2004-855 TOWN OF QUEENSBURY
ET
742 Bay Road, ueensbu NY 12804-5902 (518) 761-8201
Community Development - Building & Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: P20040855 Date Issued: Monday, November 08, 2004
This is to certify that work requested to be done as shown by Permit Number P20040855
has been completed.
Tax Map Number: 523400-239-007-0001-005-000-0000
Location: 129 ASSEMBLY PT. Rd
Owner: ROCHELLE ADAMS
Applicant: ROCHELLE ADAMS
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 4iot--
property owner of the responsibility for compliance with Site Plan, ("- J VVY
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: P20040855 Application Number: A20040855
Tax Map No: 523400-239-007-0001-005-000-0000
Permission is hereby granted to: ROCHF,T,T,R ADAMS
For property located at: 129 ASSEMBLY PT. 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: ROCHELLE ADAMS
129 ASSEMBLY PT Rd Septic Alteration Residential
Total Value
LAKE GEORGE, NY 12845-0000
Contractor or Builder's Name /Address Electrical Inspection Agency
OI JEENSBIIRY SEWER
JAY SWEET
Plans&Specifications
2004-855
SEPTIC ALTERATION
$25.00 PERMIT FEE PAID -THIS PERMIT EXPIRES: Saturday, October 29, 2005
(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.)
,� j er 29, 2004
' 'vhak
Dated at the Town f Q ue i bury f�Fri1�
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: / , / '_1:-.1-%yY.b /-r /)J
Tax Map No. / /
- File Permit NoD ?5
Fee Paid
Owner's Name: /.fir c ; 1 4,.:_:1 4 G'l t c
Address: l 7 (`,/f N' ry (j Pr J
2. INSTALLER'S NAME 1-.. ..-t ' is 3 -r)--• ( C `�
J PHONE NO. J
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 = 3 3 6
Garbage Grinder Installed yes_ /
Spa or Hot Tub Installed yes— / ng pa S
i `S
4. PARCEL INFORMATION: (circle applicable information&indicate measurements)
Topography Soil Nature Ground Water Bedrock or Impervious Material . Domestic Water Supply
CWa� Viand at what depth at what depth municipal
Rolling loam feet feet well
Steep slope clay
if 13 �� well; water supply
—%slope other from any septic-system
depth: f)rT 7 2��0 absor tion/is ft.
other ��
Percolation Test: (To be completed by licensed professional engineer or!acchitect)
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:P_S 6) 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:T� < p f, i.6 length and/or size 17. l f\ - ; `� �c
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 of the Town of Queensbury Sanitary Sewage Disposal Ordinance.
= s
g tur0of responsibl person Date
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7. SIONATURE &INFORMATION FOR. ,ONW.01.s:re"''•,``' w'"""' ",
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Septic Inspection Report
Office No. (518) 761-8256 Date Inspection reque t received:
Queensbury Building&Code Enforcement Arrive: am/ a . m/p
742 Bay Rd., Queensbury,NY 12804 Inspector's Initials: c,
NAME: 4\16L•v.5 PERMIT NO.: 0 J/
LOCATION: t 2Age_i-N- (5 (A-- INSPECT ON: 4✓ , ,A0)4/
RECHECK: (Pe
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. ( l< _ ° I<7
Size of Stone ru(mi
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
)6/1/ eC- .
Location/Separations I /a&
Foundation to tank ft. // O Ci
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 iddle Rear
S stem Use Stat :
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
Septic Inspection Report
Office No. (518) 761-8256 Date Inspection request received: ,
Queensbury Building&Code Enforcement Arrive: am/pr� Depart: / 1am/pm
742 Bay Rd., Queensbury,NY 12804 Inspector's Initials: J
NAME: p. 4 #k t I PERMIT NO.: V 1456
LOCATION: fl A' 'CO , INSPECT ON:
RECHECK:
Comments and/or diagram
Soil Type Sand/Loo�I 'Clay
Type of Wa . unicipal/Well Water
Waterline separation distance l/7j t ft.
Well separation distance ft.
Other wells: ft.
Absorption Field: Total length C4 jay,& Q ft.
Length of each trench 41'rj ft.
Depth of trenches ft.
Size of Stone , jc i) yi
Seepage Pits: Number
Size: x
Stone Size:
Piping Size Typp
434 4o tank Ip Pv �q�L �( SSi < e
Tank to Distribute Box • yi l-•sQ $ - !pot,d
Distribution Box • Fi: d/Pit 11 K 6C P 3�
Opening Seale. Y/ /Partial
Location/Separations B
Foundation to tank /1 474N ft.
Foundation to absorption - deid 61 ft.
Separation of Pits ft.
Conforms as per Plot Plan N
Location of'Syste on Property: � vY 6/(/.4
6C�V
Front Rear Left Side Right Side
Middle ront Middle Rear
System Use Status:
pproved
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
MAP REFERENCE: EXCEPTING AND RESERVING ANY RIGHTS TO
MAP OF LANDS OF THE PUBLIC THOSE LANDS THAT LIE WITHIN a
PAUL KNOX III THE BOUNDS OF KNOX ROAD. a_
DATED: SEPTEMBER 28, 1994
LAST REVISED: MAY 26, 1998 �• GEO-TEXTILE COVER
4 PERFORATED PIPE w o
BY: WAYNE R. RAYMOND _I I�I, =',1111= 'TYPAR 3401 OR EQUAL SLOPE 1/16 1/32 PER FT. N
LEGEND. �
LICENSED LAND SURVEYOR 17" MAX. —)III — — U
MAP OF A SURVEY MADE FOR O IPF = IRON PIPE FOUND 10" MIN. O 0
MICHAEL & GAIL DAWSON O IRF = IRON ROD FOUND 0
DATED: NOVEMBER 24, 1999 O CIRF = CAPPED IRON ROD FOUND
LL-
LAST REVISED:MARCH 4, 2001 _ _
OIRF moo., — UTILITY POLE
BY: VAN
DUSEN & SIEVES °�• '°` �; :�:..: �
LAND SURVEYOR . .,. , :. .._,...:._ ; �;,:; �::; :: �:�:`-�`��'�• cn
TYPE B IN-DRAIN UNIT
jl CONCRETE SAND ` • .i ~
NO N
X BY ELJEN CORPORATION NYSDOT ITEM #703-07 —
� Q
EX. TREE -'--- ROAD BIO—MAT ABSORPTION SYSTEM
_ STANDARD TRENCH PROFILE o Z
w $82��$� E N.T.S.
E
�$ NOTES:
NO WELL ON TH15 W EX. TREE N 329. N19'13'S3"E S828 07'48"E 1. END OF DISTRIBUTOR PIPE MUST BE
PROPERTY WITHIN 100' OF 62' 4.51' 4 PLUGGED.
COMMON PROPERTY LINE N 40 LF ELJEN
IN-DRAIN UNITS
CO
2 23 Q ASPHALT
617' MIN.4
AREA WEST
LANDS EX
OF F N • ' . SEPTIC TANK OF ROAD 0
!
KNOX :, OUTLET COVER 33,327 sq.ft. Jo,
c EX. TREE ING TOP ` W 0.77 acres �o�' /� p'�• Ro/lIv,
EXI OF SLOPEto ,
NEW TOP132 V: OF .�i`V. , jiJjii
OF SLOPE
1- 1 2" SEWER �� �jc�,`V�� `/^ AREA EAST I BACKFlLL WITH SUITABLE MATERIAL
F EXISTING TOE 1 BACKFlLL WITH SUITABLE MATERIAL �tt�
�� MAN ry'�• ►.`� OF ROAD
OF SLOPE NEW TOE NEW V • .� 675 S .ft. 4" MIN. TOPSOIL,
OF SLOPE
q SEED AND MULCH
PUMP STATION 20 U" OF 4" PVC '4 3' 0 0.02 acres
Mob
NEW DRAINAGE GRAVITY SEWER �"�ih� 1 OVERFILL TO ALLOW '�'��� ''•.,,, ���`
DITCH LINE 300, ,3 2 NEW FINISHED GRADE FOR SETTLEMENT
93 °� ��'n�rltl►I�►�►`
N82`'48-WC17
NN
i 1 M 3 36" 0,..
4• .
IR T'Eu472 6 4"0 PERFORATED PIPE MIN
17" MAX. w
SEPTIC SYSTEM DESIGN NO WELL ON TH15 .0 t FROM SHORE
PROPERTY WITHIN I00' OF GEO-TEXTILE COVER W
TYPAR 3401 f703-07 y7l"COMMON PROPERTY LINELANDS N F TYPE B IN-DRAIN UNIT6
DESIGN FLOW - NEW 3 BEDROOM HOUSE = 3300 GAL/DAY OF o / N82'57'48"W BY ELJEN CORPORA11ON "''• i : MIN.
DAWSON 4.19' CONCRETE SAND � W x
EX. SEPTIC TANK - 1,250 GALLON TANK REQUIRED NYSDOT ITEM #703-07 4' MIN. M
ABSORPTION FIELD - SYSTEM REQUIRES 3' USEABLE SOIL (WITHIN 1,000' OF LAKE GEORGE)
- TEST PIT SHOWS M O SEASONAL HIGH GROUNDWATER. - THEREFORE MAXIMUM SEASONAL HIGHSTANDARD SYSTEM PROPOSED WITH USE OF ELJEN IN DRAIN UNITS TOGROUNDWATER ELEYAl10N oti XGEO�� " 0
REDUCE SPACE REQUIREMENTS. � a Cr
- AT NYSDOH APPROVED APPLICATION RATE:
REQUIRES
IRE DESIGN FLOW WITH 1 TO 5 MINUTE PERCOLATION RATE �.�R IS BA� BIO—��AT ABSORPTION SYSTEM 0
REQUIRES A MINIMUM 39 LINEAL FEET OF ELJEN IN DRAIN UNITS. � z
- USE 1 LINE OF IN-DRAIN UNITS WITH 40 FT OF IN-DRAIN UNITS IN STANDARD TRENCH SECTION
EACH = 40 FEET TOTAL
Dec�►at N.T.S. FASITE PLAN ' z
8CJ1LE T-30' r.. 10000,
/ 0
wb
SOILS DATA INSTALLATION OF DISPOSAL FIELDS
z
m
0 -6" TOPSOIL 1. CONSTRUCTION SHALL BE AS SHOWN ON THIS DRAWING,
6 -17" FINE SILTY LOAM AND SHALL BE IN ACCORDANCE WITH THE N.Y.S.
DEPARTMENT OF HEALTH INDIVIDUAL HOUSEHOLD SYSTEMS, AND
17-56" FINE SAND COMPACT ASTM F481-76 INSTALLATION OF THERMOPLASTIC PIPE AND
56-68" FINE SAND O
CORRUGATED TUBING IN SEPTIC TANK LEACH FIELDS.
MOTTLING AT 53 2. NO HEAVY EQUIPMENT SHALL BE ALLOWED WITHIN THE LIMITS a+
PERCOLATION RATE - 1" IN 4 MINUTES - 52 SECONDS CONCRETE OR STONE OF THE DISPOSAL FIELDS AFTER PIPE INSTALLATION HAS BEGUN. W FINISHED MARKER ABOVE ALL 3. AFTER EXCAVATION OF 4' WIDE TRENCH TO THE DEPTHS REQUIRED,
SOIL & PERC. TEST BY NACE ENGINEERING, P.C. 9-27-04
GRADE BURIED COVERS THE WALLS AND FLOOR OF TRENCH SHOULD BE CLEANED
RECOMMENDED. AND RAKED TO ACHIEVE AN EVEN SURFACE AND TO LOOSEN
SMEARED SECTIONS OF TRENCH.
ACCESS LATCH 4. PLACEMENT OF CONCRETE SAND, IN-DRAIN UNITS, PERFORATED PIPE,
INLET BAFFLE HOWN AND IN ACCORDANCE V
12" IN. COVERRO�(ER ATH
ELJEN IN-DRAIN DESIGN MANUALD GEO TEXTILE SHALL BE AS SAND NYS OH APPROVAL CONDITIONS.
STRUCTU E 5. THE PIPE AND IN-DRAIN UNITS SHOULD BE LAID AT THE GRADES
ELECTRICAL JJNCTiON AND TO THE RELATIONSHIPS SHOWN ON THIS DRAWING, MAINTAINING a
STRAIGHT CONTINUOUS GRADES WITHOUT SAGS HUMPS SEPARATED x
BOX JOINTS OR OTHER UNSUITABLE CONDITIONS. W4E PIPE SHALL BE LAID
WITH THE HOLES DOWN IN ALL CASES. gyp;
0 O TO ABSORPTION 6. ALL DISPOSAL FIELDS SHALL BE GRADED TO SHED RAINFALL w 6
FIELD AND TO DIVERT SURFACE RUNOFF FROM ADJACENT AREAS AWAY ^
FROM THE DISPOSAL FIELD. F� v
BMERSIB :.• ALL OUTLET INVERTS 7. NO PART OF THE DISPOSAL FIELD SHALL BE INSTALLED UNDER DRIVEWAYS.LIQUID LEVEL PUMP To SET AT w
_ Al." PVC EXACTLY THE SAME A•..
MIN. SLOPE it ELEVATION.
1/8" PER FOOT ALARM ON
2 DIA. PI DISTRIBUTION BOX PEA GRAVEL Fil. FCq PC
EXISTING 1250 GALLON PUMP ON iO " 'E 1-1/2" FORCE MAIN - PVC OR COPY SEPTIC TANK POLYETHYLENE PIPE N.T.S.
PUMP OFF N CHECK VA
I m
Cr
{A'z.
` CONCRETE TO BE
TROWEL FINISHED ILL. R-4 `x �4 � <„ �5`1 a wT 1 0 MANHOLE
I.D. PRECAST CONCRETE MERCURY FLOAT EFFLUENT PUMP `./MANHOLE AND
INTEGRAL BASE SWITCH WITH INSTALLATION Gq�°�'I�V1/E°1� a`r
AND FLAT SLAB TOP. WEIGHT TYP.
AS MANUFACTURED BY FORT MILLER ( ) E
OR EQUIVALENT DATE
(NO LADDER RUNGS)
0000 O
�� W A
EFFLUENT PUMP STATION_ r�
EXISTING SEPTIC TANK
N.T.S. w
N.T.S. 1. PUMP TO BE EFFLUENT PUMP RATED AT A MINIMUM OF 30 GPM
AT 16 FEET TOTAL DYNAMIC HEAD. PUMPS TO BE 1/3 HP GOULDS MODEL 3885WE03L OR EQUAL
'r bolieve
I ^f azr tl , f
al .,t,e �• , �„ Dates OCiOber,2004
2. PUMP CONTROL PACKAGE TO ALTERNATE BETWEEN LEAD AND LAG
..,� , 10
PUMPS AND TO BE SUPPLIED BY PUMP MANUFACTURER. AUDIBLE ' r a v,� SCALE_AS
NOTEDAND VISIBLE ALARM TO BE ACTIVATED BY LAG PUMP ON FLOAT. � t�p If
3. PUMP CYCLE VOLUME - 21 GALLONS - 8OX OF ABSORPTION r?1•
ABSORPTION FIELD PIPE VOLUME. I 1
Id " jF ` 49148
%EfftOF2
DWG. NO. 49148