2010-354 TOWN OFQ UEENSBURY
ws 742 Bay Road,Queensbury,NY 12804-5902 (518) 761-8201
Community Development- Building &Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: P20100354 Date Issued: Thursday, September 30, 2010
This is to certify that work requested to be done as shown by Permit Number P20100354
has been completed.
Tax Map Number. 523400-301-008-0002-005-000-0000
Location: 10 COTTAGE HILL Rd
Owner. XENIA WIELAND
Applicant: XENIA WIELAND
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 ("--- a.P4
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
E!
Community Development- Building&Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20100354 Application Number. A20100354
Tax Map No: 523400-301-008-0002-005-000-0000
Permission is hereby granted to: XENIA WIELAND
For property located at: 10 COTTAGE HILL 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 Queens bury Zoning
Ordinance. Type of Construction Value
Owner Address: XENIA WIELAND
10 COTTAGE HILL Rd Septic Alteration Residential
QUEENSBURY,NY 12804 Total Value
Contractor or Builder's Name/Address Electrical Inspection Agency
Plans &Specifications
2010-354
septic alteration residential
$25.00 PERMIT FEE PAID- THIS PERMIT EXPIRES: Tuesday,July 26,2011
(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 e I,iration date.)
Dated at the To of Qu e •u' 4 ,July 26,2010
SIGNED BY for the Town of Queensbury.
Director of Building&Code Enforcement
OFFICE USE ONLY /,FB n
TAX MAP NO.,30i4g—Z--� PERMIT NO. / -3ERMIT
FEE
APPROVALS: ZONING TOWN CLERK
J
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: y-C1.�\P\ k 3 ►` S) INSTALLER: Tr` %.‘')i----7.-' '' + -k '�,4, „^_
ADDRESS: \Q Cb \T P - \ L c%� ADDRESS: �
PHONE NOS. Z CIV — :7)13 7 PHONE NOS.
LOCATION OF INSTALLATION: k b C 1 Y $P.t6c__ \lc e l I eLsz).
YEAR BUILT N0.OF RESIDENCE INFORMATION:
BEDROOMS x COMPUTATION= = TOTAL DAILY FLOW
1980 or older X 150 gallon per bedroom = GARBAGE GRINDER
INSTALLED?
1981 -1991 X 130 gallon per bedroom -
1992 resent _ SPA OR HOT TUB
p � X 110 gallon per bedroom = INSTALLED?
-
A P R L IL INFORM 4N: 1J Eve F% �v' h ►J 1rt0 F
ATI N
✓ TOPOGRAPHY: Flat rolling N. Steep slope %Slo e
p
✓ SOIL NATURE: Sand ✓ Loam
Clay Other
✓ GROUNDWATER: At what depth? •\b
✓ BEDROCK/IMPERVIOUS MATERIAL: At what depth?
✓ DOMESTIC WATER SUPLY: Municipal x' Well (If well: Water supply from any septic
system absorption is ft.)
✓ PERCOLATION TEST: Rate is k -
per minute 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).
TANK SIZE: 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 4c5C7 ft. Each trench X
0 SEEPAGE PIT(S) (WITH NO. 3 STONE) How many? Size?
ALTERNATIVE SYSTEM Bed or other type? '- -`-MtJ o k-A-,,P---ifkt% 6 A i EtA 1
5. E-1-
❑ HOLDING TANK SYSTEM Total required capacity? ‘ \--"S - c v-
Tank size? Number of tanks?
li NOTE: ALARM SYSTEM AND ASSOCIATED ELECTRICAL WORK M
UST BE . ............._.....:
APPROVED ELECTRICAL INSPECTION AGENCY. PLEASE REVIEW LIST PROVIDED.
ED BY A TOWN
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.
Septic Inspection Report
Office No. (518) 761-8256 Date Inspectign request received:
Queensbury Building &Code Enforcement Arrive: ?- 4' am/pry, Depart: am/pm
742 Bay Rd., Queensbury, NY 12804 Inspectors Initials: �i..//I�--
NAME: (k) I C-<-- '\ lup PERMIT NO.: /O. f -37-7
LOCATION: ec-ri ACC --‘i`c_. INSPECT ON: 117,Z//D
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
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 T Y_ N
Location/ Separations
Foundation to tank ft.
Foundation to absorption ft.
Separation of Pits ft. Ai r/tE'
Conforms as per Plot Plan Y_ N Arp. ' 60,0
Engineer Report and As-Built Y_ N
Location of System on Property:
Front Rear Left Side Right Side Middle Front Middle Rear
System Use Status.
Approved
Partial Approved and needs to be re-inspected, please call the Building &Codes Office
Disapproved
Last revised 06/18/07 L:\Building&Codes Forms-OLD\Building&Codes\Inspection Forms\Septic Inspection Report.doc
General Notes
--
TABLE I Minimum Disposal Field Requirements .�-� f 1. See NYSDOH's"Appendix 75-A,Wastewater
SEPA TION DISTANCES FROM WA WATER SYsli Con>PONENrs P un Q
rB ee<m.L<te. Design #of Length°fEachT°LLength Design Pero Rate Jf d/ .�
f/j t//) // Treatment Standards-Individual Household Systems"
sym<m Comrro,KM< -r«Suq,on «"�� @). D.'=nine Pr°peny t'u,< aR Flan Rate Laterals �:eral(feet) (fee,) (min.1-h) r
&Individual Residential Wastewater Treatment
"(wurnrc7o;m°) wa`<", u s to. 3 330 3 20 60 1-5
Systems-Design Handbook"for additional design
so oum.u< 1
ro w,t«.mm LTI so ro and instaliallon requirements
am«mro-,<.oa;uanm;on no. so so 'o
oumwn«,nox ,00 too yo r'a° House to Septic Tank: 4"PVC SCH 40 pipe,tight
j' Information on this sheet is for septic system design
° °n,W< roo a joints,min.slope 1/4"per foot(2%).
a ,so, ,00 m ,o I purposes only.
xu+.e«Mama <a roo ,o ,
tm<,ma«m sw c,n«a rm. Septic Tank to D-Box&D-Box to Disposal Field:
,00" ,W xo re I 3. Construction shall be as shown on this drawing and in
Na.wualmm<srara++.,a+ so so re 4"PVC SDR 35 tight joints,min.slope 1/8"per foot.
A"
a accordance with all NYSDOH and system
Neo-w.mawm<S,rt<uewiN so to {1°r>. f
Imanufacturer's requirements.
a�«wttnv oirK v<r�<o-mn.s'm<0°°'m<ma m�w,� �maw'.y°°nrr mum' Cww.a,.n,.a< SoilsfWater Supply Information' 4. Heavy equipment shall be kept away from the disposal
OTP(Test Pit)determined by K.Manz, ( field.
R E.on 7/19/10 w/Owner resent; / ( 5 Smeared trench floors and wails are to be raked.
<=)F«.u:rn<msm•d.iosu,<Pt.«o,m<orrnrmx<r;.t.=y,=.nio"aui.nc<sm<nic..�e<er,n< P
m<or,a<noo<ara<mt.
Disposal field shall be graded to shed rainfall and to
ta)smmman a.+,m,«<w,°wxm<,+«<a nom�n«as<oru.a<+�e,mma oaamona 000w=om<.+ 0"-72" Med.Sr.Sand ��� /•
am«,'nm rns�ion'rt-A.a t"xs) I divertsudacerunoff from adjacent areas.
No Groundwater Evident 7. all
sem«i�.M. �k�°m,.weir m<tn.purr nw°°�+=^r nM«rou<mr.�.�it N>rym«r<) Remove disposal
field area.plants and organic debris
/ from the disposal field area.
(p wum+om mum.m ae�mue<wu<a,an,om<on<,,ut<m"<n,.a.+rnmno"n;<mn««nx I All sketches are N.T.S.and dimensions only should be
ma«m m sa fire
(arrn<r;ma wn<...<us<,mr°aona;suau uom<onvminvn wm«ssnxt x;n<m<+m uy sow ! ( used.
»M �w"rm� �`m -°� "°'�""n 0.f �'° °ndc1fa 0 1 m n�° •(Percolation Tests)determined by K.
«6i<°<d,nen a,<®<emn rwv;Ne lncm<e to xparaiion dsmrc<slWl x pr°rldmwiN men mdi<m,W / .
Manz,P.E.on 7/19/10;
/
Highest Stabilized Rate=2 mint Inch.
a
Lot is on municipal water. {Lot Area=0.33+/-A,.
-�B I
', ❑Record Dwq.Dimensions: A=19a R�/ t 10
1:• ••, ,rranx, re:Novne,eoovsn �3 'Q�
8=18'a C=11',D=27'a E=38'r F=23'• yy`'
,,}morouna ,.«m naEr MN. E° tox
::F-. __ fin w
"....it t aN.ma rrI O � y
:.:.: .:....::.:::.'.::;::.:.;.:.:. �rr�n 1250 gal. D-BOX I �p �0621A3'`��C�
�FESSipNPI.
3 Row of Five
ve (5)Eljen In-
1. 1 p q / Ex.3 BR House Drain Type p
1.Pipe to be sealed with asphaltic material ore equivalent, Rev. Date D2SCfl tlbn
2.Speed leveling devices are recommended on all outlet pipes. l "B"Units,8' 1 8/4/2010 Added Rec.DW .Info.
{on slab)
° DISTRIBUTION BOX E• o.c.(i.e.3-20'
rows) Description of Proposed Installation:
r erg / D C
e^
SWASLEBACKFLL a; I Eljen Septic System Design
I: (COBBLE8,aOCit8 TO8E PETADVEO)
wwr ,I ourt[r M TDPsofl ....
eoor a
° V• PERFORiPtP6 IroLEsss7oeL.oc fr J T� ! CLIENT: XENIA WIELAND
.�
tr i°pa.,a ..a ,• a4p OEOMIDINGTEXTILE COVER SITE LOCATION: 10 COTTAGE HILL RD.
BUIaNa srRAPs _—
Notes: ^""e a "�'""'nar ° r /..— — — — —•—.J QUEENSBURY,NY
1.A minimum of 3"of clean sand or pea gravel,or 5"of washed CONCRETE SMD 12804
aggregate 0.75"-1.5"diameter shall be placed under tank. 6 — COUNTY OF:WARREN
2.Minimum tank capacity shall be as follows: - i•i Min.10'to property line TOWN OF:QUEENSBURY
-For 3 bedrooms or less,tank shall be min.1,000 gallons. sMNIMUM x (typ•)&to utilities Cottage Hili Road
-4 bedrooms shall have min.1,250 gallon tank.For each rTowmenwous eTRnTq BEmlaa(,
additional bedroom add 250 gallons.For hot tub/spa and/or FRwTI��Roacoa eEAsorInLlBox
garbage grinder,add 250 gallons to tank size for each,+use dual- ORWNDWATER
compartment tank for this case&any tank 1,250 gal.or greater. KEITH R.MANZ, P.E.
SEPTIC SYSTEM LAYOUT PLAN 14 Norland Court Saratoga Springs,NY 12866
SEPTIC TANK ELLEN TRENCH X-SECTION 18'O.C.) Scale T'-30'
SHEET OF 1PATE: 7/20/2010
b -/a
leiekittesia-t
Septic Inspection Report
Office No. (518) 761-8256 Date Inspection request received:
Queensbury Building &Code Enforcement Arrive: 1 S S am/pm De it: am/pm
742 Bay Rd., Queensbury, NY 128. Inspector's Initials:
NAME: �" ' Ar PERMIT NO.:
/0-35
LOCATION: iN11 . INSPECT ON: F-z/-/D
RECHECK:
Comments and/or diagram
Soil Ty• Loam/Clay
Type of Water: ,.I/ Well Water
Wate r-ration 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 i ft.
Length of each trench 'ft.
Depth of trenches
Size of Stone
Seepage Pits: Number
Size: x
Stone Size:
Piping Siz ,' Type
Building to tank 4C6
Tank to Distribution Box
Distribution Box to Field/ Pit r1
Opening Sealed: N
End Cap N
Inlet/Outlet Pipes&Baffles Y—N
Manholes 12"or less below grade _N
[provide extension collar if Yes] Y N
Location/ Separations /l
Foundation to tank 4, v
Foundation to absorption
Separation of Pits - .
Conforms as per Plot Plan —N
Engineer Report and As-Built _Y N
ETU Maintenance Contract Y N
provided
Loca -• r- on Property:
Front Re.r Left Side Right Side Middle Front Middle Rear
stemU - 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\Inspection Forms\Septic Inspection Repor#,_03 29 10.doc
General Notes
--
TABLE I Minimum Disposal Field Requirements .�-� f 1. See NYSDOH's"Appendix 75-A,Wastewater
SEPA TION DISTANCES FROM WA WATER SYsli Con>PONENrs P un Q
rB ee<m.L<te. Design #of Length°fEachT°LLength Design Pero Rate Jf d/ .�
f/j t//) // Treatment Standards-Individual Household Systems"
sym<m Comrro,KM< -r«Suq,on «"�� @). D.'=nine Pr°peny t'u,< aR Flan Rate Laterals �:eral(feet) (fee,) (min.1-h) r
&Individual Residential Wastewater Treatment
"(wurnrc7o;m°) wa`<", u s to. 3 330 3 20 60 1-5
Systems-Design Handbook"for additional design
so oum.u< 1
ro w,t«.mm LTI so ro and instaliallon requirements
am«mro-,<.oa;uanm;on no. so so 'o
oumwn«,nox ,00 too yo r'a° House to Septic Tank: 4"PVC SCH 40 pipe,tight
j' Information on this sheet is for septic system design
° °n,W< roo a joints,min.slope 1/4"per foot(2%).
a ,so, ,00 m ,o I purposes only.
xu+.e«Mama <a roo ,o ,
tm<,ma«m sw c,n«a rm. Septic Tank to D-Box&D-Box to Disposal Field:
,00" ,W xo re I 3. Construction shall be as shown on this drawing and in
Na.wualmm<srara++.,a+ so so re 4"PVC SDR 35 tight joints,min.slope 1/8"per foot.
A"
a accordance with all NYSDOH and system
Neo-w.mawm<S,rt<uewiN so to {1°r>. f
Imanufacturer's requirements.
a�«wttnv oirK v<r�<o-mn.s'm<0°°'m<ma m�w,� �maw'.y°°nrr mum' Cww.a,.n,.a< SoilsfWater Supply Information' 4. Heavy equipment shall be kept away from the disposal
OTP(Test Pit)determined by K.Manz, ( field.
R E.on 7/19/10 w/Owner resent; / ( 5 Smeared trench floors and wails are to be raked.
<=)F«.u:rn<msm•d.iosu,<Pt.«o,m<orrnrmx<r;.t.=y,=.nio"aui.nc<sm<nic..�e<er,n< P
m<or,a<noo<ara<mt.
Disposal field shall be graded to shed rainfall and to
ta)smmman a.+,m,«<w,°wxm<,+«<a nom�n«as<oru.a<+�e,mma oaamona 000w=om<.+ 0"-72" Med.Sr.Sand ��� /•
am«,'nm rns�ion'rt-A.a t"xs) I divertsudacerunoff from adjacent areas.
No Groundwater Evident 7. all
sem«i�.M. �k�°m,.weir m<tn.purr nw°°�+=^r nM«rou<mr.�.�it N>rym«r<) Remove disposal
field area.plants and organic debris
/ from the disposal field area.
(p wum+om mum.m ae�mue<wu<a,an,om<on<,,ut<m"<n,.a.+rnmno"n;<mn««nx I All sketches are N.T.S.and dimensions only should be
ma«m m sa fire
(arrn<r;ma wn<...<us<,mr°aona;suau uom<onvminvn wm«ssnxt x;n<m<+m uy sow ! ( used.
»M �w"rm� �`m -°� "°'�""n 0.f �'° °ndc1fa 0 1 m n�° •(Percolation Tests)determined by K.
«6i<°<d,nen a,<®<emn rwv;Ne lncm<e to xparaiion dsmrc<slWl x pr°rldmwiN men mdi<m,W / .
Manz,P.E.on 7/19/10;
/
Highest Stabilized Rate=2 mint Inch.
a
Lot is on municipal water. {Lot Area=0.33+/-A,.
-�B I
', ❑Record Dwq.Dimensions: A=19a R�/ t 10
1:• ••, ,rranx, re:Novne,eoovsn �3 'Q�
8=18'a C=11',D=27'a E=38'r F=23'• yy`'
,,}morouna ,.«m naEr MN. E° tox
::F-. __ fin w
"....it t aN.ma rrI O � y
:.:.: .:....::.:::.'.::;::.:.;.:.:. �rr�n 1250 gal. D-BOX I �p �0621A3'`��C�
�FESSipNPI.
3 Row of Five
ve (5)Eljen In-
1. 1 p q / Ex.3 BR House Drain Type p
1.Pipe to be sealed with asphaltic material ore equivalent, Rev. Date D2SCfl tlbn
2.Speed leveling devices are recommended on all outlet pipes. l "B"Units,8' 1 8/4/2010 Added Rec.DW .Info.
{on slab)
° DISTRIBUTION BOX E• o.c.(i.e.3-20'
rows) Description of Proposed Installation:
r erg / D C
e^
SWASLEBACKFLL a; I Eljen Septic System Design
I: (COBBLE8,aOCit8 TO8E PETADVEO)
wwr ,I ourt[r M TDPsofl ....
eoor a
° V• PERFORiPtP6 IroLEsss7oeL.oc fr J T� ! CLIENT: XENIA WIELAND
.�
tr i°pa.,a ..a ,• a4p OEOMIDINGTEXTILE COVER SITE LOCATION: 10 COTTAGE HILL RD.
BUIaNa srRAPs _—
Notes: ^""e a "�'""'nar ° r /..— — — — —•—.J QUEENSBURY,NY
1.A minimum of 3"of clean sand or pea gravel,or 5"of washed CONCRETE SMD 12804
aggregate 0.75"-1.5"diameter shall be placed under tank. 6 — COUNTY OF:WARREN
2.Minimum tank capacity shall be as follows: - i•i Min.10'to property line TOWN OF:QUEENSBURY
-For 3 bedrooms or less,tank shall be min.1,000 gallons. sMNIMUM x (typ•)&to utilities Cottage Hili Road
-4 bedrooms shall have min.1,250 gallon tank.For each rTowmenwous eTRnTq BEmlaa(,
additional bedroom add 250 gallons.For hot tub/spa and/or FRwTI��Roacoa eEAsorInLlBox
garbage grinder,add 250 gallons to tank size for each,+use dual- ORWNDWATER
compartment tank for this case&any tank 1,250 gal.or greater. KEITH R.MANZ, P.E.
SEPTIC SYSTEM LAYOUT PLAN 14 Norland Court Saratoga Springs,NY 12866
SEPTIC TANK ELLEN TRENCH X-SECTION 18'O.C.) Scale T'-30'
SHEET OF 1PATE: 7/20/2010
Septic Inspection Report
Office No. (518) 761-8256 Date Inspection -•u-- : :
Queensbury Building &Code Enforcement Arrive: it i . / ►-part: 1 i ci•m
742 Bay Rd., Queensbury, NY 12804 Inspector's Initials: i , f 0� `3 -y
NAME: ).EiN iq Lk4l Rr3D PE' ►J
NO.: PE, fli
LOCATION: to Cbl T tom_ \k1LL RC) INS CT ON: ""( —Z—1t)
RECHECK:
Comments and/or diagram
Soil Type: Sand/ Loam/Clay
Type of Water: Municipal/Well Water �p
Waterline separation distance ft. C \� l �_- �-' `
kbL.`
Well separation distance fL
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 oftrenches ft.
Sizeze of Stone - .-C2‘
�v L\ 'BE_Dv3/4-0(1
Seepage Pits: Number
Size: 0 O 1 • 31EMC \1 b
x v uV"
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 ft.
Separation of Pits ft.
Conforms as per Plot Plan e 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
stem Use Stat
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 Report 03 29 10.doc