2005-938 TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518) 761-8201
Community Development - Building & Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: P20050938 Date Issued: Thursday, December 22, 2005
This is to certify that work requested to be done as shown by Permit Number P20050938
has been completed.
Tax Map Number: 523400-279-013-0001-014-000-0000
Location: 56 DREAM LAKE Rd
Owner: STANLEY J YURGARTIS
Applicant: PETE PETERS & LYNN CHENIER
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
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 En rcem t
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: P20050938 Application Number: A20050938
Tax Map No: 523400-279-013-0001-014-000-0000
Permission is hereby granted to: PF,TF,PF,TF,RS &T,YNN C;T-TF,NTF,R
For property located at: 56 DREAM LAKE Rd
in the Town of Queensbury,to construct or place
at die 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. Tyne of Construction Value
Owner Address: STANLEY J YURGARTIS
56 DREAM LAKE Rd Septic Alteration Residential
Total Value
LAKE GEORGE, NY 12845
Contractor or Builder's Name /Address Electrical Inspection Agency
01JEENSBURY SEWER
JAY SWEET
Plans&Specifications
2005-938
SEPTIC ALTERATION
$25.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Thursday, December 14, 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 To f Queens)jury; Wednesday, December 14, 2005
SIGNED BY for the Town of Queensbury.
Director of Building Co nforcement
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. (O -98
Tax MapNo. 7 ,/
i Fee Paid
Owner's Name: le T e Inr, 5 ri.Chi Ph t
Address:_,; 3 /^/¢ i t✓o ad- A2r Q y-c-ells�u�r9��
DEC a 9 2005
2. INSTALLER'S NAME :. G�PehS Gri 56' T"'c ►OVVN OFP Tb
Bull-DING ANDCUta
3. RESIDENCE INFORMATION: (circle year of dwelling, indicate# e room(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 F1
1980 or older x 150 gaYbdrm =
1980—1991 x 130 gaUbdrm =
1991 —present 3 x 110 gal/bdrm = o
A e t✓ Z e,4, w �Tjr7Lr/ems
Garbage Grinder Installed yes, / no
Spa or Whirlpool Installed yes_ / no
4. PARCEL INFORMATION: (circle applicable information&indicate measurements)
Topo Mhy Soil Nature Ground Water Bedrock or Impervious Material Domestic Water Supply
Flat s� at what depth at what depth municipal
Rolling oT urn --, feet eet Vwell;
Steep slope clay /U0/h ��y water supply
jam%slope other �� v'Jr11li/7�A,t from any septic system
depth: ro absorption is:2 9 5L
other
Percolation Test: (To be completed by licensed professional engineer or architect)
Rate: ,m / 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: 4000 gallon(min. size 1,000gal.)
Tile i trench`ft. Total System Length:
Seepage Pit(s): number each: ft. by ft
S.
tone to be used: # / depth or thickness eet
Bed System Size: /5� x 3 G
Alternative System: /V length and/or size
r
. 6. HOLDING TANK SYSTEM: (if required)
Number o / Size of allons
Note: Alarm System and associated electrica wo 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 fthe Town of Queensbury Sanitary Sewage Disposal Ordinance.
Slgn a of re§ponslble person Date
COMMONWEALTH ELECTRICAL INSPECTION SERVICE,INC.
Main Office 176 Doe Run Road-Manheim,PA 17545
MUNICIPAL,CERTIFICATE — ELECTRICAL APPROVAL
Permit No........................................Cert. N2 93664 Cut-in Card No......................�....
Owner...........f t...�.�..2�. ....................
........................................................................................1......�..r
Location.s��...&....�� �..Ll! ' l (�
Installation Consisting of... ° �L �� ��� a................................
...................................................................................................................................................................................
..............................11..�....................................................................................................................................................
InstalledBy.....I..S...�... 1.t�f ...................................Lie.No..................................................
The conditions following governed the issuance of this certificate,and any certificate previously issued is
cancelled:-
This certificate only covers the electrical equipment and installation conditions as of date. Upon thf
introduction of additional equipment or alterations,application shall be promptly made for inspection.
Inspectors of this Company shall have the privilege of maklipQnspections at any time, and if it;
rules are violated,the Company shall have the right®re;P�rtifie.Date.�Z-ZI^.l7 ............... INSPECTOR
.. ....................... ........
Memher NX-P.A..I.A.F.i...
c�1
Septic Inspection Report
Office No.(518)761-8256 Date Inspection request--
e uest•-r eive f
Queensbury Building&Code Enforcement Arrive: ,�-(. (�m f part: ? am/pm
742 Bay Rd., Queensbury,NY 12804 IDnsrtor's Initial F -
NAME: G' '' PERMIT NO.:
LOCATION: a�G�h C �/ INSkCT ON: ,
RECHECK:
L�
Comments and/or diagram
Soil Typ . Sand Loam/Clay
Type of Water: Municip Well Water
Waterline separation distance ft.
Well separation distance ft.
Other wells: ft.
Absorption Field: Total length ft.
Length of each trench
Depth of trenches ft.
Size of Stone
S is
Size: x
Stone Size:
Piping Size Type 1500 GR,—
Building to ilc , �� G PuN1�' -�-0 K 1/ �p
Tank to Distribution Box^ t11 L d�t.�1 ' I�- FO�C1
Distribution Box t eld/Pit q11 C MAtI
Opening Seale /Partial
End Caps p o
Location/Separations Fi ji,
Foundation tom \ ft.
( R
Foundation to absorption ft.
Separation of Pits
Co lot Plan Y
En ineer Report a As-Built Y N
Location of System on Property: t�'l'�11
Front Rear Left Side Right Side
Middle Fr nt Middle Rear
System Use S at
Approved
'al Approved and needs to be re-inspected, please call the Building& Codes Office
isapproved
Last revised 1/6/05
I3EC , 22 2005 3: 36PM HP LRSERJET 3200 p. 2
NACE ENGINEERING, P.C.
169 Haviland Road, Queensbury,NY 12804
Phone-513-745-4400 Fax -518-792-8511
December 22, 2005
Job 4 49173'
Town of Queensbury
742 Bay Road
Queensbury,NY 12804
Attention: Dave Hatin
RE: 56 Dream Lake Road Septic System
Dear Dave:
This letter is to inform you that we inspected the completed septic system for the Peters residence
at 56 Dream Lake Road on December 22,2005.
The septic system as installed was for a three bedroom house and consisted of a sewage pump
station, a 1,500 gallon septic tank and a 15 foot wide by 30 foot long absorption bed constructed
of perforated pipe and stone. The system conforms to the requirements of the approved design
drawing.
Please call me if you have any questions or concerns.
Sincerely,
Thomas R. Center Jr., P.E.
Cc: Pete Peters, Owner
SOILS DATA SEPTIC SYSTEM DESIGN
PROVIDE OWNER WITH AS-BUILT a U
DESIGN FLOW - EXISTING 2 BEDROOM CAMP WITH 1 FUTURE BEDROOMlu r 2
TEST PIT - REPLACE ALL OLD PLUMBING FIXTURES WITH NEW Vj0A
SIIC�1 AS %R121
S 3
0 10 TOP SOIL CODE COMPLIANT FIXTURES QXI LEAVE 6 LONG IRON REBAR BURIED W a
10-29" LOAMY MEDIUM FINE SAND - 3 BEDROOMS ® 110 GAL/DAY/BDRM - 330 GPD 2" BELOW SURFACE TO MARK COVER N O U
29-65" MEDIUM COARSE SAND \ �-
SEPTIC TANK - USE NEW 1,000 GAL. TANK
NO MOTTLING OR GROUNDWATER OBSERVED INLET BAFFLE E^ t S S 0
ABSORPTION FIELD - ABSORPTION BED PROPOSED. 1 MIN.
��`����'• - .'�
PERCOLATION TEST1 - 1" IN 3 MINUTES, 14 SECONDS
- AT NYSDOH APPLICATION RATE 367 SF OF ABSORPTION AREA REQUIRED. t� W
- USE 15 FT WIDE BY 30 FT LONG ABSORPTION BED WITH 3 LATERALS
AT 25 LF LONG EACH (450 SF OF ABSORPTION AREA). GROUT WITH NON-SHRINK 01 DISTRIBUTION BOX
GROUT (TYP.) EQUFALaRT MILLER OR v sip aanseaw �`i�° t1M, :=';
TEST PIT BY NACE ENGINEERING - 11/25/05 u,o� a°}�a saa« �i �uaWn�°p
•u�es�e!p auk uasa1°'a� °s�W 1• ars s�°a�1a 6`. ' � �
PERCOLA11ON TEST#1 BY NACE ENGINEERING - 11/25/05 8A��11 1pgl� �S a�,S's�Qy Se � � >q„ o o
mMI . ILOPE 0 O ..°�a°saaua� sa anasl�� �a panaasq° �° �►aa� \ \ Q
a 1/8'rPER FOOT N _N p
DRILLED � 12 ° T5 ►�°aauap'na �eS `
.. Ar
• 74 1500
T/NK EA FORT �v �v '°°O� E o o Z
GRAVEL A BOX ON --.
0 MILLER OR EQUAL INLET' do OUTLET _ PEA GRAVEL AND USE SPEED
IRON PIPE o W a. BAFFLES CL LEVELERS ON ALL OUTLETS. t.
ADJUST SPEED LEVELERS
FOUND cc 30" MIN. WITH WATER.
PAVED SURFACE) DREAM LAKE ROAD OF p SENT » 60" MAX; DISTRIBUTION BOX 9000 a3
( 00 LIQUID DEPTH Or Q
STONE d CONCRETE - �� � NOT TO SCALE
MONUMENT FOUND _O S 84`05'35"E 110.56' o o ACCESS HATCH
IRON ROD —— —— 10.0'1`4.0' �' La.ti LA-
O FOUND FRAME IRON` ' "/ + s s s
GARAGE PIPo, jNO C14P/ U7L �� INIMUM 2x WAD
F \ l0 PACE
,Fn'�"E"°USE t41 J ��- / AXIMUM 4x WIDTH JUNCTION
M BOX
•� PROVIDE 3 SAND OR --%°apt o o � •.••. • '. • '
•D,IL I AREA: � �$ PEA GRAVEL UNDER TANK SEPTIC TANK �: .
`: 0.42 ACRESt to S
W
o u :�
TAX MAP: 279.I J-1-15 a u NOT TO SCALE PUMP
o : g o, tr a —_—� 4• PVC O
(X'Z 1. ALL UNITS SHALL COMPLY WITH THE REQUIREMENTS OF THE NEW YORK _ }+
STATE DEPARTMENT OF HEALTH AND SHALL BE PRECAST CONCRETE ALARM ON `O 1-1/2" FORCE MAIN
aA m
/ Z PIPE O o `: \ ° ( i AS MANUFACTURED BY FORT MILLER OR EQUIVALENT. is SLOPE TO DRAIN
FOUND \ '°,s\ 2. ALL STRUCTURES TO BE PLACED ON FIRM, COMPACT SAND OR PUMP ON ' BACK TO PUMP STATION
ly/ '\\ \ I GRAVEL FOUNDATION. WHEREVER EXISTING FOUNDATION CONDITIONS o I A a
r w ARE UNSUITABLE, CRUSHED STONE SHALL BE PLACED AS PUMPS OFF'.- •.
140V ' N NECESSARY TO ACHIEVE A STABLE FOUNDATION. L~
Twn 20'
BENCHMARK. 1
NAIL SET IN EST\ ': PINES ` 1 w .• W
BASE OF PINE 7REE '''a . a • i ' ► ► i' • U
ELEV = 340 1 V
/ o ' R \\ \'; 22'PINE 1 48"• X 36" I.D. CONCRETE B w z W w
STONE CONCRETE S 81 16 30 E STONE& CavChETE
MONUMENT FOUND 99.69' O MONUMENT FOl/NP \ , ' 1 _\ ` AND COVER IFRIRY AT
3 1 ( INSTALLATION OF DISPOSAL FIELDS WEGHT ) GRINDER PUMP w
15 FT X 30 FT \ ° CLOLSTER I �+
ABSOIRP110N BED 1. CONSTRUCTION SHALL BE: AS SHOWN ON THIS DRAWING
W/ 3 - 25 FT LONG LATERALS D
x AND SHALL BE IN ACCORDANCE NTH THE N.Y.S. W a'
m DEPARTMENT OF HEALTH INDIVIDUAL HOUSEHOLD SYSTEMS, AND z
1500 GAL. \ 16 E \ i NOTE' SEWAGE PUMP STATION 44
ASTM F481-76 INSTALLATION OF THERMOPLASTIC PIPE AND W
o: �-wA
1 CORRUGATED TUBING IN SEPTIC TANK LEACH FIELDS. NOT TO SCALEW
SEPTIC TANK \ TOTAL AREA OF TAX MAP Cr33 \ 1 ' ' PARCELS 14, 15 & 16 TO 2. NO HEAVY EQUIPMENT SHALL BE ALLOWED WITHIN THE LIMITS
\ 4�` \ OF THE DISPOSAL FIELDS; AFTER PIPE INSTALLATION HAS BEGUN. 1. PUMP TO BE GRINDER PUMP RATED AT A MINIMUM OF 20 GPM C� �*.
1 1 BE CONVEYED TO CHENIER AT 16 FEET TOTAL DYNAMIC HEAD. PUMP TO BE 2 HP GOULDS O
'Z ;� �\ \ �0 3. AFTER EXCAVATION 2' WIDE BED TO THE DEPTHS REQUIRED, MODEL RGS2012 OR EQUAL
A\ U7L o i�\ \ � ,�N 2.69 AGRESt THE WALLS AND FLOOR OF THE BED SHOULD BE CLEANED
PEE \ s . � AND RAKED TO ACHIEVE AN EVEN SURFACE AND TO LOOSEN 2. PUMP CONTROL PACKAGE TO 8c SUPPLIED BY MANUFACTURER. O
c o 1210�\ ':�\�� a SMEARED SECTIONS OF 'FRENCH. AUDIBLE AND VISIBLE ALARM TO BE ACTIVATED BY ALARM FLOAT W a+ Ey
,y \ 3. PUMP CYCLE VOLUME = 67 GALLONS 80% OF ABSORPTION FIELD VOLUME + 10OX VOL OF FORCE�`� 0 4. PLACEMENT OF CRUSHED STONE PERFORATED PIPE AND UNTREATED BUILDING. ( E MAIN).
Nes ':• \ \ o o PAPER OR STRAW SHALL BE AS SHOWN, AND CARE SHALL BE w
AREA: 'ELISION OF FINE GRAINED SOILS AND a
NOW OR FORMERLY o EXERCISED TO AVOID IN(,
LANDS of 1.28 ACRESt \ :� \ \ \ o o p OTHER WASTE MATERIAL IN THE STONE AND PIPE.
TAX MAP: 279.13-1-16 \` °;� u \ 5. THE PIPES SHOULD BE LAID AT THE GRADES AND TO THE
ANDREW R. HOLDING & \ RELA11ONSHIPS SHOWN ON THIS DRAWING, MAINTAINING STRAIGHT
�t
✓ANICE W. HOLDING `� �. \ Un_ SEPARATED JOINTS
POLE OR
CONTINUOUS GRADES WITHOUT SAGS, HUMPS,
UBER 1363, PAGE 123 ... 33D \•'•;
\ \ OR OTHER UNSUITABLE CONDITIONS. THE PIPE SHALL BE LAID
i- \ :\ \ \ ,WITH THE HOLES DOWN :IN ALL CASES.
TAX MAP. 279.13-1-17 _�� \ \ \ O W
/ \\ \'•: ..`\ \ \ \ cn 6. THE DISPOSAL FIELD SHALL BE GRADED TO SHED RAINFALL d'
\ \ \ AND TO DIVERT SURFACE RUNOFF FROM ADJACENT AREAS AWAYco
w
FROM THE DISPOSAL FIELD. Z CAI
Na
\R S o_� m 7. REMOVE LEAVES, ROOTS, PLANTS AND ORGANIC DEBRIS. PLOW SURFACE PRIOR 12" MAX.
o : / \W TA �P. T9.1 1 14 TO SPREADING FILL MATERIAL
8. DO NOT USE HEAVY EQUIPMENT WITHIN THE ABSORPTION FIELD AREA. p e- O
9. PLACE FILL AND ALLOW TO STABILIZE IN ACCORDANCE WITH NEW YORK STATE >
I \ _ 2 DEPARTMENT OF HEALTH STANDARDS. � M--�
POND ' �\ �j L � M"-�1 �
HIQf,I POINT OZ BOTTOM OF BED 4" PERFORATED PVC 5 z
6" MIN. � � NTERCONNECT ENDS O
/ " T— OF LATERALS 10-4
LATERAL, LAID LEVEL
OLEO ��. STANDARD ABSORPTION BED PROFILE
/ SHED . FUTURE
IRON PIPE \\\ 26' E GARAQE'�>\ U7L o y
O FOUND \�=_ �� \\ \ y POLE N.T.S. Cr
T 1 a
� O �
GARAGE 1 EVSIRON ROD
nNGI
po "� • :PLYNT HELL
NOW OR FORMERLY O FOUND tS: 20'NOW s
\� PINE 22' 5a0' I `s`9o�� ►-�
LANDS OF NEW ` SQD' AAI 5Q0 � � OS00" , 1��1 Cd
I STORY SWALE AT UPHILL SIDE p
RALPH E. BARDIN & DOR07HY M. BARDIN DRILLED 3I?\ lN� LOG CABIN �� OF BED TO DRAIN RUNOFF
\ E F.F. .JUO ENS77NG J
UBER 804, PAGE 25 26' O SEPnC TANK AWAY FROM BED SLOPED TO DRAIN% �W
TAX MAP. 279.13-1-18 J/ 'srp,
t 36' �_ ALONG ENTRY CELLAR ' Lip �
1-7
SEWAGE PUMP \� �� 6" TO 12" BACKFILL •Cu
STA7)AN y MAPLE "o IICN ROD FILTER FABRIC Z x
\ IRON PIPE AM. a T F 8 70 BE SET OR GEOTEXTILE
FOUND �/ FROM PUMP STA71aV \ \ R` I w co
o u 2" MIN. a PERFORATED
.�
t� co
0'� // - �� \�� c G� LATQjAL w
�i DREAM LAKE �y � 60� a�� oo
N69'1 p— TT �� :� o� �� Gj� oho
/y NE \ 3/4 TO 1 1/2 �i
/ �N[ NOW OR FORMERLY CRUSHED STONE z
�= 95 _ _ \\ �', �s� LANDS OF (Tire.) —3 36 MIN.
t 3' c o. JONA THAN MONF OE MAXNUY
Q��
—_
Y USER 1319, PAGE• 58 GWMWAIER
SURVEY & MAP BY MAP REFERENCES R TAX MAP. 279.13-1-13 ELEVATION Datei DECEMBER 2005
BE
1) AMENDED MAP OF THAT PORTION OF LANDS ON THE NIL SIDE OF \ \ Scatei AS NOTED
DONALD L. PIDGEON, Jr. DREAM LAKE SHOWN ON A MAP OF 20 L07S OF LAND OF DANIEL LEWiS \ POSE TO
& BERTHA M. LEW1S ON DREAM LAKE, BEING PART OF LOT NO. 21, STANDARD ABSORPTION BED SECTION
OUEENSBURY PAT., TOWN OF OUEENSBURY, WARREN CO., N.Y.' MADE BY p"
LICENSED LAND SURVEYOR PLAN �S
ERNEST L.H. MEYER, C.E.-P.E., GLENS FALLS, N.Y., DATED AUGUST 1, 1953 ` N.T S. B U I L T.
N.Y.S. LICENSE NO. 50372 AND FILED IN THE WARREN COUNTY CLERK'S OFFICE ON SEPTEMBER 15, 1953.
� . «r 16 MICHAEL ROAD 2) "MAP OF A SURVEY OF LANDS OF JONATHAN B. MONROE-, MADE BY scale; 1��=40' 49173
FORT EDWARD, NEW YORK 12828 DONALD L. PIDGEON, L.S., DATED JUNE 27, 2002.
(518) 792-4146 3) "MAP OF LANDS SURVEYED FOR ANDREW HOLDING", MADE BY SHOT 1 OF I
WAYNE R. RAYMOND, L.S, DATED DECEMBER 22, 2003.