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2005-701 TOWN OF QUEENSBURY 742 Bay Road,Queensbury,NY 12804-5902 (518) 761-8201 Community Development - Building & Codes (518) 761-8256 CERTIFI CATE OF COMPLIANCE Permit Number: P20050701 Date Issued: Thursday, September 08, 2005 This is to certify that work requested to be done as shown by Permit Number P20050701 has been completed. Tax Map Number: 523400-302-014-0001-039-000-0000 Location: 48 DIXON Rd Owner: KATHLEEN A DENIO-EVANS Applicant: KATHLEEN A DENIO-EVANS This structure may be occupied as a: Septic Alteration Residential By Order of Town Board WN O U NS Issuance of this Certificate of Compliance DOES NOT relieve the 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. i TOWN OF QUEENSBURY 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201 Community Development-Building& Codes (518) 761-8256 BUILDING PERMIT Permit Number: P20050701 Application Number: A20050701 Tax Map No: 523400-302-014-0001-039-000-0000 Permission is hereby granted to: KATHLEEN A DENIO-EVANS For property located at: 48 DIXON 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: KATHLEEN A DENIO-EVANS Septic Alteration Residential 48 DIXON Rd QUEENSBURY,NY 12804-0000 Total value Contractor or Builder's Name / Address Electrical Inspection Agency SANITARY SEWER DAN DRELLOS PO BOX 224 GLENS FALLS NY Plans&Specifications 2005-701 SEPTIC ALTERATION $25.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Saturday, September 02, 2006 (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 Town of 02, 2005 ?72ZSr.V ay 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 X Location of installation: ��` _ File Permit No. Tax Map No. �jle } Fee Pard,_:- Owner's Name: yNJ' Address: �� -4 ;AK 'C1 �&D 2. INSTALLER'S NAMEA�( :;4 PFION NO. 3. RESIDENCE INFORMATIONcirof 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 -3 x 150 gal/bdrm = , 1980— 1991 x 130 gal/bdrm = � 1991 —present x 110 gal/bdrm / o�Garbage Grinder Installed yes_ / no Spa or Hot Tub Installed yes, 1 no 4. PARCEL INFORMATION: (circle applicable information& indicate measurements) a h So ature Ground Water Bedrock or Impervious Material Domestic Water Su Iv Flat sand at what depth at what depth < munici a. o ing oam 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: 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 leac field for each Garbage Grinder, Spa or Whirlpool Tub. _ ��J�r�'/�Thy b/ Septic Tank:, 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: # Z / depth or thickness _feer Bed System Size: x Alternative System: length andior 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 of the Town of Queensbury Sanitary Sewage Disposal Ordinance. ignature of respon 10 person Date r Town of Queensbury Sewers and Sewage Disposal Chapter Appendix C ABSORPTION FIELD SEPARATION REQUIREMENTS 1 lk f. POND AD Appendix C ABSORPTION FIELD SEPARATION REQUIREMENTS PON •• ' +w au- *m Wa-.u. r r "� sur�►rxc. :ClMdM L �,v►-ter r' Septic Inspection Report P P � f Office No.(518)761-8256 Date Inspection request received: i Queensbury Building&Code Enforcement Arrive: am/ Depart: a pm 742 Bay Rd.,Queensbu ,NY 12804 Inspector's Initials: NAME: PERMIT NO.: LOCATION: INSPECT ON: RECHECK: Comments and/or diagram Soil Type: a Clay Type of Water• Municip l/Well Water Waterline sepa ' ance ft. Well separation distance Other wells: ft. .12 Absorption Field: Total length ft. elf 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 -3-1— Opening Sealed: Y/N/Partial End Location/Separations Foundation to tank ft. Foundation to absorption ft. Separation of Pits ft. Conforms as per Plot Plan Y N Engineer Report and As-Built Y N Location of Syste on Property: Front Re Left Side Right Side Middle Front Middle Rear S stem Use Stat : Approved Partial Approved and needs to be re-inspected, please call the Building&Codes Office Disapproved Last revised 1/6/05 NACE ENGINEERING, P.C. 169 Haviland Road, Queensbury, NY 12804 Phone-518-745-4400 Fax -518-792-8511 August 30, 2005 Project#49183 Mr. Jay Sweet Queensbury Septic PO Box 4283 Bay Road Lake George,NY 12845 Re: Replacement Septic System Evans Residence—48 Kensington Road, Queensbury,NY Dear Jay: At your request we have reviewed your proposed replacement septic system design at the site of the existing 3 bedroom house of Kathy Evans at 48 Kensington Road in Queensbury. As per our conversation the residence has an existing failed septic systems. We have reviewed the proposed replacement septic system design and we agree that a standard absorption bed is acceptable. Based upon a design flow rate of 450 GPD (older style plumbing fixtures) and a percolation rate of 1 to 5 minutes, you will need 475 square feet of absorptive area. We recommend using a 20 ft wide by 25 ft long absorption bed with 4 — 20 foot long laterals, which will provide 500 sf of absorptive area. Please call me if you have any questions. Sincerely, Thomas R. Center, PE Septic Inspection Report Office No.(518)761-8256 Date Inspection request received: Queensbury Building&Code Enforcement Arrive: am/ epart: L p 742 Bay Rd.,Queensbury,NY 12804 Inspector's Initials: NAME: 67VA A)S PERMIT NO.: 05 LOCATION: t Xd � INSPECT ON: 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 Type Building to tank Tank to Distribution Box Distribution Box to Field/Pit Opening Sealed: Y/N/Partial End Cap* Location/Separations Foundation to tank ft. Foundation to absorption ft. Separation of Pits ft. Conforms as per Plot Plan Y N Engineer Report and As-Built Y N Location of System on Property: Front Rear Left Side Right Side Middle Front Middle Rear System Use Status: proved artial Approved and needs to be re-inspected, please call the Building&Codes Office Disapproved Last revised 1/6/05 Y TOWN OF CCU EN \y C D D BUILDING REVIEWED DATE --- a a i D PO a� is' 169 Haviland Road, Queensbury,NY 12804 Phone-518-745-4400 Fax -518-792-8511 Augur 30, 2005 Project# 49183 Mr. Jay Sweet Queensbury Septic `1 PO Box 4283 Bay Road Lake George,NY 12845 ® 201 Re: Replacement Septic System Evans Residence—48 Kensington Road, Queensbury,NY Dear Jay: At your request we have reviewed your proposed replacement septic system design at the site of the existing 3 bedroom house of Kathy Evans at 48 Kensington Road in Queensbury. As per our conversation the residence has an existing failed septic systems. We have reviewed the proposed replacement septic system design and we agree that a standard absorption bed is acceptable. Based upon a design flow rate of 450 GPD (older style plumbing fixtures) and a percolation rate of 1 to 5 minutes, you will need 475 square feet of absorptive area. We recommend using a 20 ft wide by 25 ft long absorption bed with 4 — 20 foot long laterals, which will provide 500 sf of absorptive area. Please call me if you have any questions. Sincerely, Thomas R. Center, PE