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2004-965 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: ..._P20040965- _Date Issued: Tuesday, December 21, 2004 - -This-is to certify that=work requested tube done as shown by Permit Number P20040965 has been completed. Tax Map Number: 523400-290-000-0001-041-000-0000 Location: 251 CHESTNUT RIDGE Rd ' Owner: HELEN C. RANDOLPH Applicant: HELEN C. RANDOLPH This structure may be occupied as a: By Order of Town Board Septic Alteration Residential TOWN OF QUEENSBURY Director of Building&Code Enforcement_ TOWN OF QUEENSBURY 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201 Community Development-Building&Codes (518) 761-8256 BUILDING PERMIT Permit Number: P20040965 Application Number: A20040965 Tax Map No: 523400-290-000-0001-041-000-0000 Permission is hereby granted to: HELEN C;. RANDOLPH For property located at: 251 CHESTNUT RIDGE Rd ui 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. T3qje of Construction Value Owner Address: HELEN C. RANDOLPH 251 CHESTNUT RIDGE Rd Septic Alteration Residential Total Value QUEENSBURY, NY 12804 Contractor or Builder's Name /Address ;' :i Electrical Inspection Agency SANITARY SEWER DAN DRELLOS PO BOX 224 CTLENS FALLS NY Plans&Specifications 2004-965 SEPTIC ALTERATION i $25.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Friday, December 16, 2005 (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.) I Dated at the To ueensb- r ay, December 16, 2004 SIGNED BY for the Town of Queensbury. Director of Building&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: 2 1 C4A dT'NuT- D4 File Permit No. Tax Map No. Fee Paid + ot> Owner's Name: C(_ /},r e s C e_ R A1,,-j d o(,2 A ...................................................................................................................................... Address: 2 cT) L-n Grr' N JT' 2. INSTALLER'S NAME.: ` PHONE NO. 3. RESIDENCE INFORMATION: (circle year of dw 'ndicate#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 Z x 150 gal/bdrm = c3 0 a 1980— 1991 x 130 gal/bdrm = 1991 —present x 110 gal/bdrm = Garbage Grinder Installed yes_ / no Spa or Hot Tub Installed yes_ / no�� 4: PARCEL INFORMATION: (circle applicable information&indicate measurements) Topography Soil Nature Ground Water Bedrock or Impervious Material Domestic Water Supply Flat Pay at what depth at what depth municipal olling feet feet ell Steep slope if well; water supply _%slope other from any septic-system depth: absorption is /00 ft:O- other /00 Percolation Test: (To be completed by licensed professional engineer or architect) Rate: minute per inch Se +T!}c:.h e J 4eOeP . 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. �Xcf�-tivb Septic Tank: I COO gallon (min. size 1,000 gal.) Tile Field: each trench ft. Total System Length: 90 —ft. Seepage Pit(s): number of IV tt- size of each: ft. by ft. Size of Stone to be used: # depth or thickness feet Bed System Size: D x S e 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 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 o ueensbury Sanitary Sewage Disposal Ordinance. Sig ature of responsible person Date .7ow,11 Of (lucellsbui•y •,S��tiv�:rsatttl �c:wsi);c: I)i�tlfa�ai t;lit�ltit•r AIt}mmli x C. ' IMI�I,I) ' SI;I'/1ll./�'I'I�)I�( ItI�(.ZI.JIt,i+hll�:Iu'I'� • rjP `'TELL. tN 1I�lTF'i't• .i � �- ' �ix+ruT �15t►Icq wT �. ... rr tc�►4.r . ••— . 11►.» G r • f( J, '�� c•Pay�. 5cr�t1G j F"t 0.L.>ia ► , r 7• SIGNATURE &INFORkAMON FOFL SYvPI;sXsL:,rrwx,,zvj,,4 u„om..,.,,..", i Commercial Final Inspection Report �( Office No.: (518) 761-8256 Date Inspection re est r ceive�d:� Queensbury Building&Code Enforcement Arrive: pm epart: am in 742 Bay Road, Queensbury,NY 12804 ector's Initia�s/ram` NAME: ��C C��� PERMIT LOCATION: a 4-4 t DATE: ✓ — COMMENTS: Y N NA Chimney/"B"Vent/Direct Vent Location Plumbing Vent Through Roof 6"/Roof Complete Exterior Finish Grade Complete 6"in 10' or Equivalent Interior/Exterior Guardrails 42 in.Platform/Decks Interior/Exterior Ballisters 4 in. Spacing Platform/Decks Stair Handrail 34 in.—38 in./Step Risers 7"/Treads 11" Vestibules For Exit doors>3000 sq. ft. All Doors 36 in.w/Lever Handles/Panic Hardware,if required Exits At Grade Or Platform 36 (w)x 44" (1)/Canopy or Equiv. Gas Valve Shut-off Exposed&Regulator 18") Above Grade Floor Bathroom Watertight/Other Floors Oka Relief Valve,Heat Trap/Water Temp.110 Degrees Maximum Boiler/Furnace Enclosure 1 hr. or Fire Extinguishing System Fresh Air Supply for Occupancy/Ventilation Combustion Low Water Shut Off For Boilers Gas Furnace Shut Off Within 30 ft. or Within Line Of Site Oil Furnace Shut Off at Entrance to Furnace Area Stockroom/Storage/Receiving/Shipping Room(2 hr.), 1 '/7.doors > 10%> 1000 s .ft. 3/4 Hour Corridor Doors&Closers Firewalls/Fire Separation,2 Hour, 3 Hour Complete/Fire Dampers/Fire Doors lop Ceiling Fire Stopping, 3,000 s . ft.Wood Frame Attic Access 30"x 20"x 30"(h),Crawl Space Access 18"x 24" Smoke Vents Or Fan, if required Elevator Operation and Si a e/Shaft Sealed Handicapped Bathroom Grab Bars/Sinks/Toilets Handicapped Bath/Parking Lot Si na e Public Toilet Room Handicapped Accessible Handicapped Service Counters, 34 in., Checkout 36" Handicapped Ramp/Handrails Continuous/12 in. Beyond Active Listening System and Signage Assembly Space Final Electrical Site Plan/Variance required Final Survey,New Structure/Flood Plain certification,if req. As-built Septic System Layout Required or On File Buildi ng Number or Tenant Address on Building or Driveway Water Fountain or Cooler Building Access All Sides by 20' /Driveable Surface 20' wide Okay To Issue Temp. or Permanent C/O \ Okay To Issue C/C Last printed 6/3/2003 9:27 AML:\PamW\Building&Codes\Commercial Final Inspection Report.doc Septic Inspection Report Office No. (518)761-8256 Date Inspection req est rec 'rued: Queensbury Building&Code Enforcement Arrive: am/ m/ part: alr� 742 Bay Rd., Queensbury,NY 12804 Inspector's Initia NAME: R p¢N�oP� 1 MIT ER NO.: -Z3QAA LOCATION: g-Q INSPECT ON: 1 Z— ZI -©L4 RECHECK: Comments and/or diagram Soil T e: Sf Loa Cla -- — -. T e of Wate . mcl al Well Wa e Waterline separation distance ft. Well separation distance I ft. Other wells: ft. Absorption Field: Total length ft. Length of each trench LA Q—Z&t. Depth of trenches ft. Size of Stone _ Seepage Pits: Number Size: x Stone Size: Piping Size Type Building to tank Tank to Distribution Box L1 a LAA i Distribution Box to Field/Pit Opening Seale Y)N/ artial Location/Separations Foundation to tank ft. Foundation to absorption c ft, Separation of Pits ft. Conforms as per Plot Plan Y N Location of System on Property: Front Rear Left Side Right Side Middle Front Middle Rear System Use!Kipproved Partial Approved and needs to be re-inspected,please call the Building&Codes Office Disapproved L:1SueHemingway\Building.Codes.Inspection.FORMS1Septic Inspection Report.doc January 28,2003 NACE ENGINEERING, P.C. 169 Haviland Road, Queensbury,NY 12804 Phone-518-745-4400 Fax -518-792-8511 7 November 26, 2004 Project#4915X, Mr. Jay Sweet RECEIVED 6S Queensbury,Septic DEC 1 6 2004 PO Box 4283 Bay Road TOWN BUILDING AND CODE Y Lake George,NY 12845 Re: Percolation Test Clarence Randolph Residence -251 Chestnut Ridge Road, Queensbury,NY Dear Jay: At your request I have performed soil testing (deep test and percolation test) at the site of the 3 bedroom house of Clarence Randolph on Chestnut Ridge Road in Queensbury. The tests were performed in the location of the proposed replacement septic system, approximately_ 10 feet directly downhill from the west side of the existing in-ground pool. The results of the testing are as follows: Deep test 0-8" topsoil 8-36" loamy med. to fine sand w/stones 36-70" fine to coarse sand w/gravel 8c stones compact very slight mottling at 47"'; no water Percolation test Stabilized percolation rate— 1" in 6 minutes, 08 seconds Based upon these tests and the owner modifying.the house to a 2 bedroom home, I agree that constructing the proposed replacement septic system as a standard absorption.bed is acceptable. Based upon a 2 bedroom house and a percolation rate of 6 to 7 minutes, you will need a 375 square feet of absorptive area. I recommend using 20 ft wide by 25 ft long absorption bed, which will provide 500 square feet of absorptive area. Please call me if you have any questions. Sincerely, Thomas R. Center, EI cc: Dave Hatin, Town of Queensbury ........................... w - - 0 ti _ -0�7 r� a ® eq ILDI G of. :. R *WED BY 1•. _ RECEIVED DEC I S- 2004 fa- TOWN OF QUEENSBURY BUILDING AND CODE ----------- - - "I have seen or observed, or believe I saw evidence of, all objects such as houses, wells, trees,fences, etc., shown on this document. I also repres! e_t I_have----- .personall-y-measu d-th dis aces set forth on the diagram." SIG ATURE DATE