2010-521 0111141%_ QUE TOWN OFENSBURY
742 Bay RoadQueensbury,NY 12804-5902 (518)761-8201
Community Development- Building &Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: P20100521 Date Issued: Wednesday, December 15, 2010
This is to certify that work requested to be done as shown by Permit Number P20100521
has been completed.
Tax Map Number. 523400-239-016-0001-021-000-0000
Location: 8 BURNT RIDGE Rd
Owner. LENTON & BARBARA SIMMS
Applicant: LENTON & BARBARA SIMMS
This structure may be occupied as a:
Septic Alteration Residential By Order of Town Board
Test Pit/ Perc Test Review TOWN OF QUEENSBURY
/9 Issuance of this Certificate of Compliance DOES NOT relieve the CD' ,� 4 .
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.
l�� TOWN OF QUEENSBURY
pow 742 BayRoad,Queensbury,NY 12804-5902 (518)761-8201
Community Development- Building&Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20100521 Application Number. A20100521
Tax Map No: 523400-239-016-0001-021-000-0000
Permission is hereby granted to: LENTON &BARBARA SIMMS
For property located at: 8 BURNT RIDGE 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: LENTON&BARBARA SIMMS
8 BURNT RIDGE Rd Septic Alteration Residential
LAKE GEORGE,NY 12845 Test Pit/Perc Test Review
Total Value
Contractor or Builder's Name/Address Electrical Inspection Agency
Plans &Specifications
2010-521
deep hole/perc test- septic alteration
$225.00 PERMIT FEE PAID- THIS PERMIT EXPIRES: Tuesday,December 06,2011
(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,&
,4
Dated at the To o ens > I : :y,December 06,2010
SIGNED BY �1" d for the Town of Queensbury.
Director of Building&Code Enforcement
Town of Queensbury• Building&Codes Enforcement Office■742 Bay Road■ 11isy( ' n
E.
VIE
DEEP HOLE/PERC TEST
Request for Town Engineer Revie i OCT 2 7 20 0
TOWNS dF Qu ssopy
Property Owner: L.. v. 11 1, ..: Phone: BUILDING : •.
Property Owner's
Address: s3 cekv6(g Vh
Location of Test: ' ..9e4-t-i, Qt��c, ' Tax ID#:
*Applicant's Engineer: : f{h..S t..J " 6 Phone: 7(/ .
Applicant's Agent: Phone:
Additional Notes:
1. Reason for Request? New Septic System AReplacement Septic System Failed Septic System
Subdivision Site Plan Review
2.Are Wetlands present? YES NO UNKNOWN
*Note: Applicant is required to engage an engineer for design and testing of the system. The Town
Engineer's responsibility is to witness system testing only.
PLOT PLAN: Plot plan, to scale, to be submitted with application
FEE SCHEDULE:
a. $200 Flat Fee Date Paid: _"7 i
Check No.:
b. OR Fee to be determined during To Be Determined:
Site Plan/Subdivision review process
SIGNATURE:
In carrying out the provisions of Article IV, the Local Board of Health or the enforcement officer may
engage the services of a qualified professional consultant for expert review and recommendation arising
from the carrying out of the provisions of Art. IV, including but not limited to the review of plans,
specifications and reports, attendance at inspections, dye tests, deep hole test pits, septic related deep
hole and percolation tests, system installations, and any other aspect of any matter contained in this Art.
IV, and any costs incurred in such review shall be paid to the Town by the owner of the property before
any approval can be granted under this Art. IV shall become effective within 30 days of presentment of an
invoice for same, whichever is sooner. Such costs shall not exceed$1,500 without prior written notice to
the party to be charged with same.
My signature below indicates I have thoroughly read and understand the instructions, agree to the
submission requirements and have completed the application. I also fully understand that additional
engineering fees may be necessary per Town of Queensbury Local Law 136-14D.
SIGNATURE OF APPLICAN . Date:
SIGNATURE OF AGENT: /t7fr 44 ,i i Date: 34.73//0
Original (B&C File) Canary(Planning) Pink(Applicant) Gold (Town Clerk)
0 Community Development Office : I
3
Town of Queensbury • 742 Bay Road • Queensbury, New Yor iii $04 n'frBSE .. ;i , �'�� i r'F
I r
Office Use Only
t,=--- '
TAX MAP Ner39, /6 -7 I
PERMIT NO. G7 / PERMIT FEE
APPROVALS:. ZONING 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.
OWNER: L eTO,U OAR ZA S l4 5 INSTALLER: 0,L2StP 3(7r-i14. [Jj1C`1INIV1 NCI
ADDRESS: g -3,c,,JT`"" l a2r-• ; RI) ADDRESS:
PHONE NOS. ;} PHONE NOS. `�7 /q
2-,..2(077LOCATION OF INSTALLATION: g 3./R.IVi t'i t"i)i 6. RT)
RESIDENCE INFORMATION:
YEAR BUILT NO.OF X COMPUTATION =
BEDROOMS (Gallons per bedroom) TOTAL DAILY FLOW
GARBAGE GRINQER
1980 or older X 150 = INSTALLED? 1,10
1981 -1991 X 130 = SPA OR HOT TUB
1992-present 3 X 110 = '33o INSTALLED? 106
PARCEL INFORMATION: /
✓ TOPOGRAPHY: FLAT ROLLING ., STEEP SLOPE %SLOPE
✓ SOIL NATURE: SAND X LOAM CLAY OTHER
✓ GROUNDWATER: AT WHAT DEPTH? N SS"
✓ BEDROCK/IMPERVIOUS MATERIAL: AT WHAT DEPTH?
S3
✓ DOMESTIC WATER SUPLY: MUNICIPAL WELL k (If well:water supply from any septic system absorption is: i I Q ft)
✓ PERCOLATION TEST: RATE IS S PER MIINUTE PER INCH[mpi] (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).
—EK(t 11/4(1
TANK SIZE: it000 GALLON (MIN. SIE 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?
El ALTERNATIVE SYSTEM 0 or other type? 20` X ZZ' Ae,Saz'v`I v j Be 0
0 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 hav- read the reg .tions with respect to this application and agree to
abi'- by th-se•n• - requirements of the Town of Queensbury QUESTIONS? CALL 761-8256 OR EMAIL
S. ary :wa -: •osal Ordinance. / codesCa�queensburv.net
t 0
i•• 1••f Person Responsible Date ` VISIT OUR WEBSITE FOR MORE INFORMATION
www.queensburv.net
C,. (4 C ufl f►„ . k.-- LNC k- to >---Y
Septic Inspection Rept
Office No. (518)761-8256 Date Ins :' illow,a-iv i
Queensbury Building&Code Enforcement Arrive: \ G 1�a 1, part: am/pm
742 Bay Rd., Queensbury, NY 12804 Inspector's Initials: 4
NAME: ti 1 ' Mei NO.: 1C) —,17-1-1
LOCATION: � T i.1.CX E �� • ON: 1 z—i 3-1(�
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.
Well Casing Length 50'+/- Y N N/A
[150'to well required if NO]
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
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 f,
Separation of Pitsft.
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 R- • Left Side Right Side Middle Front Middle Rear
stem - S..1 .
Approved
Partial Approved and needs to be re-inspected, please call the Building&Codes Office
Disapproved
L:\Pam Whiting\2010\Building Codes Forms\Inspection Forms\Setic Inspection Report03 29 10.doc
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P� Report tic Inspection Re rt
p
Office No. (518)761-8256 Date Inspection req -. -•- -•:
Queensbury Building&Code Enforcement Arrive: y�? a In�� 7 s5'h"�air a
742 Bay Rd., Queensbury, NY 12804 Inspector's Initials:
-/ -
NAME: `'Vt,) - i IT NO..
LOCATION: ?�r;, . ,-T ,e_!`mac-/ INSPECT ON: C_.
RECHECK: `I
Comments and/or diagram
Soil Tye San aha.„/Clay
Type of Water: Municipal/Well Water
Waterline separation distance ft.
Well separation distance tr ft.
Other wells: ft.
Well Casing Length 50' +/- Y N N/A
[150'to well required if NO]
Absorption Field: Total length y... 2Z _ft. i jrt),E__
Length of each trench ft.
Depth of trenches \t 112 ft.
Size of Stone -AV z_
Seepage Pits: Number
Size: x
Stone Size:
Piping Size Type
Building to tank 51...v.51-1 F-,
Yt P Tank to Distribution Box ‘121 p &2C� M.6,46
Distribution Box to Field/ Pit .2 ( -\Opening Sealed: N
End Cap Nr ` 'vb __
Inlet/Outlet Pipes&Baffles N
Manholes 12"or less below ,,,(:::)1
[provide extension collar es
Location/Separations
Foundation to tank
Foundation to absorption ZC$"" ft.
Separation of Pits ft.
Conforms as per Plot Plan w Y / ILI
b t� - _�=
Engineer Report and As-Built _Y I tJ 1
b iRtz-
ETU Maintenance Contract Y N
provided L.
Location of System on Property:
Front Rear Left Side Right Side Middle Front Middle Rear
em S t
Approved
Partial Approved and needs to be re-inspected, please call the Building&Codes Office
Disapproved
L:\Pam Whiting\2010\Building Codes Fom,s\Inspectlon Fomrs\Septic Inspection Repor�03 29 10.doc
WASTEWATER SYSTEM DESIGN
3 BEDROOM RESIDENCE
WATER SAVING FIXTURES (1.6 GPF MAX. FLUSH, 3.0 GPM MAX. FAUCETS)
DESIGN FLOW - 110 GPD/BEDROOM
SYSTEM DESIGN FLOW - 330 GPD
SEPTIC TANK - EXISTING 1000 GAL PRECAST CONCRETE
PUMP STATION - EXISTING 1000 GAL PRECAST CONCRETE W/DUPLEX PUMPS
ABSORPTION BED AREA REWO = (330 GPD)/(0.8 GPD/SF) = 412 SF
(UP TO A 10 MIN PERCOLATION RATE IN NEW SYSTEM FILL MAIL PER
APPENDIX 75-A)
ABSORPTION BED AREA PROVIDED = 20'x22' = 440 SF
APPLICATION RATE TO EXISTING SOIL: 0.8 GPD/SF, BASED ON
6-7 MIN/IN PERCOLATION RATE (APPENDIX 75-A p.46)
POTABLE WATER SUPPLY - ON-SITE WELL SUPPLY
MAINTAIN 100' FROM ABSORPTION FIELD AND INFILTRATION
DEVICES FOR DRIVEWAY AREAS.
n
t11'
APPROXIMATE
EXISTING GRADE
S 1-78 :36' E
4" MINIMUM TOPSOIL ON
ENTIRE FILL AREA;
SEED AND ESTABLISH TURF
SYSTEM FILL MATERIAL AS
NEEDED TO ESTABLISH GRADES,
MECHANICALLY STABILIZE WITH
TRACKED EQUIPMENT, 8-10
MINUTE IN-PLACE STABILIZED
PERCOLATION RATE
SYSTEM INSTALLATION NOTES
CONSTRUCTION SHALL BE AS SHOWN ON THIS DRAWING AND IN ACCORDANCE WITH THE N.Y.S.
DEPARTMENT OF HEALTH INDIVIDUAL HOUSEHOLD SYSTEMS AND ASTM F481 INSTALLA77ON OF
THERMOPLASTIC PIPE AND CORRUGATED TUBING IN SEPTIC TANK LEACH FIELDS.
AFTER EXCAVATION OF 20' WIDE ABSORPTION BED TO THE DEPTHS REQUIRED, THE WALLS AND
FLOOR SHALL BE CLEANED AND RAKED IN ORDER TO LOOSEN SMEARED AREAS OF SOIL.
PLACEMENT OF CRUSHED STONE, PERFORATED PIPE AND FILTER FABRIC SHALL BE AS SHOWN, AND
CARE SHALL BE EXERCISED TO AVOID INCLUSION OF FINE GRAINED SOILS AND WASTE MATERIAL IN
THE STONE AND PIPE.
THE PIPE SHOULD BE LAID AT THE GRADES INDICATED, MAINTAINING STRAIGHT CONTINUOUS GRADES
WITHOUT SAGS, HUMPS, SEPARATED JOINTS, OR OTHER UNSUITABLE CONDITIONS. PIPE SHALL BE
LAID WITH HOLES DOWN IN ALL CASES.
ALL DISPOSAL FIELDS SHALL BE GRADED TO SHED RAINFALL AND DIVERT SURFACE RUNOFF AWAY
FROM THE DISPOSAL FIELD.
FROM 0, , � _
DO NOT USE HEAVY EQUIPMENT WITHIN THE ABSORPTION AREA AFTER PIPING HAS BEEN INSTALLED.
THE WASTEWATER TREATMENT SYSTEM IS DESIGNED AND APPROVED BASED UPON THE INSTALLATION
OF WATER CONSERVING FIXTURES AND A DESIGN FLOW OF 110 GPD PER BEDROOM. THE SYSTEM IS
NOT DESIGNED TO ACCOMMODATE EXTREME WATER USE FIXTURES, SUCH AS JACUZZI -TYPE SPA TUBS
OR WATER TREATMENT EQUIPMENT. THE INSTALLAT70N OF NON -CONSERVING WATER FIXTURES OR
EXTREME WATER USE FIXTURES IS CONTRARY TO THE APPROVAL OF THIS WASTEWATER TREATMENT
SYSTEM.
ROOF, FOOTING, GARAGE, CELLAR AND SURFACE WATER DRAINAGE MUST BE EXCLUDED FROM THE
WASTEWATER SYSTEM.
CONSTRUCT DRAINAGE SWALE UPGRADE OF SYSTEM IN ORDER TO DIVERT SURFACE RUNOFF AROUND
ABSORPTION FIELD.
S 88°06'00" E ±498.0'
487.0'
65'
19FITNITIMPTIMM
20' BED WIDTH
ABSORPTION BED SECTION DETAILS
EXISTING SEPTIC TANK TO REMAIN
(LOCATION APPROXIMATE)
EXISTING PUMP STATION TO REMAIN
(LOCATION APPROXIMATE)
128.12'
±250.0' (TO SHORE)
'l-1/2" PVC SDR -26 OR
HDPE SDR -11 FORCED
MAIN, SLOPED TO DRAIN
BACK TO PUMP STATION.
MAINTAIN 4' OF COVER..
PROPOSED DISTRIBUTION BOX
PROPOSED 20' X 22'
ABSORP 77ON BED
SITE SOILS DATA
TEST PITS
TP -1 - 11/30/2010 BY T. HUTCHINS, P.E., WITNESSED
BY QUEENSBURY TOWN ENGINEER
0-43" - LIGHT BROWN SAND GRANULAR FILL
43-54" - ORIGINAL TOPSOIL
55+" - VERY FIRM/ROCK
NO WATER EVIDENCE ENTIRE DEPTH
PERCOLATION TESTS
PT -1 - 11/30/2010 BY T. HUTCHINS, P.E.
STABILIZED PERCOLATION RATE: 5 MIN PER INCH
SITE PLAN
SCALE: 1 "=20'
2" MIN. STONE COVER
4" SDR -35 PVC PERFORATED LATERAL
INSTALLED NEAR LEVEL, IN BED CONFIGURATION
6" MIN. STONE BELOW PIPE
EXISTING 77MBER
RETAINING WALL
TO BE REPLACED
4" SDR -35 PVC PERFORATED
LATERAL INSTALLED NEAR
LEVEL, 1N BED CONFICURA77ON
4" MINIMUM TOPSOIL ON
ENTIRE FILL AREA;
SEED AND ESTABLISH TURF
22' BED
LENGTH
22'
20'
ABSORPTION
BED DETAILS
TOWN OF QUEE
BUILDING & C(X
ROVIOWed By:
Date. __ h
APPROXIMATE EXISTING
GRADE
FILTER FABRIC,
TENCATE MIRAFI 140N
OR EQUIVALENT
ABSORPTION BED PROFILE DETAILS
MAP REFERENCE:
PROPERTY LINE AND HOUSE LOCAT70N FROM
A SURVEY TITLED "MAP OF A SURVEY
SHOWING LANDS BELONGING TO AND LANDS
TO BE CONVEYED BY LENTON & BARBARA
SIMMS" DATED APRIL 2, 2002 BY DONALD L.
PIDGEON JR., LICENSED LAND SURVEYOR, 16
MICHAEL ROAD FORT EDWARD, NY 12828.
LIMIT OF 20'x32'
STONE BED
4" PERFORATED PVC
LATERALS INSTALLED NEAR
LEVEL IN BED CONFIGURATION
PROPOSED
DISTRIBUTION BOX
TAX PARCEL # 63.4-2-17