2010-287 TOWN OFQ UEENSBURY
wow742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development- Building &Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number. P20100287 Date Issued: Wednesday, June 16, 2010
This is to certify that work requested to be done as shown by Permit Number P20100287
has been completed.
Tax Map Number. 523400-289-011-0002-003-000-0000
Location: 833 BAY Rd
Owner. ALICE DALLEK
Applicant ALICE DALLEK
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,
Variance, or other issues and conditions as a result of approvals by thee-
Director of Building&Co. . . o"koment
Planning Board or Zoning Board of Appeals.
TOWN OF QUEENSBURY
fi742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development- Building&Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20100287 Application Number. A20100287
Tax Map No: 523400-289-011-0002-003-000-0000
Permission is hereby granted to: ALICE DALLEK
For property located at: 833 BAY 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: ALICE DALLEK
833 BAY Rd Septic Alteration Residential
QUEENSBURY,NY 12804 Total Value
Contractor or Builder's Name/Address Electrical Inspection Agency
QUEENSBURY SEWER
JAY SWEET
Plans &Specifications
2010-287
septic alteration residential
$25.00 PERMIT FEE PAID- THIS PERMIT EXPIRES: Wednesday,June 15,2011
(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.)
Dated at the To . eensb , y es),,y,June 15, 2010
SIGNED BY L a /ri for the Town of Queensbury.
Director of Building&Code Enforcement
23'
yy l��Z OFFICE USE ONLY
r.....................
TAX MAP NO. D .., _,.:..:...
PERMIT N0.3
%i'
PERMIT FEE s '''
4.__L) / ;
, lAPPROVALS: ZONING
TOWN CLERK
' 71...°."_____________________________ .__ �
. .,
APPLICATION FOR SEPTIC DISPOSAL SYSTEM PEWIT;
A PERMIT MUST BE OBTAINED BEFORE WORK BEGINS.APPLICATION IS SUBJECT BJECT TO REVIEW BEFORE ISSUANCE •F A VALID
OWNER: 0
INSTALLER: FLK. - pi-
v,_ , ,f.. „..,
ADDRESS: Y 3
i ADDRESS: illio t " ,
PHONE NOS. .7 C:il 6 I 1 7 3
PHONE NOS. _ Jr 1
LOCATION OF INSTALLATION:
YEANO.OF
R BUILT X COMPUTATION=
BEDROOMS RESIDENCE INFORMATION:
1980EA or older = TOTAL DAILY FLOW
X 150 gallon per bedroom GARBAGE GRINDER
1981 1991 X 130 gallon per bedroom =
INSTALLED? _
1992-present X 110 gallon per bedroom
_ SPA OR HOT TU
PARCEL INFORMATION: INSTALLED? _
✓ TOPOGRAPHY: Flat rolling
Steep slope %Slope
✓ SOIL NATURE:
Sand_, Loam__
Clay Other
✓ GROUNDWATER:
At what depth?
✓ BEDROCK/IMPERVIOUS MATERIAL:ERIAL: At what depth?_________
✓ DOMESTIC WATER SUPLY:
Municipal Well (If,weIJ: Water supply from any septic
,/ PERCOLATION TEST: Rate is system absorption is eft.)
er minute per inch.
(Test to be completed by a licensed ed 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),
7 o
TANK_: lszr�GALLON (MIN. SIZE IS 1,000 GAL.)Add 250allons
each garbage grinder, spa or whirlpool tub. g to the size of the septic tank for
SYSTEM TYPE:
❑ ABSORPTION FIELD (WITH NO. 2 STONE) Total length
❑ SEEPAGE PIT(S) (WITH NO. 3 STONE How -__ft. Each trench X
many?
❑ ALTERNATIVE SYSTEM Size?
or other type? i _
❑ HOLDING TANK SYSTEM Total � � � ,2.0 �
l required capacity?
Tank size? Number of tanks?
NOTE: ALARM SYSTEM AND:...:...:...........:.:.:...........:.:......:..............:.:......:...
PLEASE ASSOCIATED
ICAL WORK MUST BE INSPECTED Y A
APPROVED ELECTRICAL INSPECTION AGENCY.
:..., ..... :. :. :...:..........:........ REVIEW LIST PROVIDED. B TOWNI.
For your protection . ..................... ...................::.....:........:......:.......:....:...:...........:....:.:.:....
, pease note that pursuant to Section 136-29 of the Code of the Town nt n
permit or approval granted which is based uDon nr le _, .
failures to.Y,,,t,,. - .Y—. . .
COMMONWEALTH ELECTRICAL INSPECTION SERVICE,INC.
Main Office 176 Doe Run Road-Manheim,PA 17545
MUNICIPAL CERTIFICATE - ELECTRICAL APPROVAL
Permit No...0 _•-? ` Cert. N 2 10248 Cut-in Card No.
Owner 1) C.,c.c
Location... A9-17 - a
Installation Consisting of S" ! nA Pte`'&A/7726'-�
G(J//2/ C /9i4/8/'e
Installed By A.: .s �yC�-- Lie.No.
The conditions following governed the issuance of this certificate,and any certificate preciously issued is
cancelled:-
This certificate only covers the electrical equipment and installation conditions as of date. Upon the
introduction of additional equipment or alterations,application shall be promptly made for inspection.
Inspectors of this Company shall have the privilege of ma g 'nspections at any time, and if its
rules are violated,dthe Company shall have the right to rev th' cer ificat
Date... L'J �/O INSPECTOR
Member N.F.P.A..I.AE.I.
Septic Inspection Report
Office No. (518) 761-8256 Date Ins on req w: r='
Queensbury Building&Code Enforcement Arrive: ;10 a pm i i part: Illir a /p
742 Bay Rd., Queensbury, NY 12804 Inspector's Initials:
T
NAME: 0 fa Lt F-_k P r NO.:
LOCATION:
LOCATION: (82---7-) (�`( I CT ON: to..— !- --- tiQ
RECHECK:
Comments and/or diagram
Soil Type: Sanoam/Cla
Type of Water: Municipal a ate
Waterline separation distance ft.
Well separation distance \tIYD ft.
Other wells: 1 v ft.'H
Well Casing Length 50' +/ - Y N N/A
[150'to well required if NO]
Absorption Field: Total length bp ft.
Length of each trench ft.
Depth of trenches ft.
Size of Stone 2—
Seepage
Seepage Pits: Number
Size: x1
Stone Size:
1 1
Piping Size Type \L, to \Ail kl,
Building to tank ''-v" Cil- ‘9\i-9,
Tank to Distribution Box 1",‘" b0 C,_;
Distribution Box to Field/ Pit
''‘ 60 8:35. --b Lk 5)ck PES_
Opening Sealed: N
End Cap
Manholes 12"or less below grade _pes&Baffles Vs/ '✓N ''�`��� -__-_\..._. ._.--..C.,' --
[provide extension collar if Yes] N i ��
Location/ Separations
Foundation to tank i ft.
Foundation to absorption ft.
Separation of Pitsft.
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 Middle Rear
System Use Stus:
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\Septic Inspection Report03 29 10.doc
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ENGINEERING,, /O-
169
NAC E I P.C.Haviland Road, Queensbury,NY 12804
Phone-518-745-4400 Fax -518-792-8511
June 11, 2010
Project# 49316
Mr. Jay Sweet
Queensbury Sewer
P.O. Box 4283
Queensbury, NY 12804
Re: Proposed Replacement Septic System
Alice Dallek Residence— 823 Bay Road, Queensbury,NY
Dear Jay:
At your request we have reviewed your proposed replacement septic system design at the site of
the existing 3 bedroom house of Alice Dallek at 823 Bay Road 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 330 GPD and a percolation rate of
1 to 5 minutes, you will need 348 square feet of absorptive area. We recommend using a 20 ft
wide by 20 ft long absorption bed with 4 — 15 foot long laterals, which will provide 400 sf of
absorptive area. The absorption bed should be constructed with a new distribution box, 4 inch
diameter perforated pipe and stone.
Please call me if you have any questions.
Sincerely,
Thomas W.Nace, PE
Cc: Dave Hatin, Town of Queensbury