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2011-522 .4" TOWN OFQ UEENSBURY tivo742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201 Community Development- Building & Codes (518) 761-8256 CERTIFICATE OF COMPLIANCE Permit Number: P20110522 Date Issued: Wednesday, October 26, 2011 This is to certify that work requested to be done as shown by Permit Number P20110522 has been completed. Tax Map Number: 523400-316-017-0001-012-000-0000 Location: 19 PALMER Dr Owner: ROSE M MERRITT TRUST Applicant: ROSE M MERRITT TRUST 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 :244 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 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201 Community Development-Building&Codes (518) 761-8256 BUILDING PERMIT Permit Number: P20110522 Application Number: A20110522 Tax Map No: 523400-316-017-0001-012-000-0000 Permission is hereby granted to: ROSE M MERRITT TRUST For property located at: 19 PALMER Dr 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: ROSE M MERRITT TRUST Septic Alteration Residential C/O GARLICK DONNA Total Value 5800 HALLOWING Dr LORTON VA 22079-4107 Contractor or Builder's Name/Address Electrical Inspection Agency Plans&Specifications 2011-522 septic alteration residential $40.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Thursday,October 18,2012 (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 the Tovvh--sf Quedinsbury; ; i TUesd*y, October 18,2011 ` SIGNED BY ,_- • :K ' "�4 for the Town of Queensbury. Director of Building&Code Enforcement Ar-„2„„q> i in 1 t i , ,, ,, ! u Community Develo,reef Office 1 � ,., a ;a J, " R Town of Queensbury • 742 Bay Road • Queensbury, New York 11281114-77-. iP ---.-, I____ i !! i) ( i cor)t.cs • Office Use Only 3j6• /7_/-/ZI-522_ (j`,TAX MAP NO. PERMIT NO. I PERMIT FEE C l�-' APPROVALS: ZONING TOWN CLERK APPLICATION FOR SEPTIC DISPOSAL SYSTEM PERMIT: A PERMIT MUST BE OBTAINED BEFORE WORK BEGINS./ APP (CATION IS SUBJECT TO REVIEW QIEFORE ISSUANCE OF A VA ,ID PERMIT. R:,, OWN ©W pAs- SPA R Lt G IC.. ig b se /41,14416( INSTALLER: J�4—NV:TA �J/�`'^'c/`_ - tz`Jt`6 ADDRESS: 5)0 C 14 Al t o wV Ott, L&XTr"1 VA— ADDRESS: E z -?-0N4 -2-2-Lf. G F PHONE NOS.7 0 3 - 3 0 9 - 2 PHONE NOS. "7 g , U P S.J LOCATION OF INSTALLATION: / / e L ft 4-42.. Dat de. RESIDENCE INFORMATION: NO. COMPUTATION YEAR BUILT BEDROOMS X (Gallons per bedroom) = TOTAL DAILY FLOW GARBAGE GRINDEPt , 1980 or older 1 X 150 = j ,5'J INSTALLED? WO 1981-1991 X 130 = SPA OR HOT TUB duD 1992-present X 110 = INSTALLED? PARCEL INFORMATION: ✓ TOPOGRAPHY: FLAT ROLLING STEEP SLOPE %SLOPE ✓ SOIL NATURE SAND LOAM CLAY OTHER, I GROUNDWATER: AT WHAT DEPTH? I BEDROCK/IMPERVIOUS MATERIAL: AT WHAT DEPTH? ✓ V" „ ' I DOMESTIC WATER SUPLY: MUNICIPAL WELL (If well:water supply from any septic system absorption is: t f ft) I PERCOLATION TEST: RATE IS PER MIINUTE PER INCH[mpl] (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). TANK SIZE:1 ©°V GALLON(MIN.SIZE IS 1,000 GAL.)Add 250 gallons to the size of the septic tank for each garbage grinder, spa or whirlpool tub. SYSTEM TYPE: ❑ABSORPTION FIELD(WITH NO.2 STONE) Total length ft. Each trench X ❑SEEPAGE PIT(S)(WITH NO.3 STONE) How many? Size? ALTERNATIVE SYSTEM :ed o other type? 2,0 `4 '2 ❑ HOLDING TANK SYSTEM Total required capacity? Tank size? Number of tanks? NOTE: ALARM SYSTEM AND ASSOCIATED ELECTRICAL WORK MUST BE INSPECTED BY A TOWN APPROVED ELECTRICAL INSPECTION AGENCY. PLEASE REVIEW LIST PROVIDED. 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 h- :d • - -g -;•ns with re '-ct to this application and agree to .•i• b these,"•• . =•uire -•„:of the Town of Q ensbu QUESTIONS? CALL 761-8256 OR EMAIL S. r Se • sp•--1 ••ince. /40 , <7 <; codes(vtqueensburv.net /" ,_ '' INFORMATION ture of Person Responsible Date VISIT OUR WEBSITE FOR MORE ' www.queensbury.net , 3C ) Septic Inspection Report Office No. (518) 761-8256 Date Ins • Queensbury Building&Code Enforcement Arrive: I �r ��- '•rt: = ZOIP' 742 Bay Rd., Queensbury, NY 12804 Inspector's Initia;t NAME: / 7f • '1 NO.: LOCATION: ! /j.-_g —' /NsPEcr ON: . RECHECK: Comments and/or diagram Soil Type: tram CJay Type of Water: Munid L/ilile1l Water Waterline sep.rati6tf fiance ft. Well separation distance Other wells: 1ff ft.A Well Casing Length 50' +/- Y N N/A [150'to well required if NO] Absorption Field: Total length ' 'C• ft. Length of each trench 4 'LK) ft. --- t��r-j Mtge) Depth of trenches ft. Size of Stone -�. Seepage Pits: Number Size: 7-0 x Zi ' \ v Stone Size: Piping Size Type Building to tank 4 *` Tank to Distribution Box i �. 3 c- Distribution Box to Field/ Pit 0 p R t✓Y Opening Sealed: N End Cap N Inlet/Outlet Pipes&Baffles N Manholes 12"or less below grade X [provide extension collar if Yes] Location/ Separations Foundation to tank ft. Foundation to absorption ft. Separation of Pits ft. Conforms as per Plot Plan _N Engineer Report and As-Built _•_,,,Y N ETU Maintenance Contract Y N provided Location of System on Property: Front Rea Left Side Right Side Middle FrorC Middle Rear em U S Approved Partial Approved and needs to be re-inspected, please call the Building&Codes Office Disapproved L:\Pam Whiting\2010\Building Codes Forns\Inspectlon Forms\Septic Inspection Report..03 29 10.doc 4 CENTER PROJECT SERVICES 73 Sheridan Street, Glens Falls, NY 12801 Phone-518-796-2515 October 10, 2011 Project# 147 Dan Drellos Sanitary Sewer Services Luzerne Road Queensbury,NY 12804 Re: Proposed Replacement Septic Garlick Residence— 19 Palmer Drive, Queensbury,NY Dear Dan: At your request we have reviewed your proposed replacement septic system design at the site of the existing 1 bedroom house of at 19 Palmer Drive in Queensbury. As per our conversation the residence has an existing failed septic system. We have reviewed the proposed replacement septic system design and we agree that a standard absorption bed is acceptable. Based upon a design flow rate of 220 GPD and a percolation rate of 1 to 5 minutes, you will need 232 square feet of absorptive area. We recommend using a 20 ft wide by 25 ft long absorption bed with 4 — 20 foot long laterals, which will provide 500 sf of absorptive area. The absorption bed can be constructed with a new 1,000 gallon septic tank, new distribution box, and 4 inch diameter perforated pipe and stone. Please feel free to contact me at 796-2515 if you have any questions and that you for your assistance with this request. Sincerely, Thomas R. Center Jr, P.E. • ck Septic Inspection Report Office No. (518)761-8256 Date Inspection = :. _ : Queensbury Building&Code Enforcement Arrive: rj+,� ,dart: (;�[ 742 Bay Rd., Queensbury, NY 12804 Inspector's Initials:: /It. NAME: NI e1 GR2UC PE. IT NO.: i;=tv�\ –, /1 < LOCATION: \ ✓ IN ON: 1C� -5–i l RECHECK: Comments and/or diagram Soil Type: Sand/ Loam/Clay Type of Water: Municipal/Well Water � ' � ����-� t � � Waterline separation distance ft. V'� Well separation distance ft. Other wells: ft. o\ � 1j Well Casing Length 50'+/- Y N N/A [150'to well required if NO] Absorption Field: Total length ft. Length of each trench ft. \ CQ ,b gW\L71v Y_ Depth of trenches ft. Size of Stone Zv L_C1\c \-\ c =7 Seepage Pits: Number �7 (� Size: x -- o u3B rs- v\ Stone Size: Piping Size Type M ,A \ kj \JV1 IN Building to tank Tank to Distribution Box ) f \ C?•-t- t"k \))0_ Distribution Box to Field/ Pit Opening Sealed: Y N End Cap Y N Inlet/Outlet Pipes&Baffles Y^N Manholes 12"or less below grade _._Y—N [provide extension collar if Yes] 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 ETU Maintenance Contract _Y+,N provided Location of System on Property: Front Rear Left Side Right Side Middle Front Middle Rear em S.tu_. Approved Partial Approved and needs to be re-inspected, please call the Building &Codes Office Disapproved L:\Pam Whiting\2010\BuIlding Codes Forms\Inspec`on Forms\Septic Inspection Report 03 29 10.doc , i Li , ti yv‘D,� _D c�tut- i TOWN - OF QUEENSBURY 4` ,. f :,r BUILDING 'l-` _`'' .--.1 '' _ ..�. & CODES DEPT. _ Reviewed By: Date: \�- — -- i TOW OF QUEENSBURY ` BUIL I f NG DEPARTMENT Based on our ti,ited examination, with our comm anon,corn i. �` :_ is shah not be constr ., -- — — �; indicating the pians and specifications d in � full compliance with the Building Cod s of New York State, ,f-' t r �.� z __—._ . n _ s tI tl 'et i I ..r — 20 III • /--- [ 5 It- i Y