2001-907 W -4-3)
TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518) 761-8201
Community Development- Building &Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Pernik Number: P20010907 Date Issued: Tuesday, August 07, 2007
This is to certify that work requested to be done as shown by Permit Number P20010907
has been completed.
Tax Map Number: 523400-239-012-0002-061-000-0000
Location: 16 HOLLY Ln
Owner: MARY HODGKINS
Applicant: MARY HODGKINS
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 Enforcement
Planning Board or Zoning Board of Appeals.
" TOWN OF QUEENSBURY
f 742 Bay Road,Queensbury,NY 12804-5902 (518) 761-8201
Community Development- Building& Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20010907 Application Number: A20010907
Tax Map No: 523400-239-012-0002-061-000-0000
Permission is hereby granted to: MARY HODGKINS
For property located at: 16 HOLLY Lii
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: MARY HODGKINS Septic Alteration Residential
916 CHARLTON Rd Total Value
SCOTIA,NY 12302
Contractor or Builder's Name/ Address Electrical Inspection Agency
FIFIELD. BRUCE
NY 12804-0000
Plans &Specifications
2001-907
SEPTIC ALTERATION AS PER PLOT PLAN SPECIFICATIONS
$25.00 PERMIT FEE PAID THIS PERMIT EXPIRES: Wednesday,December 11,2002
(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.)
TI
Dated at the1 . of Q nsbury; T sday,December 11,2001
i) i
SIGNED BY( a1 for the Town of Queensbury.
Director of Buil g& de Enforcement
Application for Permit-Septic Disposal System
Town of Queensbury 742 Bay Road Queensbury,NY 12804 (518) 761-8256
1. OWNER INFORMATION: - �- - - ----hL•47
/ Office UseLocation of installation: (�• G
File Permit N ) �07
Tax Map No.094/ 2 / 6/ o n
Fee Paid :DI) .
Owner's Name: 4,Ati- 4 N P14//Ur ..__._._._................................
Address: 4 4/-y t!4/ 8,44/ '- / 't/7 / 2D
di--
2. INSTALLER'S NAME ate Tfz�.fi PHONE NO.
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 gallbdrm = RECEIVED
E
x 130 al/bdrm =
1991-present �' x 110 gal/bdrm = -0 -t�®E C 1 1 20 01
Garbage Grinder Installed yes— / no ✓ TOWN OF QUEENSBURY
or Whirlpool Installed yes / no ✓ BUILDING AND CODE
Spa Wh p _
4. PARCEL INFORMATION: (circle applicable information&indicate measurements) -
Topography •' .attire Ground Water Bedrock or Impervious Material Domestic Water Supply
Flat sand at what depth at what depth municipal
Rolling -oam 7 --feet , feet well
teep slope clay if well;water supply
_°o slope other from any septic-system
depth: absorption is ft.
other AJ% 4 6
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: /Z�D gallon (min. size 1,000 gal.)
Tile F ?i Fie each trench T7ift. Total System Length: C7---- ft. id/ .
Seepage Pit(s): number of size of each: ft. by A
Size of Stone to be used: # / depth or thickness feet
Bed System Size: x
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.
1
Septic Inspection Report
Office No. (518) 761-8256 Date Inspection request received:
Queensbury Building&Code Enforcement Arrive: am Depart: am/pm
742 Bay Rd., Queensbury, NY, 12804 Inspector's Initials:
NAME: M
L/ PERMIT NO.:LOCATION: �I INSPECT ON: 0d
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:
Stone Size: ._----.--
Piping Size Type
Building to tank
Tank to Distribution Box
Distribution Box to Field/ Pit
Opening Sealed: Y/ N/ Partial
End Cap
Inlet/Outlet Pipes&Baffles ____Y T N
Location/ Separations
Foundation to tank ft.
Foundation to absorption ft.
Separation of Pits _ ft.
Conforms as per Plot Plan Y.�N � / �/e L� `
Engineer Report and As-Built _Y—.N 4ic f ti' Ake / /sc
Location of System on Property: � et-
Front Rear Left Side Right Side
Middle Front Middle Rear
S stem U e to s:
Approved
Partial Approved and needs to be re-inspected, please call the Building &Codes Office
Disapproved
Last revised 021006
Last revised 1/6/05
•
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• INFORMATION FOR BUILDING DEPARTMENT ANDIOR
LENDING AGE
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• Application _
Date
Electrical t r •
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MAIN OFFICE: (607) Q
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RECEIVED •
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Septic Inspection Report rau j____
Office No. (518) 761-8256 Date Inspection request received:
Queensbury Building &Code Enforcement Arrive: /O 61 am/p1 Depart: am/pm
742 Bay Rd., Queensbury, NY 12804 Inspector's Initials: 1,4r
NAME: afalr , PERMIT NO.: -?� -/_ �F67
LOCATION: /.�,` ,/,f 4.: INSPECT ON: 7 2`//a
RECHECK: / ��
Comments and/or diagram
Soil Type: Sand Loam Clay
Type of Water: ipal/ Well Water Lc +e,
Waterline separation distance ft.
Well separation distance ft.
Other wells: ft.
Absor•tion Field: Total len.th 5Z ft.
Length of each trench 412 ft.
Depth of trenches
Size of Stone iT 0111/}%}
Seepage Pits: Number
Size: x
Stone Size: -R
Piping Size Type
Building to tank ' f
Tank to Distribution Box `/ ' 5p/a
Distribution Box tp7Ekeld/ Pit `('' ,5 0/r�
Opening Sealed: N/ Partial
End Cap
Inlet/Outlet Pipes&Baffles —Y N
Location/ Separations
Foundation to tank ft.
Foundation to absorption _ ft.
Separation of Pits ft.
Conforms as per Plot Plan xi Y N
Engineer Report and As-Built Y T N
Location of System on Property:
Front Rear Left Side Right Side /e/ AI / // c/j.oc
Middle Front Middle Rear i.
System Use Status:
Approved
Partial Approved and needs to be re-inspected, please call the Building &Codes Office
Disapproved
Last revised 021006
Last revised 1/6/05
ti
Septic Inspection Report
Office No. (518) 761-8256 Date Inspection request received:
Queensbury Building&Code Enforcement Arrive: OW am/r4 y epart: am/pm
742 Bay Rd., Queensbury,NY 12804 Inspector's Initials:
NAME: / t / PERMIT NO.: ,` 07
LOCATION: /ev //( 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. l/' 4_04_ car
Size of Stone
Seepage Pits: Number _ Sasz. ` -i�
Size: x '
Stone Size: 7) CJJ s. i SIG y61.1 0
Piping Size Type 11
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 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:
Approved
Partial Approved and needs to be re-inspected,please call the Building&Codes Office
Disapproved
Last revised 1/6/05
-z_)
Septic Inspection Report
Office No. (518) 761-8256 Date Inspection request received:
Queensbury Building &Code Enforcement Arrive: am/p fj,Depart: am/pm
742 Bay Rd., Queensbury, NY 12804 Inspector's Initials: /
NAME: f �t 1,3 PERMIT NO.: 2 O — 7v '7,
INSPECT ON: ��
LOCATION: �� (�j`�J�y f a�
RECHECK: /
Comments and/or diagram
Soil Type: Sand/ Loam/ Clay
Type of Water: Municipal/ Well Water �J��� 7446.Waterline separation distance ft. J
Well separation distance ft.
Other wells: ft.^ /*--;) ,(J � �/
Absorption Field: Total length ft. Dab N oC I I J A'"I
Length of each trench ft.
Depth of trenches _ft. // , ��/t) A i reci-
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
Inlet/Outlet Pipes &Baffles _Y N
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:
Approved
Partial Approved and needs to be re-inspected, please call the Building &Codes Office
Disapproved
Last revised 021006
Last revised 1/6/05
- IL,4+0 Lr- rrvr
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6)3' I 37 g..1
GARAGE HODGKINS /
__ _____
IGARAGE ,-- __
• 10'
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GC'
X1_,_,4.4° "All
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338 •..... HOLLY LANE _ SLEEVE LVCZ0PE
•
WOOD FENCE _
337 . r —I
o ... . :. .........I•• 337 • .
18"
• •. ASH PINEI
N.
.O. 336
336 • .... .
335 • i FM 335 r". ,
•'n z
rn 334 •• 334 n
333I..
REMOVE CONC.
r}b 333 "
tv1 I
SEPTIC TANK ��_ 10 51,,v�0
----i 0
12 GAL °`s
REMOVE SEEPAGE ST 332
PIT ON ADJACENT i•• ••. .
PARCEL
HODGKINS •
i
GONGRETE fa-5,000 ISI
•I STEEL RMWORMCNT
L jTMENG AWADI8,GRADE 0 cl INFIL TRA TOR
T D�S16N LOADNfi MSHTO H-10 �- / INSTALL CONTROL PANEL INDOORS. MAKE ALL
} ELECTRICAL CONNECTIONS OUTSIDE PUMP CHAMBER. ABSORPTION SYSTEM
�{ PANEL BOX SHALL HAVE A WARNING LIGHT AND
;. DAME pI O AUDIBLE ALARM. SEAL CONDUIT AND AIR PASSAGES
0 PROVIDE 4" PVC PUMP CHAMBER VENT. FROM PUMP CHAMBER WITH SEAL-TIGHT FITTINGS AND/OR � S SiYALL BE SOLE '11'II�LTRATOR EQt/ALIZHt 24' GNT�
LOCATE SCREENED OPENING AS FAR AS NON-SHRINK GROUT TO PREVENT OUTFLOW OF GASES. /JLTRATOR SYSTEM /(C.. OLD SAYBROOX CT 06475.
* PRACTICABLE FROM RESIDENCES. FB.L BETWEEN L1�TS SHALL BE N'ELL-DRAp1�0 GRANIX AR i
iPF 335 67.7' IPF sm Fat EFFLLair FL TRAT/av
• LT-DUTY MH
FRAME S COVER
336 : FIN/SHED GRADE PROVIDE A DISCHARGE BALL
II 334 — I o zX I VALVE FOR THROTTLING
1. -'— '. 6 C/L SPACING
TAX MAP ID E239.12-2-538
N e�ETE GRAB BAR CONDUIT TO PANEL BOX
• FIN GRADE
j 1 I/2" BAKER' OR
I .... .—... I d -MARTINSON* PITLESS 1 1/2' SWING CHECK
d ADAPTER
337 4' SCH 40 PVC INLET POWER 1 1/2' PVC FORCE MAIN F�MSH WITH 6' TOPSOL.
ABSORPTION SYSTEM ,Y• s FROM SEPTIC TANK: LEAD ' • : . . . . . . SLOPE/ON 5 TO E)MM GRADE
0• SEAL WALL PENETRATIONS l I/2 ' GALV. STEEL PIPE I2' MIN. BACKFILL SOIL ' .
42' 6 ROWS A 42 LF - . . . .
246 LF INFILTRATORS 500-GALLON ALARM
PREGA5T P15TRIDUTION DOX PRECAST I - PRECAST -
I .250 CAI, SEPTIC TANK SEPTIC TANK GOULDS EFFLUENT PUMP START
-- -- -- PUMP MODEL WE0511H
- Li
335 NTe NTS PUMP STOP A'GRANULAR soL
PT#1 Io-
TRATlON HANKER
TERMITESET CASTING ON 12' S �c TRA�TOR
_ _ COMPACTED CRUSHED ROCK EOUALIZER 24'IhVTS
2" AS / .'_ 2 I/ PHAL T BINDER ;-
PT#2 O FIN GRADE '
24'HIM CLEAN SANDY FILL
�..
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
38 AT ROAD GR05SING DETAIL
_ __
DENSELY COMPACTED
F-PL "' EFFLUENT LIFT STATION
-- --
10
DB
5ELEGT GRANULAR
'ITEM 4'
336 ? PART- SECTION THRU INFILTRATOR
I FM p F-PL 42 '
N �n AD50RPTION SYSTEM
COVER NTS
I l 337 -?t . INITIAL DAGKFILL �'...........'.... ..'.......'.'.......'.'............I............
PIPE ZONE
GARAGE HODGKINS '?; 0 -,� HAUNGHING
GARAGE I ::::=-::::::.777 ::.:=-::: .7.7::: .7.7:::::::=-::::: .----:
10' GIZUSHED ROGK OR BEDDING GRADE c
.• NO TE:
I ROAD CROSSING PERMIT
I 1 �--.- --.......--.......-.-.......--.......-.-...GARAGE 18' MIN. IS REQUIRED FROM TOWN LOAMY TOPSOIL
HIGHWAY SUPERINTENDENT DB 1 0
SEWER DEDDING DETAIL RICHARD MISSITA. :::=:=:::::::.... ::::=:=:::::::_..7 ::::=:=::::::...7:::77.
NT5 0.4
1 :....__.......__.......__.......__.......__.......__...
................................................................. .... ...
FINE DROWN SAND
JOB DESCRIP TION
338 HOLLY LANE —4` DIA EVE.. PVC PIPE REMOVE EX/STING SEPTIC TANK ON SOUTHWEST CORNER OF INCREASE FM DIAM TO 4 "
.••'•• SLEEVE. L - 20' . ' .
•••••�••••••••.••••••••••.•�'•• HOUSE. REMOVE SEEPAGE PIT ON ADJACENT LOT AND FILL
6 FEET AHEAD OF DB
W000 FENCE
THE HOLE. RESTORE THE FINISHED GRADE TO LAWN. 2" DIAM FORCE MAIN -
_ 1,8
337. —1 INSTALL NEW /250-GAL SEPTIC TANK ON NORTHWEST CORNER PLAN OF INFILTRATOR 5Y5TEM
o _ OF HOUSE W15TH CLOSE-COUPLED 500-GAL. LIFT STATION. NTZ
o
o INSTALL 4 " SCHED 40 PVC BUILDING DRAIN FROM WALL TO SEPTIC
337 TANK AT 2% SLOPE. INSTALL 2" CLASS /60 PLASTIC FORCE MAIN
.. ASH 18"PIN TO DISTRIBUTION BOX. ENCASE THE FORCE MAIN IN 20-FOOT
•S• 0 :. 336 SLEEVE AT ROAD CROSSING AS DIRECTED BY ENGINEER. (PERMIT PERCOLATION TEST RESULTS MEDIUM-COARSE SAND
336 REQUIRED FOR CROSSING.)
FM I � INSTALL "INFIL TRA TOR SYSTEM" COMPRISING SIX (6) "EQUALIZER 24 "
TESTS RUN T 24 " DEPTH
m 335 335 r- LATERALS EACH 42 FEET LONG A S SHOWN ON THE PLAN. AFTER TER EXTENDED PRESOAK
m .
I m RESTORE GROUND SURFACES AND ALL DISTURBED LAWN AREAS TO ON SEPTEMBER 17, 200/
rn 334 .' 334 n
m THEIR ORIGINAL CONDITION. P T / S TA BIL IZED RA TE - 7 MIN/INCH
REMOVE CONC. 333 .• :.......... ... .•... L. + INSTALL SIMPLEX PUMP, POWER AND CONTROL WIRING COMPLETE. P T 2 S TA BIL IZED RA TE - 5 MIN/INCH
SEPTIC TANK "" !0� 333
PANEL BOX SHALL GO IN THE HOUSE BASEMENT-. INTERIOR WIRING 6 2 NO GROUNDWATER,
AND PLUMBING IS EXCLUDED FROM THE SCOPE 19F THIS PROJECT. DESIGN A PPL I CA TION RA TE = I. 0 GPD/SF MOTTLING OR ROGK i
REMOVE SEEPAGE o 1250 GALI
TO 6-FOOT DEPTH
PIT ON ADJACENT ST 332
PARCEL
S OIL LOG
330 HODGKINS : JOB SPECIFI CA TIONS BASIS OF DESIGN NT 5
HOUSE I -
4 BEDROOMS Cad HO = 440 GPD
329 LIFT STAT/ON SET ALL CONCRETE CASTINGS DEAD LEVEL ON 12" CRUSHED ROCK. 440 / 1. D x 2 = 220 LF REOU/RED LOG SHOWN 15 TYPIGAL
I FLOOR ELEV I MAINTAIN FIVE (5) FEET OF COVER ON THE 2" DIAM. FORCE MAIN. PROVIDE 6 42 = 252 LF FOR TWO TE5T HOLE5 )328 •••`� RES TORE THE HOL L Y L PA c" ao I
ANE VEMENT SA . TOR TO THE TOWN
327 I I HIGHWAY SUPERINTENDENT. RECEIVED
LA Y INFIL TRA TORS LEVEL. PROVIDE WELL -DRA/NIrD GRANULAR SOIL DEC 1 1 2001
326 �. I BETWEEN ROWS OF INFIL TRA TORS. PROVIDE 12" LOAMY TOPSOIL ABOVE
325 CROWNS OF INFIL TRA TORS TO FINISHED GRADE. TOWN of QUEENSBURY
INSTALL IN THE LIFT STATION A GOULDS EFFLUENT PUMP. MODEL ROBERT C. and MAR Y K. HODGKINS BUILDING AND CODE
TAX MAP ID f239.12-2-6I1 J885. WEO511H. CAPABLE OF DELIVERING 50 GPM AGAINST A TOTAL
D YNA M/C HEAD OF 25 FEET OF WA TER. PA Y CL 0 SE A T TEN T/ON TO
CONICTHE L IF T S TA TION DE TAIL ON THIS SHEE T. NE W W1 S TE WA TER S YS TE111
WALL
LAKE QUEENSBURY STANDARDS 16 HOLL Y LANE
GEORGE
W.S. 3/9 ASSEMBLY POINT. OUEENSBUR Y. NY
A CONSTRUCTION PERMIT IS REQUIRED FROM THE TOWN OF QUEENSBURY.
THE SANITRAY REGULATIONS OF THE TOWN OF QUEENSBURY GOVERN THE Q�,OfESSION,�•', DECEMBER 2001 SCALES AS SHOWN
DESIGN AND CONSTRUCTION OF THE NEW WA S Tt=WA TER SYSTEM. H.
HODGKINS � .
CONTRACTOR SHALL TAKE CARE TO MAINTAIN ALL HORIZONTAL SETBACKS ;
REQUIRED UNDER THE PUBLISHED STANDARDS. SCUDDER ASSOCIATES
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CONSUL TING ENGINEERS
Sl PL A N / e of °9 `�:•' P.O. Box 792
��l/ L� °. jNf �E b .'
o• TiY �!/ 'r`p` �L �J,o,a l 1'Six�i PIS•a �o4 GLENS FALLS. N Y 12 8 01 FIL.F. ' t P
Y
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2 '—� / � CHARLES H. SCUDDER
518 / 793 - 1475 i-)F QUEENSBUF Y
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