2003-024 TOWN OF QUEENSBURY
742 Ba Road ueensbu NY 12804-5902 518 761-8201
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Community Development - Building & Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: P20030024 Date Issued: Thursday, August 14, 2003
This is to certify that work requested to be done as shown by Permit Number P20030024
has been completed.
Tax Map Number: 523400-289-011-0001-022-000-0000
Location: 4 OSPREY VIEW
Owner: DONALD & SANDRA KRUGER
Applicant: DONALD & SANDRA KRUGER
This structure may be occupied as a:
By Order of Town Board
Septic Alteration Residential TOWN OF QUEENSBURY
Director of Building&Code Enforcement
TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
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Community Development-Building& Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20030024 Application Number: A20030024
Tax Map No: 523400-289-011-0001-022-000-0000
Permission is hereby granted to: DONAT,D & SANDRA KRT JEER
For property located at: 4 OSPREY VIEW
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: DONALD & SANDRA KRUGER
3 OSPREY VIEW Septic Alteration Residential
Total Value
QUEENSBURY,NY 12804-0000
Contractor or Builder's Name /Address Electrical Inspection Agency
Plans&Specifications
2003-0024
SEPTIC ALTERATION AS PER PLOT PLAN SPECIFICATIONS
$25.00 PERMIT FEE PAID-TITIIS PERMIT EXPIRES: Friday,January 30,2004
(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, own Qu sb ; s�' 1 s.ay,January 30,2003
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: 0 5 ' '-E
Tax Ma No. / / File Permit Ner„--)�'03 —()
p ;0)
Fee Paid c?c�
Owner's Name: 0 Y L ✓✓
a`) `
Address: 0.5 1 Y
tel
2. INSTALLER'S NAME : 03 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 = j RECEIVED
Garbage Grinder Installed yes '( / no
Spa or Hot Tub Installed yes y / no JAN 3 0 2003
TOWN OF QUEENSBURY
4. PARCEL INFORMATION: (circle applicable information&indicate measurenNUIING AND CODE
Topography So' e Ground Water Bedrock or Impervious Material Domestic Water Supply
Flat sand at what depth at what depth municipal
Rolling oam 5`feet 45 feet
Steep slope clay if well; water supply
_%slope other from any septic-system
depth: absorption is ,B 0 ft.
other
Percolation Test: (To be completed by licensed professional engineer or architect)
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: (?S`O gallon (min. size 1,000 gal.)
Tile Field: each trench ft. Total System Length: (a ft.
Seepage Pit(s): number of size of each: ft. by ft.
Size of Stone to be used: # 7_ / depth or thickness feet At___
Bed System Size: /5— x *i i
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, case note that pursuant to Section 136-29 of the Code of the Town
of Queensbury, an permit or approval granted which is based upon or is granted in
reliance upon an material misrepresentation or failure to make a material fact or
circumstance own by or on behalf of an applicant, shall be void.
I have read the regul 'offs with respect to this applic tion and agree to abide by these and all
requirements of t e o of eensbury Sani ewage Disposal Ordinance.
Sig ature of responsible person Da e
Town of (Ineorrcitnrry
+'' Sowers : rci Sewage Disposal (limpid.
Appon i x (: i
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7. SIGNATURE &INFORMATION FOR. ,,SriiI'4 WLrr rzs`-'•,r` ww0••-•- ,....,
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Septic Inspection Report
Office No. (518) 761-8256 Date Inspection request received:
Queensbury Building&Code Enforcement Arrive: PO an Depart: am/pm
742 Bay Rd., Queensbury,NY 12804 Inspector's Initials:
NAME: krr PERMIT NO.: 0 3—°
LOCATION: C4,. - INSPECT ON: 8''iti r 1 �^
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 length ft.
Length of each trench ft.
Depth of trenches ft.
Size of Stone
Seepage Pits: Number
Size: x
Stone Size:
Piping Size e
Building to tank
Tank to Distribution Box
Distribution Box to Field/Pit i
Opening Sealed: Y/N/Partial
Location/Separations '
Foundation to tank ft.
Foundation to absorption ft.
Separation of Pits ft.
Conforms as per Plot Plan V Y N
Location of System on Property:
Front 0% Left Side Right Side
Middle Front Middle Rear
System Use Sta us:
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
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Septic Inspection Report
Office No. (518) 761-8256 Date Inspection request received:
Queensbury Building&Code Enforcement Arrive: Cit 6( am/pm Depart: am/pm
742 Bay Rd., Queensbury,NY 12804 Inspector's Initials:
NAME: � r L) PERMIT NO.: 0 0 11
LOCATION: �! O t (',A.„u INSPECT ON:
RECHECK: -.) -
Comments and/or diagram
Soil Type• Sa oam/Clay
Type of Water: Municipal/ ell Wate
Waterline separation distance ft.
Well separation distance it `l-ft.
Other wells: ft.
Absorption Field: Total length ft.
Length of each trench ---- C,o ft.
Depth of trenches ft. ►- t (C f'
Size of Stone 2- rr
Seepage Pits: Number
Size: x
Stone Size:
•
Piping Size T Ise
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 joy_ 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:
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
TOWN OF QUEENSBURY
BUILDING & CODE ENFORCEMENT
742 Bay Road
Queens bury NY 12804
(518) 761-8256
SEPTIC DISPOSAL SYSTEM INSPECTION
Name I<VV ,e.r-
Location US/,`,�
/ 1 �"
Date I24b 2 - Permit # (i3.--6,--
SOIL TYPE: Sand-Loam-Clay-
Results of Percolation Test-
(if applicable) Rate-Minute/Inch
TYPE OF SYSTEM:
ABSORPTION FIELD: Total Length
Length of each trench
Depth of trenches
Size of stone
SEEPAGE PITS: Number-
Size - ft. x { ft.
Stone size
PIPING: Size ype
Bldg. to Tank
Tank to Dist. Box
Dist. Box to Field/Pit
Openings Sealed? Yes . No Partial
LOCATION/SEPARATIONS:--'
Foundation to Tank feet
Foundation to Absorption; feet
Separation of Pits feet
Conforms as per Plot Pla Yes No
LOCATION OF SYSTEM ON PR PERTY:
(circle one)
Front - Rear - Left Side Right Side
Middle Front - Middle Reak
COMMENTS:
,hri tn.„JL
_57)
/mut vim/ 6/- "lb^ Y
SYSTEM USE APPROVED: YES NO
Arrived: '41-3
Departed:
Buildin9�sP ector
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.1• _,.i C1✓TAT""T N? /";, l�T-\liGr^ ^ �i���V �r ` -- -.. ..-._ M _Nly .5 ;5
r n p VET A., A T� prr H h -1SECONDS L1, _ C l IN A
j F �'' BELOW GRADE. THE GI 0 ND IS FLAT f 3
IN f zIS 1'.'Z--A AND PROVIDES A MI'!" `/IL'M OF `: OF FSOIL.
'T�TABLE
?THE SEPTIC SYSTEM EM IS DESIGNED FOR �
W 3 - BEDROOM
T' `;ID1� CE O �V'" T? MODERN PLUMBING FIXTURES. THE EXISTING
2. CONC-", -'.TE SEPTIC TANK ( NEW IN 2902 NOT YET ? T �
JSED) 1S A 1,250 ,GALLON TANK, NT SIZE A�__ V�' L_ BE
`',._mil �� 't r'., r TT\ >/01.E :J ACCEPTAB.—E FOR A RESIDENCE.tCY. A NEW - BEDROOM
�L 1 I'Z LTA r'f" i `� .-•SIDElY CE � IT L HAVE a -
r N�� � ARGE�OF '.D. A\D �J'I,�, REQUIRE TOTAL
v , BUILDING E '.
BED As.- OF Q. T. 3�0 D VII;T c,- „
( 1 J BY .. ). Tr1E :3ED SIZE CHOSEN"OR ' - 1S .2BS0RP'_110N AREA WIT T E 2 REVIEWED B
�. ✓ B 15 F BY �S FT.. THE ( 3 ) 20 FT.LATERAL S OF 4" PERFORATED PIPE WILL B'� r r /
C. \TARS ',,'1TIi T'�FT'� « ."STALLED ALLED n , , FT. DATE }
- -1,
OPEi�", EN'
CAPPED A # C 0 N C ' TF,
DSTRIBUTI;`i1' BOX WILL BE USED m rr.
ED =O ACCEPT EFFLUENT '�ROM THE r SEPTIC TANK AND FEED THE 3 LAT'E''RALS T11 LATERALS �
T iSTA E
LLrD LEVEL THE 4 BE cr. ��J1LL BE r
D --�DF.WALLS WILL EXTEND 2'-�" F
CENTER -':Z ENDS OF THE I.ATERAL;�. THE ENTIRE B • - RC_� THE
^ _
IJD AREA SHALL BE
COVE_ED WITH A PERMEABLE GEOTEXTILE FABRIC AND THE TOP OF
!_•_ ;_ F !; �O � 1
THr BED `'MALL HAVE A MINIMUM �?F 2'-0"-UF E.XISTING SITE MATERIAL
COVER. ABOVE THE SITE MATERIALS A MINIMUM
WILL BE APPLIEL'
uET O1 6 OFTOPSOIL RECEIVED
THE ENTIRE AREA WILL BE SEEDED UPON Et_ S�NO GR�uL1LZ I
t
COMPLETION. ' / �
3. ALL SEPARATION DISTANCES LISTED IN TABLE v
20FT T� T, HE NEW YORK - e , �. .'o' ' . (-1, ' '.� ..
- TOWN OF QUEENSBURY
STATE F?� �' ' CIE ITT 0 HEALTH DESIGN n ` ' a (� -1 BUILDING AND CODE
_.
HANDBOOK FOR INDIVIDUAL (�+' r. �` 1
R._, _ �l 'DER � � _ '
,,iSTEWA TREATMENT SYSTEMS , _ � ;- - � .'TENS 1996 SHALL BE _ --
M ET. -- --- - ,
4. T��E S E�m T� TANK r SHALL
I -- __.-- .__ _.._. `_ �_ _ --G __•_` __/ / � �
��p4ES510Na1�
�A�K .;1�ALL BE PUMPED OUT AT OPTIMUM 1 UM INTERVALS TO ` w°. .•`,\0NT
PREVENT ANY CARRY-OVER SOLIDS TO THE ABSORPTION FIELD. I ! , ► r, �F., /
5 YI: SEPTIC ' >NK AND THE DISTRIBUTION BOX SHALL BE OF P 1
CONCRETE AS MANUFACTURED 2 s, THE T RE-CAST G
O R 1 MILLER CO. OR APPROVED EQUAL.
6• Tr A FOT'RT=' -,7„200� IS A CT� ��,._._.�,.•.__ �p fry s
r , _ k DDED, NOW OR LATER THE �L-- /' j
` , T HL 1,250 GALLON
-- _C TANK 1'4IL1. STILL BE ACCEPTABLE,. THE ABSORPTION -. • ,-- /ICJ /
3=� `v'^' 1- E 2'?' X 25' W'TH 4 EA. LATERALS 20' LON'G.
ant , ;� 1 NT('
� � z � TOMFR V ,
' CONSULTING ENGINEER
Z
DONALD
& SANDRA KRUGER -
2 3 OSPREY VIEW, QUEENSBURY, NY.
Scale: 1"= 10'-0"Revisions: Drawn by: P.J.B. Date: 01-03-03
Revisions:
Revisions:ons:
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