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2015-451 TOWN OF QUEENSBURY 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201 Community Development- Building& Codes (518) 761-8256 CERLUTLIFICATE OF CO-M-PLI-ONCE Permit Number: P20150451 Date Issued: Wednesday, September 23, 2015 This is to certify that work requested to be done as shown by Permit Number P20150451 has been completed. Tax Map Number: 523400-308-018-0001-012-000-0000 Location: 31 HONEY HOLLOW Rd Owner: RICHARD & KIMBERLEE KOKE Applicant: RICHARD & KIMBERLEE KOKE 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 /f 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: P20150451 Application Number: A20150451 Tax Map No: 523400-308-018-0001-012-000-0000 Permission is hereby granted to: RICHARD &KIMBERLEE KOKE For property located at: 31 HONEY HOLLOW 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: RICHARD&KIMBERLEE KOKE Septic Alteration Residential 31 HONEY HOLLOW Rd QUEENSBURY,NY 12804 Total value Contractor or Builder's Name/Address Electrical Inspection Agency Plans&Specifications 2015-451 Residential Septic Alteration $40.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Thursday, September 22,2016 (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 theown �&/l d ,September 22,2015 SIGNED BY for the Town of Queensbury. Director of Building&Code Enforcement SEPTIC DISPOSAL APPLICATION Office Use Only —fi­­ — -- n�_.� Received DATE: Z — / 1� IE M TAX MAP ID: mit No. ap I© Zc71�_ �� ZONE: SEP 22 2015 rmit Fee 0 APPLICANTe — BUILDING& t 6 f) ONE E-MAILthqgto ADDRESS INSTALLER/ PHONE/E-MAIL BUILDER )Cl/l3fc�+� /SID OWNER lG/i�1tr" .(ClZ ADDRESS 3 I 1 f, L HT1 CONTACT PERSON FOR BUILDING&CODE COMPLIANCE: D PHONE/E-MAIL —7q6— )'Z3LQ RESIDENCE INFORMATION Year Built #of bedrooms X gallons per bedroom =total Daily flow 1980 or older Garbage grinder installed Yes No 1981-1991 Spa or Hot Tub installed Yes _No 1992-Present 1 PARCEL INFORMATION Topography F trolling Steep slope _%Slope Soil Nature Sand Loam Clay Other Groundwater At what depth: lr� Q Bedrock/Impervious material At wha epth: Domestic Water Supply Municipal Well(if well,water supply from any septic system absorption is_ft.) Percolation Test Rate: X—rper minute per inch(test to be completed by licensed engineer/architect) PRO OSED YSTEM FOR NEW CONSTRUCTION Tank iz gallons(min.size 1,000 gallons,add 250 gallons to size for each garbage cylinder or spa or hot tub System Absorption field with 42 stone Total length__V51�> ft.;Each Trench V9 t Seepage Pit with#3 stone How many: _;Size C. C 1A � Alternative System Bed or other type: Holding Tank System Total required capacity? Tank size #of tanks Notes: 1)Alarm system&associated electrical work must be inspected by a Town approved electrical inspection agency;2)We will no longer allow systems to be covered until such time as an As-Built plan is received&approved. The installed system must match the septic system layout on file—no exceptions. Declaration: Any permit or approval granted which is based upon or is granted in reliance upon any material representation 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 and agree to abide by these and all r rueensbury Sanitary Sewage Disposal Ordinance. PRINT NAME: 2 L/y DATE: /j r SIGNATURE: � DATE: Town of Queensbury Building&Codes Principal Structure Application Revised September 2014 txj TOWN OF QUEENSBURY FINAL INSPECTION CERTIFICATE PROPERTY TAX MAP NO.\ZJ�, - TOWN MJF �UEEEEi` f BUILDING �: Fl E COPY R viewed By. Daft EPTIC PLOT PLAN 1 HAVE SEEI OR OBSERVED ALL OBJECTS x '997 SUCH AS HO ES, WELLS, TREES, FENCES, ETC '' 1 Ey 1�T1 SHO T S DOCUMENT.I HAVE PERSONALLY MEASd TH IST C S FORTH ON THIS DIA RAM. S1GNATUHE QAT -- _ + ' 901 LSC 0VE ' Q � � SE u�� r I ] TOWN OF QUEENSBURY BUILD] G & CODES rte.. �. 1._EPrClac GEM 6' DICK KOKB 31 HONEY HOLLOW ROAD QUEENSBURY, NY rces 1�The above sketch shows the locations of the units comprising your eisa1.system for future reference in case of difficulty. It shows measuredom buildings, trees, garage, fence posts, etc., to the components of youJ 0 V i system. TOWN OF QUEENSBURY BUILDING & CODES Constructed by: Date installed. . - Design Basis 1. Number of Bedrooms L4 5. Septic Tank Type: U- Gal. 2. Daily flow: ��,�� > GPD 6. Size ofLeachiniz Device: \S' 4Z6 �)C\A L3� 3. Undisturbed soil depths: 7. Type of System(Conventional, A. To Groundwater: # ., fill, etc: B. To Impervious Lens: ti 4. Percolation Rate: NHN/IN Approved By: Date: -` 1 Septic Inspection Repo Office No. (518) 7618256 Date In ion r st re iv Queensbury Building &Code Enforcement Arrive: m rt: am m 742 Bay Rd., Queensbury, NY 12804 Inspector's Initials: NAME: by,E P R NO.: LOCATION; VA) N ECT ON: Ci —Z RECHECK: Comments and/or diagram Soil Type: Sand / Loam/ Clay T e 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 O ninq Sealed: Y_ N End Cap Y N Ince Outlet Pipes &Baffles Y N Manholes 12"or less below grade _Y_N � - R&)\C . ,� `IUD) [provide extension collar if Yesl N Location / Separations Foundation to tank ft. � �, �Ff � 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 Y .70 V� F L Location of System on Property: Front ear Left Side Right Side Middle Front Middle Rear System Use S tus: Approved Partial Approved and needs to be re-inspected, please call the Building &Codes Office Disapproved L.\Pam Whiting\2010\$uilding Codes Forms\Inspection Forms\Septic Inspection Report_03 29 10.doc clkv� Town of Queensbury Building & Code Enforcement Office No. (518) 761-8256 Septic Inspection Report Inspection request received: Name: Inspected on: Location: Arrive: a.m. P: Permit No.: �_�— �-} � Inspector's Initials: ,r Com e and/or diagram Soil Type: and 11 am I Clay i` s Type of Water. unicipal Well Water Waterline separation distance ft Well separation distance ft. Other wells: ft. Well Casing Length 50' +/- Y N_NIA [150'to well required if NO] Absorption Field: Total length ft. Length of each trench Depth of trenches ft. Size of Stone Seepage Pits; Number Size; 6FA x Stone Size: ' + Piping Size Type Building to tank 41 Tank to Distribution Box A= 1N t k Distribution Box to Field I Pit i DR 3E To "I 16D R Opening Sealed: —N n1 End Cap — Lit 4r--�� c 1 T'4� k4t ' 35 �b lnleVOutlet Pipes&Baffles Y_N Manholes 12"or less below grade _N [provide extension collar if Yes] _Y_N Location I Separations Foundation to tank ft. Foundation to absorption `Z a Separation of Pits Conforms as per Plot Plan _N Engineer Report and As-Built _Y_N ETU Maintenance Contract provided _Y_N Location of System on Property: k Front Rear Left Side Right C Middle Front iddle Rear � t�� - -' �� System Use Status; Approved Partial Approved and needs to be re-inspected, please call the Building&Codes Office Disapproved Septic Inspection Report