2005-880 TOWN OF QUEENSBURY
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742 Bay Road,Queensbury,NY 12804-5902 (518) 761-8201
Community Development- Building & Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: P20050880 Date Issued: Tuesday, December 279 2005
This is to certify that work requested to be done as shown by Permit Number P20050880
has been completed.
Tax Map Number: 523400-297-007-0001-006-000-0000
Location: 55 CHESTNUT RIDGE Rd
Owner: ANN MC CANN
Applicant: ANN MC CANN
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
e owner of the responsibility for compliance with Site Plan
property sp ty p ,
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.
r TOWN OF. QUEENSBURY
r _a 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development-Building&Codes (518) 161-8256
BUILDING PERMIT
Permit Number: P20050880 Application Number: A20050880
Tax Map No: 523400-297-007-0001-006-000-0000
Permission is hereby granted to: ANN MC; C',ANN
For property located at: 55 CHESTNUT RIDGE 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.
., i ? Tv ,of Cons ne truction Value
Owner Address: ANN MC CANN
55 CHESTNUT RIDGE Rd Septic Alteration Residential
. Total Value
QUEENSBiJRY!NY 12804
Contractor or Builder's Name /Address l Electrical Inspection Agency
SANITARY SEWER
DAN DRELLOS
PO BOX 224
GLENS FALLS NY
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Plans&Specifications
2005-880
SEPTIC ALTERATION
a
$25.00 PERMIT FEE PAID-THIS PERMIT'EXPIRES: _ Tuesday, November 14, 2006
(If a longer period is required,an application for an extensionimtst a tnade,to the code Enforcement Officer
of the Town of Queensbury before the expiration date.)
Dated at the•Tppwn of een bury/ Monday, November 14, 2005
SIGNED BY r`a �` for'th'e Town of Queensbury:
Director of Budding&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.
Tax Map No.
1 Fee Paid
Owner's Name: C C- .................. ............................................................
Address: L k-41 e-1;7;AJ 1 91.D, 6,e
2. INSTALLER'S NAME PHONE NO.'7 9 2 -796'2
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
Garbage Grinder Installed yes no �;� RECEIVED
Spa or Hot Tub Installed yes no
NOV 0 8 2005
4. PARCEL INFORMATION: (circle applicable information&indicate measure fM OF QUEENSBURY
P U'nLD'% IUQAN9�� p
a h Soil Nature Ground Water Bedrock or Impervious Nra er, t____ � er Su-PI
Flat 4-loam
d at what depth at what depth municipal
)
ling ;a feet —feet we
Steep slope if well; water supply
%slope other from any septic-system
depth: absorption is J60 ji.-I
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: gallon (min. size 1,000 gal.)
Tile Field: each trench 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
Bed System Size: X 4,0
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,please note that pursuant ursuant 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.
1,14ve 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 resK6nsible person bate
Town of Queensbury
Sewers and Sewage Disposal Chapter
Appendix C
ABSORPTION FIELD
SEPARATION REQUIREMENTS
POND
Ncxx 4� iicv=
A�6pRP`Y"�y. .
1R.
Appendix C
ABSORPTION FIELD
SEPARATION REQUIREMENTS
PON.
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Septic Inspection Report
Office No.(518)761-8256 Date Inspection)req: c ive
Queensbury Building&Code Enforcement Arrive: part: am/pm
742 Bay Rd., Queensbury,NY 12804 Inspector's InitvNAME: NO.LOCATION: S T ON:
RECHECK:
Comments and/or diagram
Soil Type: Sand/Loam/Clay
Type of Water: Municipal/Well Water Ul I
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 Caps
Location/Separations
Foundation to tank ft.
Foundation to absorption z ft.
Separation of Pits ft.
Conforms as per Plot Pl N
Engineer Report a As-Built Y N
Location of System on Property:
Front Rear Left Side Right Side
4St
t Middle Rear
System pproved
Partial Approved and needs to be re-inspected, please call the Building&Codes Office
Disapproved
Last revised 1/6/05
.56
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Septic Inspection Report
Office No. (518) 761-8256 Date Inspection re ues e_ce'Y_d: `7
Queensbury Building&Code Enforcement Arrive: 2° art: C J/`h7 ] n In
742 Bay Rd., Queensbury,NY 12804 Inspector's Initia
NAME: ERMIT NO.: —
LOCATION: ,cz� , INSPECT ON: —
RECHECK:
Comments and/or diagram
Soil Type Sand oam/Clq3/'
Type of ater unicipal/ ell Wat
Waterline separation distance
Well separation distance \p C-, ft. '
Other wells: ft-
Absorption Field: Total length 7-0 ft.
Length of each trench C-- 7, ft.
Depth of t ft.
Size of Stone
Seepage Pits: Number
Size: x
Stone Size:
Piping Size Type
Building to tank H P F -A
Tank to Distribution Box a °
Distribution Box t Field/Pit Lj i l
Opening Seale . Y Partial
End Caps -
Location/Separations 1 �
Foundation to tank
Foundation to absorption ft.
Separation of Pits ft. J l
Conforms-as-p Plot Plan _Y
ir -e'r R nd As-Built Y N
Location of System on Property: l
Front Rear Left Side Right Side
1Vli�Frontddle Rear
System Use Status:
,Approved
/ Partial Approved and needs to be re-inspected,please call the Building& Codes Office
Disapproved
Last revised 116105
169 Haviland Road, Queensbury,NY 12804
Phone-518-745-4400 Fax -518-792-8511
October 22, 2005
Project#49198
Mr. Jay Sweet
Queensbury Septic
PO Box 4283
Bay Road
Lake George,NY 12845
Re: Percolation Test
Ann McCann Residence—55 Chestnut Ridge Road, Queensbury,NY
Dear Jay:
At your request, on October 20,2005, I performed a percolation test at the Ann McCann
residence located at 55 Chestnut Ridge Road in Queensbury. The test was performed to the east
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 14 minute, 27 seconds
The test was run in the native sand at a depth of 24 inches in'a 30 inch deep hole. The hole was
presoaked and the test was run 5 times until it stabilized with three consecutive runs of 13:54,
14:13 and 14:27 respectively.
The design flow for this 2 bedroom residence with added capacity for 2 new bedrooms at 110
gallons per bedroom,requires an absorption area of 733 sf' The replacement system for the
residence should consist of a 20 foot wide by 40 foot long absorption bed (800 sf of absorption
area) with 47 35 foot long laterals.
Please call me if you have any questions.
Sincerely, ECEIVED
G7 Go n� NOV
Thomas R. Center Jr., PE 8 2005
TOWN OF QUEENSBURY
Cc: Dave Hatin, Town of Queensbury'. BUILDING AND CODE
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BUILDING AND CODE
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f 1 i,a ae seen or observed, or believe I saw evidence of,
1 W w obliects such as houses, wells,trees, fences, etc.,
O > t-- sh--own on this document. I also represent that I have
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C o 'pefsonally measured the distances set forth on the diagram."
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Sl ATURE DATE