2006-674 01111104,
OF TOWN QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development - Building & Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: P20060674 Date Issued: Wednesday, January 16, 2008
This is to certify that work requested to be done as shown by Permit Number P20060674
has been completed.
Tax Map Number: 523400-303-012-0001-005-000-0000
Location: 162 QUEENSBURY Ave
Owner: WILLIAM & GLORIA MANN JR
Applicant: WILLIAM & GLORIA MANN JR
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,
(---- 4.19 4 V45(17
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.
eek TOWN OF QUEENSBURY
742 Bay Road,Queensbury;NY 12804-5902 (518)761-8201
Community Development- Building &Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20060674 Application Number: A20060674
Tax Map No: 523400-303-012-0001-005-000-0000
Permission is hereby granted to: WILLIAM &GLORIA MANN JR
For property located at: 162 QUEENSBURY Ave
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: WILLIAM &GLORIA MANN JR
162 QUEENSBURY Ave Septic Alteration Residential
QUEENSBURY,NY 12804 Total Value
Contractor or Builder's Name/ Address Electrical Inspection Agency
MORNING STAR SEPTIC
Plans&Specifications
2006-0674
SEPTIC ALTERATION RESIDENTIAL
$25.00 PERMIT FEE PAID- THIS PERMIT EXPIRES: Thursday, October 25, 2007
(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 th expiration da .)
Dated at the T wn of e 1W
i / esday, October 25, 2006
SIGNED BY 44k, for the Town of Queensbury.
Director of Building&Code Enforcement
3_13 4 1 OFFICE USE ONLY
TAX MAP NO. PERMIT NO. PERMIT FEE
APPROVALS: ZONING `SEP 2 6 2006 i
TOWN CLERK
APPLICATION FOR SEPTIC DISPOSAL SYSTEM PERMIT:
A PERMIT MUST BE OBTAINED BEFORE WORK BEGINS.APPLICATION IS SUBJECT TO REVIEW BEFORE ISSUANCE OF A VALID
PERMIT. -7
OWNER: INSTALLER:
ADDRESS: / .ZAt( 41ADDRESS:
PHONE NOS. .79'? 6 2 6.0 PHONE NOS. 297 2_2_9'0 2 y4(25-y3.7 c.
LOCATION
4(2 /39-
LOCATION OF INSTALLATION:
NO.OF RESIDENCE INFORMATION:
YEAR BUILT BEDROOMS X COMPUTATION= I = TOTAL DAILY FLOW
GARBAGE GRINDER
1980 or older < X 150 gallon per bedroom = z INSTALLED? y
1981 -1991 X 130 gallon per bedroom = SPA OR HOT TUB
1992-present I X ? 110 gallon per bedroom I = INSTALLED?
PARCEL INFORMATION:
✓ TOPOGRAPHY: FLA ROLLING STEEP SLOPE %SLOPE
✓ SOIL NATURE: SAND >c LOAM CLAY OTHER
✓ GROUNDWATER: AT WHAT DEPTH? BEDROCK/IMPERVIOUS MATERIAL: AT
WHAT DEPTH?
✓ DOMESTIC WATER SUPLY: MUNICIPAL )( WELL
(IF WELL: WATER SUPPLY FROM ANY SEPTIC-SYSTEM ABSORPTION IS FT. )
✓ PERCOLATION TEST: RATE IS PER MIINUTE PER INCH (TEST TO BE
COMPLETED BY A LICENSED PROFESSIONAL ENGINEER OR ARCHITECT)
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. jj
✓ SEPTIC TANK: for GALLON (MIN. SIZE IS 1,000 GAL.) TILE FIELD: EACH TRENCH UQ FT.
✓ TOTAL SYSTEM LENGTH: / ' FT. SEEPAGE PIT(S): HOW MANY?
✓ SIZE OF EACH FT. X FT.
✓ SIZE OF STONE TO BE USED: # /DEPTH OR THICKNESS / 1/
✓ BED SYSTEM SIZE: X
✓ ALTERNATIVE SYSTEM: LENGTH AND/OR SIZE
✓ HOLDING TANK SYSTEM: (If required) NO. OF TANKS: /SIZE OF EACH
✓ GALLONS./TOTAL CAPACITY: GAL.
NOTE: ALARM SYSTEM AND ASSOCIATED ELECTRICAL WORK MUST BE INSPECTED BY A TOWN
APPROVED ELECTRICAL INSPECTION AGENCY. PLEASE REVIEW LIST PROVIDED.
E.....................u.,.....,........., .,,..,.......... ..,.,...............,............,.... ...........,.. .,,..•. ... ..,...a.,.,,,.,u u u,...a,.,..,.,,.... .,a,,,.,
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 QUESTIONS? CALL 761-8256 OR EMAIL
Queensbury Sanitary Sewage Disposal Ordinance. codes@queensburv.net
VISIT OUR WEBSITE FOR MORE INFORMATION
www.queensbury.net
Signature of Person Responsible ate
Town of Queensbury • Community Development Office • 742 Bay Road, Queensbury,NY 12804
Septic Inspection Report
Office No. (518) 761-8256 Date Inspection request received:
Queensbury Building &Code Enforcement Arrive: am/T.I.t am/pm
742 Bay Rd., Queensbury, NY 12804 Inspector's Initials:
NAME: friU-A
PERMIT NO.: �� 416,LOCATION: hiv ./11-vc INSPECT ON:
RECHECK: ✓
Comments and/or diagram
Soil Type: Sand/ Loam / Clay
Type of Water: Municipal/Well Water
Waterline separation distance ft. daSe-- l.)4— -
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: 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 iddte Rear
stem U.- 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
TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development- Building&Codes (518) 761-8256
Inspections per Permit
Permit# P20060674
Inspection Date Inspection Type
Approved/Denied Comments Permit Type Person Responsible
10/25/2006 12:00:OOAD Septic Septic Alteration Residential JOHN O'BRIEN
Approved 2006-674
levelers installed in d-box
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518-793-2290
' •
Fax#518-793-2115
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AIWZMilla-- E-mail:momingstarseptic@hotmail.corn
www.momingstarseptic.com
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TOWN OF QUEENSBURY
PERCOLATION AND DEEP HOLE TEST
Conventional Absorption System Date: 10/17/2006
Time: 7:45
Location: 162 Queensbury Avenue
Information from application: Contact Person: Frank Shaw
Depth of projected bottom of trench from existing/finished grade: 30' Telephone#:
Owner Name: Gloria Mann
Distance to Lake George >2000' Tax Map#
!Distance to water other than LG >200' Engineer: Frank Shaw
depth 'location BL# 07
homeowner
Adjacent has well for Well is under porch.
Wells irrigation Approximately 60'from Home and neighbors all
Visible? only percolation test pit 1 ,have municipal water
Percolation Test Results(2 within proposed area, bottom of test holes to be as projected above)
Hole to be 12"x 12" or 12"diameter Do Not Perform when ground is frozen
Presoak* Date Timo *4 hour minimum unless clean sand or gravel
10/17/2006 8:00 <24 hrs before test
Continue testing until times within same pit are 5 1 min.for 1-30 min/inch;5 2 min.for 31 -60 min/inch
Measure time for 1"drop with 6"water depth
Pit Depth Pit Dimension Run Time(min) Deep Hole
PIT#1 37" 12" 1 1.5 Minimum of 5'below bottom of absorption trench
2 1.7 Must be within or adjacent to proposed absorption area
3 1.8 Hole Depth Depth to Water Soil Mottling
4 2.1 0-6" Topsoil None Depth:None
Stabilized rate of percolation 2.0 6-48" sandy loam
48-80" clay
PIT#2 37" 12° 1 1.7 80-96" fine sand/clay mix
2 1.9
3 2.0 No indication of groundwater,mottling or bedrock.
4 2.0
Stabilized rate of percolation 2.0
Expansion
Area if soil is
different soil appears similar
Witnessed by: ,Barton&Loguidice,P.C.
Date: 10/17/2006 Time: 13:00
1 •n
oguidice,PC.
kw_
Engineers•Envlronmenral Scientists•Planners-landscape Designers
BL Form 2006-1
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162 Queensbury Avenue 10/17/2006
October 17,2006
Dan Stec, Town Supervisor
Town of Queensbury
742 Bay Road
Queensbury,New York 12804
File: 686.007
Dear Supervisor Stec:
I have reviewed or witnessed the following items relating to septic systems that have been referred to us by your
office:
Owner: Gloria Mann Location: 162 Queensbury Avenue
Contractor: Frank Shaw Tax Map:
BL#: 07
Application Construction
Presoak Deep hole Percolation Review Inspection
10/17/200 10/17/200 10/17/200
Date 6 6 6
Time 08:00 07:45 13:00
This will be a replacement of an existing septic system that has reportedly failed. The resident has a well that is
only used for irrigation purposes approximately 60'from the proposed system. The well currently has no
connection to the potable water system. She and all her neighbors have Queensbury municipal water in their
homes.
Attached is a copy of the inspection sheet and photos taken of the site during the inspection. Please contact me
should you have any questions relating to this inspection.
Very truly yours,
BARTON&LOGUIDICE,P.0
Ralph S. VanDusen
Senior Water Quality Scientist
668-5409
RSV/dal
Enclosures
cc: Roger Boor,Ward 1 Councilman
Richard Sanford,Ward 2 Councilman
John Strough,Ward 3 Councilman
Tim Brewer,Ward 4 Councilman
David Hatin,Director,Building and Codes
C:1Docnments and Settingsldaveh\Local Settings\Temporary Internet Files\OLK581Mann witness letter(3).doc