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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 • • L • • INFORMATION FOR BUILDING DEPARTMENT ANDIOR LENDING AGE issuingCerti • Atlantic-injarici,Inc.is in the process .pf- cate of i • ,--CorripliahOefOrtheelactriCal installationproject as covered in an -;, • _ applitatiMifiieClOtt our,main office. • Application _ Date Electrical t r • • - • , NEW YORK NO; MAIN OFFICE: (607) Q 447 4 • RECEIVED • . - • .1D cODE BUILDING AIN /6/.1A) 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 ` I -- -- i-1i-- - Ir . 335— :: i _:: .- ------- . Io Io ' y PT#2 I 338 • , Ai F-PLI - -- -- - i $ >I LJ-�.- • 336 • s,, ` 1► F-PL • o l Ito FIl' „� �� . v\'� ‘..•./.•••,. . .11 IL.' I 1-(,) 6)3' I 37 g..1 GARAGE HODGKINS / __ _____ IGARAGE ,-- __ • 10' I '0 1 I I GC' X1_,_,4.4° "All Z.. 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 z ' TE 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 �J 2 '—� / � CHARLES H. SCUDDER 518 / 793 - 1475 i-)F QUEENSBUF Y _... i*�Y