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2002-606 44.4111hi TOWN OF QUEENSBURY HIE COPY Road,Queensbury, 12804-5902 (518) 761-8201 742 Bay Qu ry, Community Development - Building & Codes (518) 761-8256 CERTIFICATE OF COMPLIANCE Permit Number: P20020606 Date Issued: Monday, August 05, 2002 This is to certify that work requested to be done as shown by Permit Number P20020606 has been completed. Tax Map Number: 523400-226-016-0001-047-000-0000 Location: 264 CLEVERDALE Rd Owner: DIANE COWAN Applicant: DIANE COWAN This structure may be occupied as a: By Order of Town Board Septic Alteration Residential TOWN OF QUEENSBURY 1/ - Director of Building&Code Enforcement 41111141 TOWN OF QUEENSBURY ` 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201 Community Development-Building& Codes (518) 761-8256 BUILDING PERMIT Permit Number: P20020606 Application Number: A20020606 Tax Map No: 523400-226-016-0001-047-000-0000 Permission is hereby granted to: DIANE COWAN For property located at: 264 CLEVERDALE 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: DIANE COWAN 59 BLIND ROCK Rd Septic Alteration Residential Total Value QUEENSBURY,NY 12804 Contractor or Builder's Name /Address Electrical Inspection Agency ROT TIER_ JOE BOX 301 CLEVERDAT,F,_NY Plans&Specifications BP 2002-606 Septic Alteration as per plot plan and specifications $25.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Saturday,July 26,2003 (If a longer period is required,an application for an extension must be made to the code Enforcement Officer of the Town of Queensbury before the expiration date.) Dated at the Town of Que bury; Friday,July 26,2002 SIGNED BY for the Town of Queensbury. Director of Building&Code Or nt Application for Permit-Septic Disposal System Town of Queensbury 742 Bay Road Queensbury,NY 12804 (518) 761-8256 1. OWNER INFORMATION: e�( Ce (2L Location of installation:iC•tee. G, / �s"4„'Z 'f4 ce Use fl /A•sueN •�j �' I '4 • !�/� i File P ' No. I � Tax Map No. /3 / _3 /,..t 7 _ Fee P d ' i`' _ 3 Owner's Name: /c,20� 4,,.,,..., - j Address: .3 7 / /f C Al - v�cXo. /(P'/.. q7 2. INSTALLER'S NAME : _ '. /�e.,G 4:, PHONE NO.s'4P-«e-3s'Yy 3. RESIDENCE INFORMATION; (circle year of dwelling, indicate#bedroom(s) and multiply# l -A(,,,- � � cl bedrooms with applicable gallons per bedroom to equal total daily flow _ 4f� Year of House: No. of Bedrooms x Computation = Total Daily Flow 1'I• 1 .rOtA, S 1980 or older x 150 al/bdrm = °Sy, uF. 1980- 1991 .3 x 130 gal/bdrm = ..,3Ro ,,, "'-uko, 1991 -present x 110 gal/bdrm = ',,�� ate. Garbage Grinder Installed yes— / no ✓ Spa or Whirlpool Installed yes / no V 4. PARCEL INFORMATION: (circle applicable information&indicate measurements) T Soil Nature Gr Wat r Bedr r I rvious Material Dom i W 1 r- lat sand at what depth at what depth municipal ,444'1 sew7.. Rolling loam G /o feet ' 4 36 feet well Steep slope clay if well;water supply _%slope other from any septic-system depth: absorption is ft. other Percolation T : (To be completed by licensed professional engineer or architect) Rate: "✓ Aa minute per inch dle ‘dioZecee7.•-.%;--7-1 , -c 2. dee./Awe.s$ aim/ 5. PR() 'OSED SYSTEM:drbr New Constr1109n: All individual sewage Xsposal 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: /es ivgallon (min. size 1,000 gal) "j/e e a w C .•-1/" e-4+ ' L / Tile Field: each trench !d?' Z. fi: Total System Length: /// ft. +J`'s Seepage Pit(s): number of size of each: ft by ft. Size of Stone to be used: # ca / depth or thickness . feet Bed System Size: /e x 3 e to I A Alternative System: length and/or size 6. HOLDING TANK SYSTEM: (if required) 4.//i4 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. ��__� L7 1 d.t— '� Signature of resp nsible person ate • l „eDA.il .,navaa a-rarcMnARMI VOA MOLLVIIO lNi '2 alifLINNIDIS 'L • r—'--_r / /- \ x Kl � /1C ,,.,ufI;l t:Irt t y j_ HI LI I \ 'AttVl' 11.139 �. - / {....- 3 O -sn`:�II ../c1(• / 3t) n 3trIc L./ • hn,,s1 ,ram • �� billSka 1tt4Mt. -It.i lV/l to -tla)� ‘ 'S.,.......„...:,-,—% ..\... J-- ltsl'f r -• - ,I.N:4I ItI512l 111?)5131 NC)I.LV21 Vd fS - ( 1'I:►.11sI .NO1:1,tuuiotfty a x!pit:)ct(iv • .t.)lcIt:tl:) liau<i,t(I aliuma5 pun s.lan�as; 1.tnclbti.);,-mt) Jo timed . a P 3 e • tiir OF Q UEENSB br 'JUL Ns � 0 1991 APPLICATION FOR PERMIT 3LDG. & CODE DEPT. For the operation of t within the a wastewa _er treatment system Lake George Park persuant to 6NYCRR Subpart 646-3 SECTION 1: System Owner (otease make corrections as needed) System Location 523400 13.-3-29 TOWN: Queensbury NP COWAN. ROBERT D. TAX MAP: Section 59 BLIND ROCK RD QUEENS BURY. NY 12804 Block Lot # _— 5.23 4OD i3. _ 3—,2.7 PHONE# 1 /t g 0 (home) 793- 13 (work) G5 94"4/ (lake) SECTION 2: General Information (please fill in as much information as you can. I. °Type of Facility: �' )( Residence Multiple Residence Hotel/Motel Restaurant °Type of Wastewater System: Marina Other ool peptic Tank-Tile Fieid A Cessp `l Septic Tank-Seepage Pit Town Sewer- ' 'i ' Neighborhood System Unknown Holding Tank ° ems qn Average Flow (DAF*):—' Other; Describe °Septic Tank Size: /oo O SD gall Ons (see definition on reverse °Absorption. Fields: aWg of trenches Date Last Pumped: NFtr �G �Q Total trench length -----' Length of eac trenc � � (\ °Absorption Beds: Number of lateralse ; Overall field dimensions Total lateral len th Length of each lateral �� �P °Seepage Pits: Number g Overall bed dimensions �V e; °Distance Between Absorption Deviceeand Lake George:of 'War x G °Distance Between Absorption Device and any other surface ter Type of Surface Water Body body ; 2. °Date of Original System Construction: i9F1. Y' ~`1(02 °Date of any subsequent repairs, modifications or a terat ens: -- °Was A Permit ever issued to you for construction or repairs of your system. ° Yes No If yes, attach a copyof owes this fac ty have a SPDES** permit if it is available. permit? Yes _No If yes, attach copy 3. °Directions to Property: /�G,c/T bi.a,E ic,e-ae��4�'`��'-` �b 'CD'y' 'QuurE� °Color of Main Dwelling: ye«o“) Siding Type f2gy,E ; onstructionType ,c/lgy�,c °Enclose a photo o main dwe ing if you happen to have one (to assist inspectors in locating property) a r . 1 • 4. °Is Dwelling easo-3; or Year-round? (ci e one) If seasonal , how many peryear. 'Total Number of Persons Using the Property on Average 2 'Maximum Number of Persons Using the Property (July 4th, etc. 7 5. °Number of: Bedrooms: 3 Bathrooms: .2 Sinks: Z . Dishwashers: Garbage Disposals: i Washing Machines: Other Waste Generating Fixtures: 6. °In the area of ne leaching device: °Topography: X Flat ��_ Steep Slope her, a Slope °Soil Type: Sand Loam Clay Other °Depth to Bedroc ,p • Oep-th easc771 High Groundwater: a 7. °Water Supply: Municipal )(Lake +r Brook Other If water supply is a well , give separation - m absorption field 8. °Property Line Dimensions or Total Area of Property: / 7.5-X GD 9. °If possible, please provide a general description of the wastewater treatment system. Also, please draw a sketch showing property lines, buildings, other structures, driveways, septic tank(s) , distribution box(s) , pump ,chamber(s) , leaching device(s) , wells, streams, lakes, and any other physical features. Include all dimensions if possible. SEA 4 i�Aciifb 10. °Septic system last pumped out: Date: Hauler Notice: In a written statement, any person who knowingly makes a false statement which such person does not believe to be true has committed a crime under the laws of the State of New York punishable as a Class A M—demeanor (PL Sec. 210.45). I certify that to the best of my knowledge the information provided is correct. Signature of Owner: Date: 7-31/ *OAF stands for Design Average Flow which is the average daily wastewater flow from your facility. This is determined for residences by multiply the number of bedrooms by 150 gallons. **SPDES stands for State Pollutant Discharge Elimination System. If you have more than one septic system on your parcel of land, a separate application must be filed for each system. Number of systems 1 1 LOCATION SKETCH t � A L � �!,!1'v= OF L 60 _ ---- I `ate — _38i: :: C 1 t•ilt i to lir gib" 7.____ —>;.L IS L .y D rid; P. z � '(L— _ _(----.._ Y0' —4 ®:/600 GA1-. CONCRETE S i. TANK (EYtsTu�:.•� ®./000 Gnu. Conic�ET& AMP L.Ambs GF ZANSEN • ' DESIGN BASIS . 1. No. of bedrooms __a_ 2 . Daily flow 450 gpd Septic tank capacity 1000 gals . 3 . Y 4 . Percolation rate min/in. 5 . Length of absorption field - ft . . NAME: Mrs . Helen Cowan iDATE: Au ust 1 1986 I The above sketch shows the locations of the units comprising your sewage disposal system for future reference, in case of difficulty. It shows measured distances from abuildings , trees , garage , fence posts , etc. , to septic l distribution box and absorption field or seepage pits . �0 . it SAVE POST IN BASEMENT--------- SAVE -- .) . M - LANDS OF LABARGE A LOCATION SKETCH 1 —"1 © 1D 1 I. G © © TI : 1Iu] ii E O /6 LANDS OF JANSEN L AC = 20' 6" EC = 20' 9" • BC = 6 ' 0" ED = 16' 9" AD. = 26 ' 0" GH = 18' 0" -., BD = 7 ' 8" FH = 24 ' 0" + DESIGN BASIS 1. No. of bedrooms 3 �,�p1 13'' Ta7e, 2. Daily flow 450 gpd �� CIA �:'g �0 to 3. Septic tank capacity 1000 gals . M �•� N - VtlA l.' Al/ 4 . Percolation rate - min/in. i �� av • . 5. Length of abs field - ft 11' '��'� - - - .. AME s Mrs . Helen Cowan _ - ) . • Auyus L. . 419.&6 The above sketch shows the locations of the units comprising . your sewage disposal system for future reference, in case of . • difficulty. It shows measured distances from buildings , trees, garage, fence posts , etc. , to ,teptic tank, sewers , distribution box and absorption field or seepage pits . SAVE POST IN BASEMENT SAVE ._ lap / 3 - 3-2" `-' /1 a \ , i , A , ( 1 I ill 3:;. - --------- Y'S ----9 6,0 N 1 .�._.�.,....... _�.��.«...,�� .._, . ._..._ ,_, .-. --..- . - . - :,: . • .ti. i TOWN OF Q UEENSB UR Y • . IA ;.-i--_:• . -Neiltii6Ayiee' ' I. .4.:.• : ._._ a - Farll °If yl-Uf- 1J_._.---7. ` •- i- J _1 1 - " �^ _ ll—�_-7 —�- fie%!11Sj 1 • • • • • • • p and lea• fields and water source. •, '.,-t •g~��—•-!--T---L J ' .-,- :t ^T .— - d 1 L c`: � T _. 1 ._ __.-)IOV.Y.__ - - I.Y..a-- ' . 1-4.-I.A_. 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CC ..........11... ■■■■0■C■■E■ 1•11 -_ _- --_ - - -- _- i. ■■■■■M ■■■ ■■ ralitiffsias- ■■■■■■I■■. ■■■ ■ ■ _-_ •-_■■■■■■■■■■■■■ ■ ■ ■ ■ ■ - ■ . . ■■■■■■■■■■ ■■■ .■.CC■ - -...._ __ -_ - ■■■.■■■■■■EM ■■C ■ _ _ _ - _ ■■■■■■■ ■ ■U■IN__ .__ _ _ ��`-'r TOWN OF QUEENSBURY BUILDING & CODE ENFORCEMENT 742 Bay Road Queensbury NY 12804 (518) 761-8256 SEPTIC DISPOSAL SYSTEM INSPECTION Name &oWl .)V Location 7Z ,y eJg0, da/ Date / a rR. i Permit # door 6 0 t SOIL TYPE: Sand Loar-Clay- / D 'JYS`, Results of Percolation Test- (if applicable) Rate-Minute/Inch TYPE OF SYSTEM: ABSORPTION FIELD: Total Length,, /4O r Length of each tren Depth of trenches Size of stone t !'�- , SEEPAGE PITS: Numb- Size - ft. ft. Stone size PIPING: lr Si a Type Bldg. to Tank i jC/6„--Atx.r� Tank to Dist. Box s/ Dist. Box to Field/• ' . '► ' Openings Sealed? Y-s No .-TT 'l LOCATION/SEPARATIONS: Foundation to Tank feet Foundation to Absorption 17 eet Separation of Pits f et Conforms as per Plot Plan Ye No LOCATION OF SYSTEM ON PROPERT : (circle one) Front - Rear - Left Side - R. t Side Middle Front - Middle Rear aA,p d5e 44. COMMENTS: SYSTEM USE APPROVED: 0 NO Arrived: Departed: ' Ail \<' ,J r Building Inspector TOWN OF QUEENSBURY BUILDING & CODE ENFORCEMENT 742 Bay Road Queensbury NY 12804 (518)761-8256 SEPTIC DISPOSAL SYSTEM INSPECTION Name Car,44:4— Location ( 4/4, v /�� Date 7 y d L Permit # 62-664 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 - f` ft. Stone size PIPING: Size ype Bldg. to Tank Tank to Dist. Box Dist. Box to Field 'i Openings Sealed? Y, s No Partial LOCATION/SEPARATIONS i Foundation to Tank feet Foundation to Absorp ` ,,n feet Separation of Pits feet Conforms as per Plot Pla -- Yes No LOCATION OF SYSTEM ON PRO' RTY: (circle one) Front - Rear - Left Side - R .ht Side Middle Front - Middle Rear COMMENTS: s`oiv ,574,i. /3 �izPJcar . SYSTEM USE APPROVED: YES S Arrived: 31m) Departed: 3 Building Inspector JUL-25-2002 THU 01:20 PM JOE ROULIER FAX NO, 518 656 9901 P. 01 loo Roollor (518)656.1544 Ilnx(3 t 9)656.9901 Ilex 30t,Clowdeto,NY 12920 ado QMV �N Z-or.Ao jr 4. JUL-25-2002 THU 01:21 PM J.OE ROULIER FAX NO, .518 656 9901 P, 02 fa 07/26/2002 12:17 518-251-5329 JAME8 C HUTCHIN3 PME 02 JAMS) E. HUTCHI S, P.E. roilauiting Enginoom PC) l30X 220» 12 t afrOle Avenue, North Crook, NY 1285:3 (W$)e8-l-4210(Phone) 1!518) 231.5329(Fax) hutchins0laceln",com July 25, 2002 02-104 Mr. Joseph Rouller P.O. Box 301 Cievencialej NY 12820 Rot Robert Cowen Residence Cleverdale Queenstxlry (T) Warren (C) Tex Map,. 13.3-29 Dear Joe: At your retluest, I visited tide above project nn July 2.3, 2002 In order to svaluAte. the design of existing wastewater system, This system Is mound type eonstructlon furtther described Its a 1991 permit application to the Town of Queensbury with an untitled drawing attached. I hand excavaLed two test holes to evaluate the soil conditions, The test_. hole sails were essentially identical and were logged as follows. Of'— 3" Brown Sandy Topsoil 3" . 28" Brown nine Sand, LILtle Slit (Very Uniform) 28" Stone Absorption Bed Pencolatlon it 14" 1172 Minifts l he existing site condlUons are generally consistent with the untitled dQalgn drawlog. 1 have olso reviewed this drawing for the mound construction. The sketch suggests that 380 *!- square feet(SF)of absorption tied was constructed. Under today's standards (Individual Residential Wastewater JUL-25-2002 THU 01:21 PM JOE ROULIER FAX NO. 518 656 9901 Pi 03 25/2002 12:17. 52s-°251--5229 JAMS � t.1uTCHYN9 PhC�F 0 . Treatment Systems Design Handbook- 1996, New York ante Department of Ntalth), this absorption area is sufficient fvr 360+/�gallons per tray. This equates to 120 +/- gallons per day per W. rooin which I�oppropriate fdr a home partially retrofitted with today's low water consumptlon toilets, faucets, and showerheads, Based on my observation, this design is in general conformance with Way%standard as noted above. I rommmend while the pressure distribution system Is being repaired, that the"as bullrconditions and dimensions are verified. . As we also discussed-on site, I fudher recoMmend that you convince yourself that failure of the pump to deliver effluent to the held Is=a result of pump problem, Assuming the pump Is operating properly, I would concur that the pressure distribution system should be Investigated, Joe, I trust the ab ovo responds to your request. Should you have any questions,do not hesitate to convict me. 1lery my your es E. Hutchins, P, . " . .. .. ._.n.. r ..a....-... -.-.. ...t w .-... .. ..,,ter •+i': - l i .,T. _ _ _ t.:y:.. ..;.' -- _.t N'•n-....,�..... ._::.. Fyn. - r n is . _r a ( M 1 LOCATION SKETCH AA L ' of Li at\czcE. N 1`o., ..- , _ -• - _--_— -- - --- L.- 1 II __ _ _ __ -t di r A Is cki g D ? La.o----- _ 2L b'_: ( O c/DOo GAL. C (-REM SEPT(c' K• ./0uo GA1_• Lora pump TANK (EAusTina ) ? © I ANDS OF TANSEN ' DESIGN BASIS , 1 No. of bedrooms 1 TOWN OF QUEENSBUR , 2 . Daily flow 450 gpd BUILDING �GD DEP . Septic tank capacity1000 gals REVIEWED BY 1� 3 . 71111111 4 . Percolation rate - min/in. DATE 5 . Length of absorption field ft. NAME: Mrs . Helen Cowan • DATE: August 1 1986 The above sketch shows the locations of the units comprising your sewage disposal system for future reference , caedifficulty. It shows measured distansfrom abuildings , trees , garage , fence posts , etc. , septic tdistribution box and absorption field or seepage pits . SAVE POST IN BASEMENT SAVE