2005-215 TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518) 761-8201
(Zt Community Development- Building& Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: P20050215 Date Issued: Wednesday, April 20, 2005
This is to certify that work requested to be done as shown by Permit Number P20050215
has been completed.
Tax Map Number: 523400-303-020-0002-026-000-0000
Location: 35 BOULEVARD
Owner: MELISSA VAN ORDEN
Applicant: MELISSA VAN ORDEN
This structure may be occupied as a:
By Order of Town Board
Septic Alteration Residential TOWN OF QUEENSBURY
r ' )j4A' 7
Director of Building&Code Enforcement
TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development-Building&Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20050215 Application Number: A20050215
Tax flap No: 523400-303-020-0002-026-000-0000
Permission is hereby granted to: MET,TSSA VAN ORDEN
For property located at: 35 BOULEVARD
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: MELISSA VAN ORDEN
35 BOULEVARD Septic Alteration Residential
Total Value
QUEENSBURY, NY 12804-0000
Contractor or Builder's Name /Address Electrical Inspection Agency
OUEENSBURY SEWER
.TAY SWEET
Plans& Specifications
2005-215
SEPTIC ALTERATION
$25.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Tuesday, April 18, 2006
(if a longer period is required,an application for an extension must be made to the code Enforcement Officer
of the Town of Queensbu before the expiration date.)
Dated at the Town f Qu sb M it 18, 2005
SIGNED BY for the Town of Queensbury.
Director of Building&Code Enforcement
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:
File Permit No.
C�1.5
Tax Map No. dc�,
�� ���A—) : Fee Paid O�
Owner's Name:
Address: lu�� �%�►'
2. INSTALLER'S NAME ��'7 u��� �� —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 x 150 gal/bdrm =
1980— 1991 x 130 gal/bdrm =
1991 —present x 110 gal/bdrm = il LID —
Garbage Grinder Installed yes_ / no
Spa or Hot Tub Installed yes_ / no 1 �
4. PARCEL INFORMATION: (circle applicable information&indicate measurements)
T9pography Soil Nature Ground Water Bedrock or Impervious Material . Domestic Water Su 1
F vii F�o5amp
at what depth at what depth unit pa
o ling feet feet we
Steep slope clay 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 architect)
Rate: 6 jo 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:,Ax�. gallon(min. size 1,000 gal)
Tile Field: each trench 1PJ&� ft. Total System Length:
Seepage Pit(s): number of size of each: ft. by ft.
Size of Stone to be used: # / depth or thickness feet
i
Bed System Size: x
Alternative System: 0 length and/or size /
6. HOLDING TANK SYSTEM: (if required)
Number of tanks: / Size of each: gallons /TOTAL Capacity: gallons
-'I own of tZucollsbury
�!`IVCI'K :I)1II �41Vj1)�(; I)l,�Tj)t):•'�:11 �:ltSll)iCt'
AI)I)t•.tuli x t
A-11S )Ii.VVION FIELD
' SI;1'111LA'1`1W1�1 ItI:tZLI�1tI�t�]I���1'!`;; '
s r#tK AM
.1
POND
00
l:p'3+c1RPtw1)
7. SIONA'TME &INFORMATION FM IIvMWL,rzr%avt`t tY,or..••.•�•.:;:' `: ::'::
.y
Septic Inspection Report
Office No.(518)761-8256 Date In11niti
e
Queensbury Building&Code Enforcement Arrive: p art: 1p,p a
742 Bay Rd.,Queensbury,NY 12804 Inspector's NAME: Q r ` (` !�y; IT NO.:LOCATION: ECT ON: —(_ ;
RECHECK:
Comments and/or diagram
Soil T S la
Type of Wate ici /Well Water
Waterline se arahon istance ft.
Well separation distance $.
Other wells: $,
Absorption Field: Total length ft.
Length of each trench
Depth of trenches ft.
Size of Stone
Seepage Pits: Number
Size: x
Stone Size:
Piping Size Type
Building to tank y»
Tank to Distribution Box
Distribution Box to Field/Pit
Opening Sealed: Y/N/Partial
End Caps
Location/Separations
Foundation to tank ft.
Foundation to absorption ft.
Separation of Pits ft.
Conform �erPllo�t�Plan N
En 'n7 Re As-Built Y N
Location of System on Pr
Front Rea Left Si t Side
Middle Front iddle Rear
System Use S .tus•
Approved
Partial Approved and needs to be re-inspected,please call the Building&Codes Office
Disapproved
Last revised 1/6/05
a.
omy
BL ILDING O ITT.
RE IEWED
DA E
i
}
i
Zv V i
1
�1
RECEIVED f
� � I
APR 18 2005
TOWN OF
QUEENSBURY
"ll ,"': :�, or G s?Iirve saweVidenc2 of,
v .., S ulis, trees, fences, etc., 3
rersent that I have
dis forth on the diagram."
IGNTrURE DATE
0
NACE
ENGINEERING, P.C.
169 Haviland Road, Queensbury, NY 12804
Phone-518-745-4400 Fax -518-792-8511
April 13, 2005
Project#49160
Mr. Jay Sweet
Queensbury Septic
PO Box 4283
Bay Road
Lake George,NY 12845
Re: Percolation Test
35 Boulevard, Queensbury,NY
Dear Jay:
At your request, on April 11, 2005, I performed a percolation test at the Van Orden residence
located at 35 Boulevard in Queensbury. The test was performed to the south 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 1 minute, 10 seconds
The test was run in the fill area of the existing failed raised system at a depth of 24 inches in a 30
inch deep hole. The hole was presoaked with 5 gallons of water and the test was run 7 times until
it stabilized with three consecutive runs of 1:04, 1:08 and 1:10 respectively.
Please call me if you have any questions.
Sincerely,
Thomas R. Center Jr., PE