2010-255 TOWN OFQ UEENSBURY
Firow742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development- Building &Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: P20100255 Date Issued: Wednesday, May 26, 2010
This is to certify that work requested to be done as shown by Permit Number P20100255
has been completed.
Tax Map Number. 523400-296-013-0001-033-000-0000
Location: 10 WINCREST Dr
Owner. DONALD R KEAGY
Applicant: IBS SEPTIC & DRAIN
This structure may be occupied j13 R KEAGY
Septic Alteration Residential
By Order of Town Board
TOWN OF QUEENSBURY
Issuance of this Certificate of Compliance DOES NOT relieve the / 11/
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.
4IF, 1011111ATOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development- Building&Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20100255 Application Number. A20100255
Tax Map No: 523400-296-013-0001-033-000-0000
Permission is hereby granted to: IBS SEPTIC &DRAIN
DONALD R KEAGY
For property located at: 10 WINCREST Dr
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: DONALD R KEAGY
10 WINCREST Dr Septic Alteration Residential
QUEENSBURY,NY 12804-0000 Total Value
Contractor or Builder's Name/Address Electrical Inspection Agency
Plans &Specifications
2010-255
septic alteration residential
$25.00 PERMIT FEE PAID- THIS PERMIT EXPIRES: Thursday,May 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 expiration date.)
Dated at the To,•- * eensb , 3 ed/•sday,May 26, 2010
A
SIGNED BY , for the Town of Queensbury.
Director of Building& de ‘ orcement
7 /—,53 C.` /3 — '�� OFFICE USE ONLY , �? �-��=--j�1' .1
TAX MAP NO. , '�� _,�..�___...K....
PERMIT N0. PERMIT FEE '1 ;s; ;.I: .,
APPROVALS: ZONING % �,-+ - )010 I
TOWN CLERK
r._r_.. I s 4 1
.___•_r ._..___r_•_.'..............r � .rix.� , � '�. �rt:..:. A
APP ' 0 ` y 's _ w, :Lr'`''
LIGATION FOR -�� �, `�;� , w ,
SEPTIC DISPOSAL SYSTEM PERMIT: ..�." -�::T
A PERMIT MUST BE OBTAINED BEFORE WORK BEGINS.APPLICATION IS SUBJECT TO REVIEW
PERMIT.
BEFORE ISSUANCE OF A VALID
OWNER: ir- A../ lit sf
INSTALLER: e I . X l
ADDRESS: I # _ 1 f
ADDRESS: I 6 r c , .
PHONE NOS.
PHONE NOS. � -
, 2
LOCATION OF INSTALLATION:
YEAR BUILT NO.OF
BEDROOMS X COMPUTATION= = TOTAL DAILY FLOW RESIDENCE INFORMATION:
1980 or older X 150 gallon per bedroom
1981 -1991 = GARBAGE GRINDER
i X 130 gallon per bedroom INSTALLED?---__
1992-present 4i X 110 gallon per bedroom
SPA OR HOT TUB
PARCEL INFORMATION: .r INSTALLED?
✓ TOPOGRAPHY: Flat rolling
Steep slop9,�ht. %Slop�/�
✓ SOIL NATURE: Sand
Loam Clay Other_
✓ GROUNDWATER: At what depth?
____ ___Z.f':
✓ BEDRO_CK/IMPERVIOUS MATERIAL: � ,�
At what depth?–=�1-_
✓ DOMESTIC WATER SUPLY:
Municipal Well�� (If,well: Water supply fro
system absorption is Y septic
✓ PERCOLATION TEST: Rate is ft.)
per minute per inch.
(Test to be comple ed by a licensed professional engineer or architect.
PROPOSED SYSTEM FOR NEW CONSTRUCTION: All individual sewage disposal )
g systems must be designed by
a licensed professional engineer or architect (unless installed in a PlanningBoard
TANK (/).(21.2
__GALLON
approved subdivision).
_GALLON (MIN. SIZE IS 1,000 GAL.) Add 250
each garbage grinder, spa or whirlpool tub. gallons to the size of the septic tank for
SYSTEM TYPE:
Xr ABSORPTION FIELD (WITH NO. 2 STONE) Total length 9 �QG ft. Each trench�_X ��3 1
❑ SEEPAGE PIT(S) (WITH NO. 3 STONE) "" ----
How many?
❑ ALTERNATIVE SYSTEM BSize?
Bed or other type?
❑ HOLDING TANK SYSTEM Tota .�
l required capacity?_______"azi_
Tank size? L
Number of tanks?
I NOTE: ALARM SYSTEM AND ASSOCIATED ELECTRICAL W
APPROVED ELECTRICAL INSPECTION AGENCY. PLEASE RE
ORK MUST BE INSPECTED BY A TOWN
For.......... .................. :.....::....:....:...:.:.:....:.....:.:::..::.:......:...:.:::....:..:.:.:VIEW LIST PROVIDED.
your protection, please note that pursuant to Section 136-29 of the Code . ,
permit or approval granted which is based upon nr n..,.,+,._i :_ .. .. of the Town of C)uaan�h:. ..
faifura to ►,•,,i,,. - __. . . _
3k, 3 o
Septic Inspection Report
Office No. (518) 761-8256 Date Inspection request received: 5��ZS �o
Queensbury Building &Code Enforcement Arrive: am/p Depart:3___\A_Oam/pm
742 Bay Rd., Queensbury, NY 12804 Inspector's Initials: _ 1
__ JJJ
NAME: K e'`4 61 PERMIT NO.: 1 0 -
LOCATION: /0 w,A c r e 5 'ritc-, INSPECT ON: 577.-j//D
RECHECK:
Comments and/or diagram
Soil Type:t= • / Loam/Clay
Type of Water: • ijj" / Well Water
Waterline -paration distance ft.
Well separation distance . ft.
Other wells: _
Well Casing Length 50' + / - Y N N/A
Absorption Field: Total length 2.-W, ft.
Length of each trench S.C.> ft.
Depth of trenches I "4--Z4'` '
Size of Stone '2-
Seepage
Seepage Pits: Number bi, r
Size: 1 " x
Stone Size:
Piping Size T pe
Building to tank A"` 3c
Tank to Distribution Box 4'^ �1b1-
Distribution Box to Field/ Pit "` S{-N)
Opening Sealed: _N
End Cap — _N
Inlet/Outlet Pipes&Baffles V Y—N
Location/ Separations
• Foundation to tank A ft.
Foundation to absorption '''' ft.
Separation of Pits JCI A-i'
Conforms as per Plot Plan J NA-
-Built dirp N
Location of Syste on Property:
Front Left Side Right Side Middle Front Middle Rear
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
Pipeline Specialists JOB
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