury Building&Code Enforcement Arrive: - 10 part:
742 Bay Rd., Queensbury, NY 12804 Inspector's Initials.
NAME: '' IT NO.: 0(1 � ;LOCATION: `- SPECT ON: �--:;S —1-7— 11
RECHECK:
Comments n r diao
Soil Type: Sand/ Loam Clay
Type of Water: Municipal Well Water � ��fc�
Waterline separation distance ft. _m �
Well separation distance ft. /
Other wells: ft.
Well Casing Length 50' +/- Y N N/A
150'to well required If NO]T---
Absorption Field: Total length ft.
Length of each trench ft.
Depth of trenches ft.
Size of Stone
Seepage Pits: Number—
Piping Size x
Stone Size
Size Type
Building to tank
Tank to Distribution Box
Distribution Box to Field Pit
Opening Sealed: Y N
End Cap Y N
InletjOutlet Pipes&Baffles Y N
Manholes 12"or less below grade Y—N
[provide extension collar if Yes Y N
Location Separations
Foundation to tank ft.
Foundation to absorption ft.
Separation of Pits ft.
r Plot Plan N
As-Built Y N
ETU Maintenance Contract _Y_N
provided
Location of System on Property:
Front /Rear Left Side Right Side Muddle Front Middle Rear
Svstem Use us:
Approved
Partial Approved and needs to be re-inspected, please call the Building&Codes Office
Disapproved
L\Pam Whiting\2010\Buf1ding codes Forms\Inspection Fomis\Septic Inspection RePort_03 29 WAX
NACE ENGINEERING., P.C.
169 Haviland Road, Queensbury, NY 12804
Phone-518-745-4400 Fax -518-792-851
December 29, 2008
Project#49282
Dave Hatin
Code Enforcement Officer
Town of Queensbury
742 Bay Road
Queensbury,NY 12804
Re: Levine Residence— 8 Ames Place—Replacement Septic System
Dear Dave:
This letter is to inform you that we inspected the completed septic system far the Levine Residence
on 8 Ames Place in the Town of Queensbury on December 29, 2008.
The septic system as installed was for a 4 bedroom house and consisted of a new 1,250 gallon septic
tank, a new distribution box and a 20 ft wide by 25 ft long absorption bed. The absorption bed was
constructed with 4 — 20 ft long perforated pipe laterals and stone. The system conforms to the
requirements of the approved design letter.
Please call me if you have any questions.
Sincerely,
Thomas R. Center Jr, P.E.
Cc: Matt Levine
Septic Inspection Report
Office No. (518) 761-8256 Date Inspec,t,io,�n r st ed:
Queensbury Building &Code Enforcement Arrive: :I a /p Depart: am/pm
742 Bay Rd., Queensbury, NY 12804 Inspector's Initials d.
NAME: L Eo i \ PE IT NO.: C9.—(oy,r,,-
LOCATION: ' ?, NME6 Pk PCF- I ECT ON: 1 Z—Z1--0 A
RECHECK:
Comments and/or diagram
Soil Type:Sand Loam/ Clay
Type of Water: Municipal/ Well Water
Waterline separation distance ft.
Well separation distance ft.
Other wells: ft.
Well Casing Length 50' + / - Y N _N/A
Absorption Field: Total length ft.
Length of each trench ft.
Depth of trenches ft.
Size of Stone
Seepage Pits: Number
Size: x
Stone Size:
Piping Size Type
Building to tank
Tank to Distribution Box
Distribution Box to Field / Pit
Opening Sealed: Y N
End Cap Y N
Inlet/Outlet Pipes&Baffles Y N
Location Separations
Foundation to tank ft.
Foundation to absorption ft.
Separation of Pits ft.
r Plo _ N
Engineer Report As-Buil Y N
Location of System on Pr
Front Rear Left Side Right Side Middle Front Middle Rear
System Use Status:
�pproved
artial Approved and nee s e
Disapproved
Last revised 06/18/07 L:\Building&Codes Forms-01-1)\Building&Codes\Inspection Forms\Septic Inspection Report.doc
Septic Inspection Report .�
Office No. (518) 761-8256 Date Inspection req Wst rat }e v
Queensbury Building &Code Enforcement Arrive: atti}/p part:
742 Bay Rd., Queensbury, NY 12804 Inspector's Initia :
NAME: `r - (^-- P MIT NO.:
LOCATION: cane S NSPECT ON: / -2—
RECHECK:
Comments and/or diagram
Soil T n Loam/ clay
Type of Water: (LTu-n1bp-alj Well Water
Waterline separation distance ft.
Well separation distance ft.
Other wells: ft.
Well Casing Length 50' + / - Y N N/A
Absorption Field: Total length ft.
Length of each trench O ft.
Depth of trenches ft.
Size of Stone
Number
Size: °
Stone Size:
Piping Size Type
Building to tank V4 4
Tank to Distribution Box
Distribution Box to Field Pit Iq +
Opening Sealed: N
End Ca N
Inlet/Outlet Pipes &Baffles Y N
Location Separations
Foundation to tank ft.
Foundation to absorption ft.
Separation of Pits
Plot Plan Y
En ineer Report and As-Built I Y N
Location of System on Prope
Front Rear . 4eft Side fight Side Middle Front Middle Rear
System t
Approved _
Partial Approved and needs o be in pes`ted,^pleasg. akthe-96 ding Code i�e
Disapproved `
Last revised 06/18/07 L:\Building&Codes Forms-01-1)\Building&Codes\Inspection Forms\Septic Inspection Report.doc
t
169 Haviland Road, Queensbury, NY 12804
Phone-518-7454400 Fax -518-792-8511
December 15, 2008
Project# 49282
Mr. Dan Drellos
Sanitary Sewer Service
Luzurne Road
Queensbury,NY 12804
Re: Replacement Septic System
Levin Residence—8 Ames Place, Queensbury,NY f 7
Dear Dan:
On 12/8/08, we performed a deep soil test pit and percolation test in the area of the proposed
replacement absorption field. The tests were performed to the west of the existing residence in
the location where construction of a replacement leach field is proposed. The current residence
has an existing failed septic system which will be decommissioned upon completion and
certification of the replacement system.
The results of the testing are as follows:
0— 13 " Topsoil Percolation Test
13 —24 " Medium Fine Sand Stabilization perc rate - 1"in I min., 26 sec.
24—28" Loamy Medium Coarse Sand
28—33" Topsoil
33 —90" Medium Coarse Sand
Moist @ 90", Mineral Staining @ 37"
The hole was presoaked and the test was run until it stabilized with three consecutive runs of
1:19, 1:23 and 1:26 respectively.
The design flow for a 4 bedroom residence (owner plans to add a bedroom in the future) at 110
gpd per bedroom requires 463 sf of absorption area. The new absorption system for the proposed
residence should consist of a new 1,250 gallon septic tank located on the west side of the
residence and a distribution box with a 20 ft wide by 25 ft long absorption bed (500 sf) located to
the west of the residence. The absorption bed should be constructed of pipe and stone and have 4
20 ft long laterals. NOTE: THE BURIED TOPSOIL LAYER MUST BE REMOVED
PRIOR TO INSTALLATION OF THE ABSORPTION BED STONE.
We have included a Standard Septic System Detail Sheet for your files and for use by the
contractor during construction.
Please call me if you have any questions.
Sincerely,
Thomas R. Center
NACE ENGINEERING., P.C.
169 Haviland Road, Queensbury, NY 12804
Phone-518-745-4400 Fax -518-792-851
December 4, 2008
Project#49282
Dave Hatin
Code Enforcement Officer `s 00
Town of Queensbury
742 Bay Road
Queensbury,NY 12804
Re: 8 Ames Place-Out of Season Test Pit Request
Dear Dave:
We are currently working with Matt Levine to design a replacement septic system for his residence
at 8 Ames Place in the Town of Queensbury. (See map attached). As you can see on the map
provided,the property is an existing 3 bedroom residence.
We would like to schedule this work as soon as possible so that we can complete our design, submit
to the Town of Queensbury Building Department for a Septic System Permit and start construction
as soon as possible.
Please feel free to contact me at 796-2515 if you have any questions and that you for your assistance
with this request.
Sincerely,
Thomas R. Center Jr, P.E.
Cc w/encl.: Dan Drellos
Town of Queensbury• Building&Codes Enforcement Office•742 Bay Road■ Queensbury,NY 12804
.:
DEEP HOLE/PERC TEST'
Request for Town Engineer Review
Property Owner: 1' Phone:
Property Owner's d
Address: S ?#M e S 0191
Location of Test: � Tax ID#: 3 4 9 !l
*Applicant's Engineer: VAIc f.� j*,g J jq .«,►,-gf5 Phone:
Applicant's Agent: JOIyj CPI?l�f Phone: 776— Z.�/ T
Additional Notes:
1. Reason for Request? E New Septic System Replacement Septic System ElFailed Septic System
0 Subdivision 0 Site Plan Review
2.Are Wetlands present? YES 5? NO F-1 UNKNOWN
*Note: Applicant is required to engage an engineer for design and testing of the system The Town
Engineer's responsibility is to witness system testing only.
PLOT PLAN: Plot plan, to scale, to be submitted with application
FEE SCHEDULE: q
a. $ 200 Flat Fee Date Paid:
Check No.:
b. OR Fee to be determined during To Be Determined:
Site Plan /Subdivision review process
SIGNATURE:
In carrying out the provisions of Article IV, the Local Board of Health or the enforcement officer may
engage the services of a qualified professional consultant for expert review and recommendation arising
from the carrying out of the provisions of Art. IV, including but not limited to the review of plans,
specifications and reports, attendance at inspections, dye tests, deep hole test pits, septic related deep
hole and percolation tests, system installations, and any other aspect of any matter contained in this Art.
IV, and any costs incurred in such review shall be paid to the Town by the owner of the property before
any approval can be granted under this Art. IV shall become effective within 30 days of presentment of an
invoice for same, whichever is sooner. Such costs shall not exceed $1,500 without prior written notice to
the party to be charged with same.
My signature below indicates I have thoroughly read and understand the instructions, agree to the
submission requirements and have completed the application. I also fully understand that additional
engineering fees may be necessary per Town of Queensbury Local Law 136-14D.
SIGNATURE OF APPLICANT: � Date: 2 O(y
SIGNATURE OF AGENT: Date:
Original (B&C File) Canary (Planning) Pink (Applicant) Gold (Town Clerk)
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INSTALLATION OF DISPOSAL FIELDS
1. CONSTRUCTION SHALL BE AS SHOWN ON THIS DRAWING, 6. ALL DISPOSAL FIELDS SHALL BE GRADED TO SHED RAINFALL
RECOMMEND ALL ACCESS AND SHALL BE IN ACCORDANCE WITH THE N.Y.S. AND TO DIVERT SURFACE RUNOFF FROM ADJACENT AREAS AWAY
eE R Bye, M��� DEPARTMENT OF HEALTH INDIVIDUAL HOUSEHOLD SYSTEMS, AND FROM THE DISPOSAL FIELD.
FINISH GRAM tRNRED COVERS ASTM F481-76 INSTALLATION OF THERMOPLASTIC PIPE AND
Li Li
RECOMMDOM CORRUGATED TUBING IN SEPTIC TANK LEACH FIELDS 7. REMOVE LEAVES, ROOTS, PLANTS AND ORGANIC DEBRIS PLOW SURFACE PRIOR
2. NO HEAVY EQUIPMENT SHALL BE ALLOWED WITHIN THE LIMITS TO SPREADING FILL MATERIAL
INLET RAFFLE >r� gat OF THE DISPOSAL FIELDS AFTER PIPE INSTALLATION HAS BEGUN. 8. DO NOT USE HEAVY EQUIPMENT WITHIN THE ABSORPTION FIELD AREA.
psmleuTION tlwc 3. AFTER EXCAVATION OF ABSORPTION BED TO THE DEPTHS REQUIRED, 9. PLACE FILL AND ALLOW TO STABILIZE IN ACCORDANCE WITH NEW YORK STATE
E�ou�MILLER oR AND R� TµODACHIEVE�AN EVEN SURFACE SHOULD AND M LOOSENCLEANED DEPARTMENT OF HEALTH STANDARDS
MIN.SLOPE O O SMEARED SECTIONS OF TRENCH.
i/a PER Fo4T ��PERMIT
AIL OUTLET � 4. PLACEMENT OF CRUSHED STONE. PERFORATED PIPE AND UNTREATED BUILDING
�� PAPER OR STRAW SHALL BE AS SHOWN AND CARE SHALL BE
At_SEPRC T A Y TUE SA►IE EXERCISED TO AVOID INCLUSION OF FINE GRAINED SOILS AND
OTHER WASTE MATERIAL IN THE STONE AND PIPE.
OLTA DISTRIBUTION BOX ��� 5. THE PIPE SHOULD BE LAID AT THE GRADES AND TO THE IL—L I
RELA11ONSHIPS SHOWN ON THIS DRAWING. MAINTAINING STRAIGHT E Q
CONTINUOUS GRADES WITHOUT SAGS, HUMPS. SEPARATED JOINTS
OR OTHER UNSUITABLE CONDITIONS. THE PIPE SHALL BE LAID
WITH THE HOLES DOWN IN ALL CASES. CD
eaa - w
L3 C..3 -R cv
aj CL)
r
NEW SEPTIC TANK
N.TA _.
12' MAX -
IF
' I 6' MIN. a) J
L INTERCONNECT EN �' Sal
8' MIN. BOTTOM OF BED 4' PERFORATED PVC OF LATERALS ' `�
r LATERAL. LAID LEVEL
tLa
STANDARD ABSORPTION BED PROFILE
N.T.S.
� Iff
SWALE AT UPHILL SIDE •'= " '•
OF BED TO DRAIN RUNOFF SLOPED TO DRAIN
AWAY FROM BED
cv
Na
EARTH ti ;r ;
GARAGE ROUSE 4� 6' TO 1 Y BACKFlLL FILL
FILTER FABRIC
LE
SEPTIC TANK AT LEAST 2' MIN. OR �E
SO'FROM MEAL AND to' 4' TEO
FROM HOIlSE/pROP•LIE W—T FROM BASEMENT WAIL
7IW JOINT PVC PIPE bw
ON SLOPE Cv 11r� a 8' MIN. / //
TILE � CRUSHED 1S'WE
DISIR UTION ROIL 4it=r 2'-6' S'-0' a 5'-0' 5'-0-E24' IN. —a•
10' polt Y SEE NOTE 5 I SEE/0 NOTE 8 DEL ELEVATION
SEWAGE DISPOSAL LAYOUT STANDARD ABSORPTION BED SECTION
d07M, N.T.S.
1. TLE FIELD TO WE 100'OR MORE FROM ANY
L41E,SWAMP,Be OR WATERCOURSE AND 1W NOTE BURIED TOPSOIL LAYER SHALL BE REMOVED PRIOR TO INSTALLATION OF ABSORPTION BED STONE.
OR MORE FROM ANY WATER LINE UNDER PRESSURE OR IN-GROUND POOL.
4. FOR SEWAGE PPE tE7111 EN HOUSE AND 06iRBUTION WX
USE OUCILE OR CAST IRON PPE,OR SOMLE 40
PVC WAN Comm jam
DISCHARGE
R SEWAGE ItR°OFSYSTEM.AAND CELLAR DRAINAGE
AWA NEW SEPTIC SYSTEM
4. DISPOSAL FIELD SHALL W CONSTaucIED PARALLEL NACE ENGINEERING,P.C. LEVIN - 8 AMES PLACE DETAILS
"rnt CONTOUR LINES. 169 HAVILAND ROAD REPLACEMENT SEPTIC SYSTEM
L FOR RAISED ABSORPTION TRENCH SYSIEMS NORMONTAL SEPARATION QUEENSBURY, NY �� T�
WTANCES SHALL WE MEASURED FROM TIE EDGE W THE FLL. Q V L•ENSB V RY, NY
109 NNrM acar.>s: NOT TO srrrs DAM is/ra/oa