2001-856 0111K TOWN OF QUEENSBURY
rip'y
742 Bay Road, Queensbury,NY12804 5902 (518) 761-8201 201
Community Development - Building & Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: P20010856 Date Issued: Tuesday, November 20, 2001
This is to certify that work requested to be dome as shown by Permit Number P20010856
has been completed.
Tax MapNumber: _
523400-279-000-000iI 022-000-0000 {
Location: 177 JENKINSVILLE Rd
Owner: VIRGINIA SCHIES.,TRUSTEE
Applicant:hcant:
VIRGINIA SCHIES TRUSTEE
This structure may be occupied as a:
By Order of Town Board
Septic Alteration Residential TOWN OF QUEENSBURY
(141P /14t
II
Director of Building&Code Enforcement
1
TOWN OF QUEENSBURY
43' 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development- Building& Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20010856 Application Number: A20010856
Tax Map No: 523400-279-000-0001-022-000-0000
Permission is hereby granted to: VIRGINIA SCHIES TRUSTEE
For property located at: 177 JENKINSVILLE 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. Type of Construction Value
Owner Address: VIRGINIA SCHIES TRUSTEE Septic Alteration Residential
177 JENKINSVILLE Rd Total Value
QUEENSBURY,NY 12804
Contractor or Builder's Name/ Address Electrical Inspection Agency
STEVENSON, WALT
Plans &Specifications
2001-856
SEPTIC ALTERATION AS PER PLOT PLAN SPECIFICATIONS
$25.00 PERMIT FEE PAID - THIS PERMIT EXPIRES: Wednesday,November 20,2002
(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.)
Dated at th n of • ensbury T esday,November 20,2001
SIGNED B 4 4 for the Town of Queensbury.
Director of Buil • g& ode Enforcement
Application for Permit—Septic Disposal System
Town of Queensbury 742 Bay Road Oareensburv, NY 12804 (518) 761-8256
1. OWNER INFORMATION:
/ Office Use
Location of installation:,ji((Jd/AO/Vd /?1 %' -G�'4'4( '1(� - �j�
ReCipitN
Tax Map No. / / !!E QO
Fee Paid ®�S'
Owner's Name: Vib 67i164- 5all/eS NOY .1,.._b
zoos
Address: rBV LDINC A�LNSBURY
r / Cope �y
2. INSTALLER'S NAME : VV M 1-7- S 7-v e 4 c DN PHONE NO. ?.? 2,7 7 b
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 IV x 150 gal/bdrm =
1980— 1991 x 130 gal/bdrm =
1991 —present x 110 gal/bdrm =
Garbage Grinder Installed yes— / no
Spa or Whirlpool Installed yes_ / no (/'
4. PARCEL INFORMATION: (circle applicable information&indicate measurements)
Topography Soil Nature Ground Water Bedrock or Impervious"Material Domestic Water Supply
Flat sand F at what depth at what depth municipal
Rolling loam G 4,r feet /o o feet well
Steep slope clay . if well; water supply
G�T %slope other from any septic-system
depth: absorption is 7 ft.
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: f(n0 p gallon (min. size 1,000 gal)
Tile Field: each trench k4D ft. Total System Length: /5-0 .ft
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
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 of Queensbury Sanitary Sewage Disposal Ordinance.
V
Signature of responsible person Date
efvriv,
TOWN OF QUEENSBURY
BUILDING&,_CODE ENFORCEMENT
742 Bay Road
Queensbury NY 12804
(518) 761-8256
SEPTIC DISPOSAL SYSTEM INSPECTION
Name �/►\�\ ,s
Location 11'1 :SQ_A \S '\e, C,1�
Date \\�-- \ Permit .,, ,,14510
SOIL TYPE: San/ oam Clay-
Results of Per o \ation Test-
(if applicable RAte-Minute/Inch
TYPE OF SYSTEM:
ABSORPTION FIEL:.: Total Length/ /6-b
Length of each Oren h y(
Depth of trench-
Size of stone a
SEEPAGE PITS: N mb:r-
Size - f ft.
Stone size
PIPING: ire Type
Bldg. to Tank
Tank to Dist. Box c, b_
Dist. Box to Field/ ''
Openings Sealed? ` =`No Par i 1
LOCATION/SEPARATIO • .
Foundation to Tank 0 feet
Foundation to Absorbtion 1 feet
Separation of Pits eet
Conforms as per Plo Plan No
LOCATION OF SYSTEM IN PROPERT .
(circler!
Front - r) - Left Side - Right Side
Middlent - Middle Rear
COMMENTS:
469PcR.A7V(0
SYSTEM USE APPROVED: NO
Arrived: l ' 7
Departed:
Aee
Building Inspector
N O 1' E S
I . "
Percolation testing was done on Friday November 9, 2001. Max in percolation time was 6 min/in.
Soil was red sand for first 3 - 4 fl. and gradually changed to regi l,er sand. No ground tenter was present in
the deep test hole and the excavator, Wait Stevenson, said he had hit no water in 35R. over the past years.
2.
A 2-bedroom residence with a percolation rate of 6-7 min./inch requires 150ft. of 4" perf. pipe if old
plumbing fixtures are used. The absorption field for this residence should have`three (3) 50i1. lengths of 4"
perf pipe or four (4) 4011. lengths of 4" pert' pipe. The lengths or pert pipe should slope a,.4,ay from the "D"
box at a slope of 1/16" per fl, of pipe. The ends of the pir)e should be capped.
3.1
All separation distances in Table 92 of Thf New York State Department of Health Design Handbook for
Individual Residential Wastewater Treatment Systems (1996) must be maintained. The "D" box must be no
closer than I001i.-from the well and should be pre -cast concrete as nirrd. by Ft. Miller C(2. or equal.
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774 IM MR 24- TAPERED HOLE & PLUG
(TYPICAL)
100000
4.t 1250 GAL.
.0 5'- 3
750 GAL. 1000 GAL.
400oo��
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1000 GAL.
51-11, Ae 8'- 81/2
751) GAL.
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LIQUID
LEVEL 10'- 2
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750-1000-1250 Gallon
zpeamless Septic Tanlf[
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INLET
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OUTLETS - FIVE 4"
KNOCKOUTS WITH
HIGH DENSI*fY POLY-
ETHYLENE FIPE SEALS.
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