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2014-482 TOWN OF QUEENSBURY 742 Bay Road,Qucensbuty,NY 12804-5902 (518)761-8201 Community Development - Building & Codes (518) 761-8256 CERTIFICATE OF COMPLIANCE Permit Number: P20140482 Date Issued: Thursday, March 24, 2016 This is to certify that work requested to be done as shown by Pern*it Number P20140482 has been completed. Tax Map Number: 523400-289-009-0001-010-000-0000 Location: 3 SULLIVAN Rd Owner: JEANNE SULLIVAN L.E. Applicant: JEANNE SULLIVAN L.E. This structure may be occupied as a: Septic Alteration Residential Test Pit / Pere Test Review 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 the Director of Building&Code nforc mcnt Planning Board or Zoning Board of Appeals. "14 TOWN OF QUEENSBURY 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201 %ireAy Community Development-Building&Codes (518) 761-8256 BUILDING PERMIT Permit Number: P20140482 Application Number: A20140482 Tax Map No: 523400-289-009-0001-010-000-0000 Permission is hereby granted to: JEANNE SULLIVAN L.E. For property located at: 3 SULLIVAN 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: JEANNE SULLIVAN L.E. Septic Alteration Residential SUSAN SULLIVAN BRIE ROSECRI Test Pit/Perc Test Review 3 SULLIVAN Rd Total Value QUEENSBURY NY 12804-0000 Contractor or Builder's Name/Address Electrical Inspection Agency Plans&Specifications 2014-482 Deep Hole/Perc Test Septic Alteration application received 8/11/15 $200.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Friday, November 06, 2015 (If a longer period is required,an application for an extension must be made to the code Enforcczncnt Officer of the Town of Queensbury before the expiration da e.) Dated at the T n of een ry4 ;/esday,August 12, 2015 SIGNED BY for the Town of Queensbury. Director of Building&Code Enforcement SEPTIC DISPOSAL APPLICATION Office Use Only Received DATE: f/ // Tax Map ID 1 - cNo. '2G\ L i TAX MAP ID: Z ( cS 7' i � - / Permit � Permit Fee ZONE: APPLICANT ///� (.,P✓f C L!I/, F,S'T Jr- PHONE/E-MAIL s„� 7.`/`'i �f7,Z 7^/ /'- r ) y`! / r'C�/ !�'1 J'7 GN C�S/G, ADDRESS 3 fL/4 i/n�7 �� `/J �cs Fr_ / Z q INSTALLER/ PHONE/E-MAIL BUILDER / / OWNER Zs' e C. G�II�%'"S �) ADDRESS 3 5L/(, ves,, leaf Lw Ice CKe� Ay I t CONTACT PERSON FOR BUILDING&CODE COMPLIANCE: /101;p4i/ L PHONE/E-MAIL J7,13-7y y- 4/2- 7/ RESIDENCE INFORMATION W b Oc wr_ F ,��F 17 Year Built #of bedrooms X gallons per bedroom =total Daily flow 1980 or older 7 Garbage grinder installed _Yes _No 1981-1991 Spa or Hot Tub installed _Yes _No 1992-Present PARCEL INFORMATION Topography _Flat rolling Steep slope 2 c%Slo (.3® f f r c "eke.— /2 F. Soil Nature '` Sand ''� Loam Clay Other f Groundwater At what depth: /1/si Bedrock/Impervious material At what depth: /!/h Domestic Water Supply Municipal 74- Well(if well,water supply from any septic system absorption is/GOft.) Percolation Test Rate: 3..4, per minute per inch(test to be completed by licensed engineer/architect) PROPOSED SYSTEM FOR NEW CONSTRUCTION Tank size /XV gallons(min.size 1,000 gallons,add 250 gallons to size for each garbage cylinder or spa or hot tub System Absorption field with#2 stone Total length Z S-O ft.;Each Trench s Q SU Seepage Pit with#3 stone How many: ;Size 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 requirements of the Town of Queensbury Sanitary Sewage Disposal Ordinance. PRINT NAME: � /C-42. / �I,i/it,P DATE: ,0/f SIGNATURE: DATE: Town of Queensbury Building&Codes Principal Structure Application Revised September 2014 iJ P "t --4-4 b k Town of Queensbury• Building& Codes Enforcement Office•742 Bay Road■ Queensbury,NY 12804 DEEP HOLE/PERC TEST Request for Town Engineer Review Property Owner: *1\110 j1-b1•1 Phone: 9/S---1114 1 I Property Owner's 5• ' WV VO , CVu Address: �,t FKit Location of Test: 6271 -Wt*. Tax ID#: ,Z531.• 0/ \,--‘0A- * *Applicant's Engineer: _ Ltu...— `r ac..(b ,5-t Phone: 61,g)'"CA50 19_(›S Applicant's Agent: . ALS Phone: 6[g- — 191.r� Additional Notes: 1. Reason for Request? New Septic System " Replacement Septic System Failed Septic System Subdivision Site Plan Review 2. Are Wetlands present? YES NO 1 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: 2 CIC.5C": 2b\� 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 APPLICANT: Date: J SIGNATURE OF AGENT: A:214;3Date: W . 264 Original (B &C File) Canary (Planning) Pink(Applicant) Gold (Town Clerk) THE )<!-- �I � - r_ North Country Office ChaKen 375 Bay Road,Queensbury, NY 12804 P: (518) 812-0513 F: (518)812-2205 COMPANIES www.chazencompanies.com Engineers Hudson Valley Office (845)454-3980 Environmental Professionals Capital District Office (518) 273-0055 Land Surveyors Landscape Architects Planners November 5, 2014 Dave Hatin, Director, Building and Codes Town of Queensbury 742 Bay Road Queensbury, New York 12804 FILE COPY Re: Soil Testing Verification 3 Sullivan Road—Livingston Property Queensbury, NY 12803 Chazen Project No.:91400.22 Dear Mr. Hatin: As requested, Chazen has completed an onsite soil testing witnessing for the above referenced location on November 5, 2014, in regards to subsurface soil conditions for a proposed replacement septic system. The testing was performed by Rucinski Hall Architecture of Saratoga Springs, NY. One test hole and one percolation test were conducted for the septic system. The test pit for the proposed septic system was performed northwest of the existing residence,the percolation test was conducted adjacent to the test pit. The soil conditions are as follows: 0-8" Top Soil. 8—14" Dark brown loamy sand 14— 38" Medium brown gravelly sand,with cobbles 38—48" Light Brown coarse sand No Mottling No Groundwater Percolation test conducted at 24": 3 min. If you have any questions or require additional information please do not hesitate to call me at 824- 1926. Sincerely, eriqan M. Doty, P.E., LEED A Senior Project Engineer,Associate cc: File Chazen Engineering,Land Surveying&Landscape Architecture Co.,P.C. Chazen Environmental Services, Inc. The Chazen Companies, Inc. Town of Queensbury Building & Code Enforcement Office No. (518)761-8256 } Septic Inspection Report Inspection request received: 5 .'2-2-1z-cm- 0 • Name: Z1Z— Name: L1 V w- gin Inspected on: 3 Z'1 r Location: 3 5-‘A., I\VO.n-� id • Arrive: W® a.' . Permit No.: 2014- Inspector's Initials: Corn e s and/or diagram Soil Type: Sand/Loam I 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 I 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 t. Separation of Pits v/it.t. as per Plot Plan _N Engineer Report and As-Built Y_N ETU Maintenance Contract provided _Y N Location of S stem on P o•e : Front Re. Left Side Right Side Middle Front Middle Rear S stem Use Stat .: V Approved Partial Approved and needs to be re-inspected, please call the Building &Codes Office Disapproved Septic Inspection Report TOWN OF QUEENSBURY .�� 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201 , Community Development-Building&Codes (518) 761-8256 Inspections per Permit Permit# P20140482 Inspection Date Inspection Type Approved/Denied Comments Permit Type Person Responsible 11/06/2014 Miscellaneous Test Pit/Perc Test Review STAFF Misc 2014-482 Chazen Co.Engineer Report rec'd&filed 08/13/2015 Septic Test Pit/Perc Test Review CHARLES DYER Staff Denied 2014-482 Site check for questions 08/21/2015 Septic Test Pit/Perc Test Review JOHN O'BRIEN Partial 2014-482 need as-built&report from Ethan Hall Need to establish lawn 08/24/2015 Septic Test Pit/Perc Test Review JOHN O'BRIEN Partial 2014-482 design professional's field inspection report received Need certified septic plot plan £ aeil�wd6E:ex'.n 9LCL/1x/E'awUi uelmns,JWiaasuo.cuwlWpasansa+lwoW\'A yiox—K'fjngsuaana`pond u[ujunoW js2M oLb sas 60 oe®•:"°"" iwd3,< udaawa fQQQ ) a Awa XaoA maN`6angsaaana`pnog MA!IlnS£ oa i 3 a cv w 9�,WM. AoPx=s =W< 33UOPISON UOISOutn17 auZ �s� F 0, e 0 R In 3anto3tlHoav�ivEitllNSNlana _ � eff aoj luaufaovjdnd oTldas z Lu g®j con ra g � 0 \ ------------------------- I — — .40 ---------------- _.- --__—--�.—. _'-, gad g t RMq a'' ' I a Rr R. _____ ___ __ "•= - it J Town of Queensbury Building & Code Enforcement Office No. (518) 761-8256 Septic Inspection Report Inspection request received: Name: i 1\'l 00 75TD tJInspected on: i—, �_� Location: _ .3 ,6 _U\) Ft, RO Arrive: Ai8:�, 1 p.m. Permit No.: 20 tit'17Z Inspector's Initials: 1Y/ 'merits and/or diagram Soil Type: Sand 1 Loam/Clay / Type of Water: Municipal/Well Water J 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 ----,- 0�—E LJ6 V` .A PZ.)F1015i\C Foundation to tank ft. Foundation to absorption ft. F1 EL 1 6P-C;,O CE (zi- Separation of Pits ft9� K 1 Conforms as per Plot Plan j_N. PFc F1,\19 PEn ineer Re ort and As-Built N ETU Maintenance Contract provided __Y_N - Location of System on Property: .EX C- - T1 C—k E _,1 .-1 _ Front Rear Left Side Right Side Middle Front Middle Rear pL D` ck_fl r, System Use Status: �------- Approved Partial Approved and needs to be re-inspected, please call the Building &Codes Office Disapproved Septic Inspection Report 4 RUCINSKI HALL ARCHITECTURE \� Ronald Richard Rucinski ��J�� Ethan Peter Hall G\ �4G'� . � 627 Maple Avenue �J G Saratoga Springs NY 12866 p�- Voice 518 580 1905 Fax 518 584 5012 Email ephall@nycap.rr,com Septic Install for Livingston Residence 21 Aug 2015 John O'Brien—Town of Queensbury Building Department 742 Bay Road Queensbury NY 12804 Re: Septic Installation for Livingston Residence—3 Sullivan Road John, At the above referenced project location I observed the installation of the sewage disposal system including the septic tank, grinder pump chamber, distribution box and tile field laterals prior to back fill. This system was installed by Morning Star Septic and was altered with our knowledge to use the E-Z Flow system for the infiltration trenches. During our site visit we observed the installation of these units and all items appear to be installed in accordance with the manufacturer's recommendations and are acceptable to this office. We will be preparing as-built plans in the near future and we will provide you with updated copies as soon as they are complete. If there are any additional questions please call to discuss. Regards, te ?E714::.‘? ifr, r glo:pi 77• . , .,,,,7, •-v- Ethan Peter Hall ' , it. Architect •j� roe 4.;:/ r F, Y:\Howard Construction\Livingston Septic\Paperwork\Septic Letter 21 Aug 201 5.doc I Town of Queensbury Building & Code Enforcement J MirOffice No. (518) 761-8256 :::::.:7---e/...-.;- - �r♦ ,, I .-711tirr t Septic Inspection Report LQGJn., Inspection request received: ir /0 1 ',-).0 15 lAd a j 3 Name: P?be-,�" ✓1‘DT-17— Co $3 - 11 '��Inspected on: _ • . d-o ;fiiiLocation: 11.•5 6141,1,1/4-#N Arrive: IP .1, a.m.I p.m. i Permit No.: .W.)I`1G 'Li-cgc? Inspector's Initials, )_� :_ Comments and/or • aqram Soil Type: Sand/Loam I Clay r� �^ ^�� Type of Water: Munici.:I I Well Water ( tom C (C Y Waterline separation dis•:nce ft. Well separation distance ft. �� Other wells: j ft. �`� 4)--7.-10r Well Casing Length; 50' / _Y N_NIA [150'to well required if NO] I _ i Absorption Field: Total lengt ft. Length of each trench ft. Depth of trenches ft. Size of Stone Seepage Pits: Number Size: x Stone Size: Piping Size Type 09Building to tank 01/4--re___Ir& Tank to Distribution Box Ad Distribution Box to Field/Pit Opening Sealed: Y N j5fZ..__- EndCap _N Inlet/Outlet Pipes&Baffles N Manholes 12"or less below gra.- _Y N [provide extension collar if Yes] _Y_N / Location I Separations I Foundation to tank ft. Foundation to absorpti n ft. Separation of Pits ft. Conforms as per Plot PI n _Y_N Engineer Report and As-Built _Y_N ETU Maintenance Contract provided _Y_N Location of System on Property: Front Rear Left Side Right Side Middle Front Middle Rear System Use Status: pproved Partial Approved and needs to be re-inspected, please call the Building&Codes Office Disapproved Septic Inspection Report Town of Queensbury Building.& Cod&Enforcement Office No. (518) 761-8256 Septic Inspection Report 1`_ Inspection request received: Name: ` A--). t U.! \N( -V Inspected on: (E(E-7A --\,1) Location: 03\)\_.- ._\`\ lJJ 1 Arrive: '`011+ 7. 1 p. • Permit No.: 1 q - y?) 7 Inspector's Initials: Alir -AIN, Com.tehts and/or diagram _... ..-2 , Soil Type- ay Type of Water: Municipal/ , ell Wat• 1 FR(\ \& Waterline separation distan - `-)'ft. Well separation distance \'() ‹ft. Other wells: ft. 'Nell Casing Length 50' +/- Y N N/A [150'to well required if NO] ''\\ .7__— \.) AA-\---) Absorption Field: Total length -c ft. Length of each trench l *'t ft. 0 L Z Depth of trenches 2,--3 ft. Size of Stone 1J I Seepage Pits: Number Size: x Stone Size: Piping Size Type Building to tank -Z ' IPA AO C N f--f, 1\IN\Q Tank to Distribution Box ;t' iPV-3 Distribution Box to Field/Pit V t M7 - Opening Sealed: Y N End Cap y N Inlet/Outlet Pipes&Baffles t/Y/ N Manholes 12"or less below grade t/Y N� [provide extension collar if Yes] Y V/N ' Location/Separations Foundation to tank /0 ft. Foundation to absorption _ Q ft.I" Separation of Pits ft/ Conforms as per Plot Plan Y vN Engineer Report and As-Built N 10 E -V. N 1�- - 1 ETU Maintenance Contract provided _Y_N V----- _-_- _-c, - -)Vb V\ Location of S stem oyLo•e eIv ��4)A-L__ �-`tLFront ear ft Side Right SiJ Middle Front Middle Rear S stem Use Sta k\D --'\-._— Approved i /zik-CA__I ‘s.\— Approved and needs to be re-inspected, please call the Building& Codes Office Disapproved L- $ :IT Septic Inspection Report PT :1st ;TEST ES 2nd TEST P, ATION " 4th, TEST )RAWINGIS TAKEN,,. PERCOLATION 5th TEST COBBLESV =TEST INFORMATION Revi w6d' y :RTY UNE = I USE t TQ: x 4 .*•• pcar TrcT iMMPUATIOWTAKFM .5Nl1VFMRFR PT -SMALI DED SO E DONE TO ACCOMP :1st ;TEST ES 2nd TEST P, 3rd TEST- " 4th, TEST )RAWINGIS TAKEN,,. TOlf 5th TEST COBBLESV 6th TEST Revi w6d' y :RTY UNE = I USE t TQ: RTY UNE SETBACKS No. '1 :DATE .F J 1 {' f �F ELECTRIC IM1 4RY SEWEiR -SMALI DED SO E DONE TO ACCOMP FAL COPY ES 7777 " )RAWINGIS TAKEN,,. TOlf VORQO N EI RY.' 1 L DICKENSON ASSOCU11I Revi w6d' y :RTY UNE = RTY UNE SETBACKS No. '=DESCRIPTION :DATE 'GROUND SERVICE REVISIONS ` ELECTRIC 4RY SEWEiR SERVICE w 7 ,