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2003-714 011 ` TOWN OF QUEENSBURY 742 BayRoad,Queensbury, 12804-5902 (518) 761-8201 �_ � Q rY, Community Development - Building & Codes (518) 761-8256 CERTIFICATE OF COMPLIANCE Permit Number: P20030714 Date Issued: Monday, December 22, 2003 This is to certify that work requested to be done as shown by Permit Number P20030714 has been completed. Tax Map Number: 523400-296-016-0001-013-000-0000 Location: 452 BAY Rd Owner: DONNA ST. JOHN Applicant: DONNA ST. JOHN This structure may be occupied as a: By Order of Town Board Septic Alteration Residential TOWN OF QUEENSBURY 4 Director of Building&Code Enforcement TOWN OF QUEENSBURY 742 BayRoad,Queensbury,NY 12804-5902 (518)761-8201 Q ry, Community Development-Building&Codes (518) 761-8256 BUILDING PERMIT Permit Number: P20030714 Application Number: A20030714 Tax Map No: 523400-296-016-0001-013-000-0000 Permission is hereby granted to: DONNA ST JOHN For property located at: 452 BAY 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: DONNA ST. JOHN 108 RIVER St SepticTotalValue Alteration Residential HUDSON FALLS, NY 12839 Contractor or Builder's Name /Address Electrical Inspection Agency KRIJGER CONCRETE 3 OSPREY VIEW Dr OIJEENSBIJRY. NY 12804-0000 Plans&Specifications 2003-714 SEPTIC ALTERATION (REPLACING TANK ONLY) AS PER APPLICATION $25.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Sunday,August 29, 2004 (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 T n uee Cury. ri y, August 29, 2003 SIGNED BY - ��': for the Town of Queensbury. Director of Building&Code nforcement Application for Permit-Septic Disposal System c Town of Queensbury 742 Bay Road Queensbury,NY 12804 (518) 761-8256 1. OWNER INFORMATION: Office Use Location of installation: �� �� � File Permit No 1, Tax Map No. ,t / 1 / 3 Fee Paid Owner's Name: 1-t tJ A NA , Si- %,,\-L.H 0 Address:4 2- ir1 1 (400 'Pd C-- 1,1)80(.2k1 , i\I(1 12 &O 4 2. INSTALLER'S NAME : k((w c(__ e l (Ci 0)A)it I PHONE NO. 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 1980 or older 2 x 150 gal/bdrm = 3c 1980— 1991 x 130 gal/bdrm = ' 1991 —present x 110 gal/bdrm = br- Garbage Grinder Installed yes / no ) i Spa or Hot Tub Installed yes / no V (— 4 4. PARCEL INFORMATION: (circle applicable information&indicate mea m s) 0— To.o 1 a.h Soil Nature Ground Water Bedrock or Im.ervious Material Dome sti * ater Su..l `_Flat sand at what depth at what depth muni,pa ing loam feet feet w• Steep slope Ecljgb if well; water supply _%slope other from any septic-system depth: absorption is ft. other Percolation Test: (To be completed by licensed professional engineer or a chitect) Rate: minute 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: I CX)U gallon (min. size 1,000 gal.) Tile Field: each trench ft. Total System Length: ft. 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: 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 o -- Town of Queensbury Sanitary Sewage Disposal Ordinance. op - ignature of responsibg•erson Date • - .i,,,,'r. Town o1 (.lt*t.t`i1s1)tit y ,` Srsver:t and St:wsit:c I)ispo :t.l (.Impl 'r A1tlx'tulix (: ABB.M()itivI't()N in EIJI) SF I'A 1r.A'l'IQN ItEQl.I11ti;[VI I4.N'1'S • s rtkri hM i :: -- '',. ... e. 5).. J....._ l — 17\v1 POND ill: c.,...*.<6 1 i WELL 1N /(►TfA• r . ylc'W1 . '111jr11T �1.16( r am •._ t- ,,,, 1 4 // ���• �I \1 ...,, . \. 110U-SE G 2E, / .... ,.‘0.4,301)'" 1 lousr- G E (":\I I' r. ri / /• C.tsar. IC, t.i .i 11\1 tar. \ i . T* T./ •\\ '../ irel\ :r3'" 1'10.1.,b • . . . ..,- ........ RUAl7 ter►.. - / w 7. SIGNATURE &INFORMATION FOR R rvrlausL rnt •'+W I7i w„oa•...'''"", op",;, �Io� n of (�Ut:t'nM1)Ury 'n Sewers :ma Scvv;ip c I)ispos:t1 (I I:Wit•r ,p mlitli x t: 1 • AI3.:i()RI''•I'I()N MEIJI.) . . RI:I'A 1tNI'1ON ItEtQ1.I1 REM I►:N'I'S ' ----\\\% S...,:ftti ta.4 — ••• '.... e( ..'oi 5)... H--"•-4 1111 .,\H(' 1 rPowp HlEtt_ w linrFA• rt ?'w.r 7.,..... \ 1 . C ,� /^ J / . i I'• cc...fp 14ousC a O. i - , 4 ,r>�" 11%>us� G E �'�� 7 c•vavl� ✓ /' $G f't lG j �� --7) • '-' (rf;\ -`'`" • \......,..._ It • 7. SIGNATURE &INFORMATION FOR RESI►ONW01- r:✓r..'W i W1904•"•••••••/ Septic Inspection Report Office No. (518)761-8256 Date Inspection request received: Queensbury Building&Code Enforcement Arrive: am/ epart: am/pm 742 Bay Rd.,Queensbury,NY 12804 Inspector's Initials: NAME: J`�'• '8 A) PERMIT NO.: ©5-7/ LOCATION: / -c( Q - INSPECT ON: L Z O 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. Absorption Field: Total lent h 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/Partial Location/Separations — Foundation to tank ft. Foundation to absorption ft. Separation of Pits ft. Conforms as per Plot Plan Y N p ArC�I�C�-� 5 /°/fill o'J s /LE Location of System on Property: Front Rear Left Side Right Side Middle Front iddle Rear S stem Use Statu Approved Partial Approved and needs to be re-inspected,please call the Building&Codes Office Disapproved L::SueHemingway\Building.Codes.Inspection.FORMS\Septic Inspection Report.doc January 28,2003 p Septic Inspection Report J Office No. (518) 761-8256 Date Inspection request received. Queensbury Building&Code Enforcement Arrive: am/prl� e art: m/pm 742 Bay Rd., Queensbury,NY 12804 Inspector's Initials: NAME: �.�. PERMIT NO.: a LOCATION: INSPECT ON: — —0 3 RECHECK: Comments and/or diagram Soil Type: Sr Cl Type of Watcipal/ e11 Water Waterline sedicta e ft.Well separatc ft. &c, i, -/1-%Cs1 Other wells,, ft. Absorption Field: Total length -�/ ft. Length of each trench (� ft. Depth of trenches ft. AW t _ 0")lZ._, Size of Stone (AJf;'( l' as(0(2 5 Seepage Pits: Number Size: x Stone Size: • Piping Size _ Type Building to tank i/ Tank to Distribution Box • _f_.) Distribution Box to Field/Pit Opening Sealed: Y/N/Partial Location/Separations Foundation to tank 4 6 ft. Foundation to absorption - ft. Separation of Pits ft. Conforms as per Plot Plan Y N Location of System on Property: Front Rear Left Side Right Side Middle Front Middle Rear System Use Status: /r '�oti&D h " pproved Partial Approved and needs to be re-inspected,please call the Building&Codes Office Disapproved L:\SueHemingwayU3uilding.Codes.Inspection.FORMS\Septic Inspection Report.doc January 28,2003 Septic Inspection Report Office No. (518)761-8256 Date Inspection request received: Queensbury Building&Code Enforcement Arrive: am/ ,Depart: � am/pm 742 Bay Rd.,Queensbury,NY 12804 Inspector's Initials: NAME: -6 v`i PERMIT NO.: 6 3 7 4 LOCATION: r-e ar _ INSPECT ON: l -(i1 0" RECHECK: Comments and/or diagram Soil Type: Sand/Loam/Clay Type of Water: Municipal/Well Water 'i A`,t,?I,` �)0c-. i1- 1Ak4-" -t Waterline separation distance _ft. Well separation distance ft. ( AS(JL Other wells: _ ft. Absorption Field: Total lent h 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 6 tank C` C . Tank to Distribution Box Distribution Box to Field/Pit Opening Sealed: Y/NI Partial Location/Separations Foundation to tank ft. Foundation to absorption ft. Separation of Pits ft. Conforms as per Plot Plan ,Y_____N Location of System on Property: Front Rear Left Side Right Side Middle Front Middle Rear System Use Status: pproved artial Approved and needs to be re-inspected,please call the Building&Codes Office Disapproved L:wueHemingway\Building.Codes.Inspection.FORMS\Septic Inspection Report.doc January 28,2003 Ci Z O V O K� A 46 O' 44 • DLO S m `�1 N c ,OS�Ll cn • � � � N • , _,, O . w- o A ►- � o � o � p _ CLLO 0 7-1 A 00 ^ J Ot I Co v = 0 Y C co 01 _ Q � sesodrnd.fnrr 6i 10 urn ousuo �Off �Q c I N -� «fS 90 /y _. has .9� co -opinoys r Pd w W > W Q E E � (Wou A VE rur d. coos 4&fi nr.VMIP.rw _z ul r O 1 i l a 1 77 V TM%QUEE &WW BU1WM DEPARTMENT Based on our Iir ow e n�strued as 1� plans and sPOdkalions are in ful C1- �mp�ence with the Bu' Codes of New York State. BUILDING �- REVIEWED BY f DATE Z • � Lands ��oR e BAY/h�i4D+0'�i 6[!L�''CLl1,t;" lAC. TC y F COPY FON C <� Iv 1� a v V v F (73741� G,00O32, _ FTHE STA`��� 10 • Y ,* . WIL JAM E. I+ ONTGOMERY JR. PE CGNSUL HNG ENGINEER N 000�- ;Sca 11 _. ��',�L.G�';iB' " ' • re- — � D of L?aye - ----- TABLE 2 REQUIRED SEPARATION DISTANCES FROM WASTEWATER SYSTEM COMPONENT: To SSre�m. Vv'eii (rJ or Watercourse (b), Property Drainage System Components Suction Line or Wetland Dwelling Line Ditch(b),(g).y House Sewer 25' if cast iron 25' 3' 10, --- (watertight joints) or PVC with 0-ring joints, 50'otherwise Septic tank 5W 50, 10, 10` 10' Effluent line to _ ' distribution box '� ` 50' 50' 10' 10' 10' Distribution box ; 100' 100, 20' 10' 20' Absorption field 100' (a) 100, 20' 10' 20' Seepage pit 150' 100, 20' 10' 20' - Dry well (roof and footing) 50' 25' 20' 10' 10 Rai'4d or �Aol rnd System (c) 100'r:: .VIJaG' i(► � " �r Intermittent Sand Filter (c) 100'(a) 100, 20' 10, 20' F•S: atranspiration- , -,-sorption system (c) 100'(a) °,0' 20' 10' 20' ..,y Conposter 50, 150, 20' 10, 10, • =°"` ........... Savitary Privy Pit 100, 50, 20' 10' 20' �/ ,p """'"''► FCmvy, y atertight Vault 50' S0' 20' 10, 10 -V e e #1 Distribution Box �y %�Z D �5010�� .r s Z. CONCRETE: 4000 PSI " REINFORCEMENT: ASTM A615-GRADE 60 ASTM A185-GRADE 65 ® 940-1000 G���ion ENTRAINED AIR: •9.096 1 MEETS ASTMM C890 1 1" Low Profile Septic Tao 20" CONCRETE: 4000 PSI REINFORCEMENT: ASTMA615-GRADE 60 N O T E S THIS TANK TAPERS IN 1" ON ALL SIDES FROM ASTM A185-GRADE 65 MIDDLE JOINT TO TANK TOP. ENTRAINED AIR: -5.0*%-9.096 MEETS ASTM C890 1. Properly is that of Donna M.St.John in Town of Queensbury,N.I;. Plot plan copied from survey done by Bruce E, Agard,Land Surveyor,N.Y.S.License" Number 049942. First septic system has failed and has become a replacement 2'-0" :.,.e emergency. ACCESS OPENING (TYPICAL) 2. Percolation tests in this area indicate a 30 minute per inch perc rate is suitable. < ` Soil is granular clay loam—sticky when wet---not too bad when dry. No I ground water was present at 3ft.below grade. 13" 3. A 2-bedroom residence with a 30 minute perc test will require 184ft.of trench for the absorption field---however,since the Bay Meadows Golf Course is the 4" adjoining property, three 60ft. line lengths will suffice and retain a sufficient barrier from the golf course property. 4. With a municipal potable water supply,the 100ft.distance from well to leach field is not applicable. ( � 2" / 5. All applicable separation distances shown in Table 2 of the New York State I / INLET Department of Health Design Handbook for Individual Residential Treatment -./ Systems(1996)shall be maintained. I ^•�. - i ' ' Sewer piping from residence to septic tank and from septic tank to"D" Box ,H, 3". I I , -. � .I. 111l2" shall be solid-walled 4" dia PVC pipe. The absorption field shall be I I I I Equallizer"24"Infiltrator units with 12"of cover for H10 loading. r 7. No garbage grinders shall be installed in this system. r I I ( .000 8. The septic tank should be pumped at optimum intervals to prevent any cary- ' I I I OUTLETS-FIVE 4" over of solids to the absorption field. 3" III-I� �t \ ( / KNOCKOUTS WITH " " HIGH DENSITY POLY- 9. The new septic tank and the should be constructed of reinforced r - ETHYLENE PIPE SEALS. concrete as manufactured by the Fort Miller Company or approved equal" fi \ �+'►TII I IAM E. MONTGOMERY M APE CONSUMNG ENGINEER \ 100, ;-of 'f 4'-10" THERE ARE INLET KNOCKOUTS ON THREE'SIDES FOR 4"Pi o PE. HIGH DENSITY POLYETHYLENE `� PIPE SEALS PROVIDED AT ALL PIPE /T�OF THE gT � CONNECTIONS SHOWN. --- L t c� ✓ems