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2012-441 ��` TOWN OF QUEENSBURY 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201 Community Development - Building & Codes (518) 761-8256 CERTIFICATE OF COMPLIANCE Permit Number: P20120441 Date Issued: Thursday, September 13, 2012 This is to certify that work requested to be done as shown by Permit Number P20120441 has been completed. Tax Map Number: 523400-226-015-0001-018-000-0000 Location: 102 BAY Pky Owner: DANIEL F O'KEEFE III M.D. AS TRUSTEE Applicant: DANIEL F O'KEEFE III M.D. AS TRUSTEE 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 the Director of Building&Cod Enforcement Planning Board or Zoning Board of Appeals. TOWN OF QUEENSBURY (EL 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201 Community Development-Building&Codes (518)761-8256 BUILDING PERMIT Permit Number: P20120441 Application Number: A20120441 Tax Map No: 523400-226-015-0001-018-000-0000 Permission is hereby granted to: DANIEL F O'KEEFE III M.D. AS TRUSTEE For property located at: 102 BAY Pky 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. Tyke of Construction Value Owner Address: DANIEL F O'KEEFE III M.D. AS TR Septic Alteration Residential ASSEMBLY POINT TRUST U/T/A Total Value 42530 N 108TH St SCOTTSDALE AR 85255-0000 Contractor or Builder's Name/Address Electrical Inspection Agency IBS SEPTIC IVAN BELL 2 LOWER WARREN STREET QUEENSBURY.NEW YORK Plans&Specifications 2012-441 Res Septic Alteration $40.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Wednesday,September 11,2013 (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 Town of Queensbury; Tuesday,September 11,2012 SIGNED BY for the Town of Queensbury. Director of Building&Code Enforcement Revised 4/14/2010 OFFICE USE ONLY TAX MAP NO.aME) 1 s -fp IIT NO. le) 17/PERMIT FEE 1O 61?) St_ 711" L I. , APPROVALS: ZONING TOWN CLERK , APPLICATION FOR SEPTIC DISPOSAL SYSTEM PERMIT: A PERMIT MUST BE OBTAINED BEFORE WORK BEGINS. APPLICATION IS SUBJECT TO REVIEW BEFORE ISSUANCE)Y�O�F A VALID PERMIT. OWNER: X\CA( 01KP ?ice INSTALLER: ..T LB ` , , ADDRESS: . I -2 Buil PO(K, VV Gly ADDRESS: '(` (,,C/L9 kit.,e WpU r P ^ )1-' PHONE NOS. b5 6-9 L11. I PHONE NOS. '-1 I D.�I \6-''V0---)61-1+ 5 U i 1/�I _ I l LOCATION OF INSTALLATION: C \ S `V 30\-1+ 5 (• r I) J RESIDENCE INFORMATION: NO. COMPUTATION YEAR BUILT X = TOTAL DAILY FLOW BEDROOMS (Gallons per bedroom) GARBAGE GRINDER 1980 or older X 150 = Lc -I INSTALLED? IV h 1981-1991 X 130 = SPA OR HOT NIA 1992-present X 110 = INSTALLED? IV it PARCEL INFORMATION: N ✓ TOPOGRAPHY: FLAT ROLLING1k STEEP`` IlSLLLOPE NJ i\ %SLOPE V 1� I SOIL NATURE: SAND `U� N LOAM`V CLAY IV I\ OTHER N ✓ GROUNDWATER: AT WHAT DEPTH? IV I BEDROCK/IMPERVIOUS MATERIAL: AT WHATpDEPTH? N N I DOMESTIC WATER SUPLY: MUNICIPAL'\ IWELL (If well:water supply from any septic system absorption" ft) I PERCOLATION TEST: RATE IS N � PER MIINUTE PER INCH Impil lam^ ((�, A.ej-fro (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: 100 0 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: N11 o ABSORPTION FIELD(WITH NO.2 STONE) Total length fL Each trench i X , - 0 SEEPAGE PIT(S)(WITH NO.3 STONE) How many? Size? o ALTERNATIVE SYSTEM Bed or other type? IV o HOLDING TANK SYSTEM Total required capacity? N)1\ Tank size? N N Number of tanks? I Y l\ NOTE: ALARM SYSTEM AND ASSOCIATED ELECTRICAL WORK MUST BE INSPECTED BY A TOWN APPROVED ELECTRICAL INSPECTION AGENCY. PLEASE REVIEW LIST PROVIDED. 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. I have read the regulations wi respect to this application and agree to abide by these and all e� irements of the Town of Queensbury QUESTIONS? CALL 761.8256 OR EMAIL Sanitary Se -ge /'s..:.1" dinance. codes(a�queensburv.net -10-11-- VISIT OUR WEBSITE FOR MORE INFORMATION Signature of • - or�' esponsible Date www.aueensburv.net Town of Queensbury* Community Development Office*742 Bay Road, Queensbury NY 12804 Septic Inspection Report Office No. (518) 761-8256 Date Inspection r-• •- r- iv : Queensbury Building &Code Enforcement Arrive: L - . •. .i • epart: c`-Z3 So P. 742 Bay Rd., Queensbury, NY 12804 Inspecto s Initials NAME: o K EE FF PERMIT NO.: Z` 1 `1 LOCATION: \ b?_ 1Ft•- ASPECT ON: —1 2__ I Z 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 [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 C Tank to Didrik066,13ex, Vol) \vj\ Distrlfi ti WBo 2to Field/ Pit ZLI Opening Sealed: Y N _ _ End Cap YTN V%\ \T\c 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 Y N Engineer Report and As-Built „^Y— N ETU Maintenance Contract _Y_ N provided Location of System on Prope • Front r Left Si.• Right Side Middle Front Middle Rear S stem Use Sta s: 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 /-3 (3r1)) Septic Inspection Report Office No. (518) 761-8256 Date Inspection requ-ieive. Queensbury Building &Code Enforcement Arrive: c �CO a 471 D=tart: a,; _ a p pm 742 Bay Rd., Queensbury, NY 12804 Inspector's Initials: ltd - NAME: 0 K E'_eNe •E'MIT NO.: / - / I/ LOCATION: / D.. 8 64.!_irot r{C (4)qi,� II SPECT ON: 01--//-/A RECHECK: Comments and/or diagram Soil Type: Sand fi_vrcicr- — Type of Water: Municipa Waterline sepa ' Is ance ft. E___ Well separation distance L .M.--ft.-t-- Other wells: 6 O ft.1' Well Casing ngth 50' + / - Y N N/A ( - Length Absorption Field: Total length ft. CED \ Y.�b 1 of each trench ft. h-L ____ Depth of trenches ' ft. 0 Eve Size of Stone L 1 i E- F -O M c\*J r\ \ O Seepage Pits: Number �)-\ 1 1,..x2, p\)66-�f;`SK) Size: x Stone Size: _ �c-- _ 7-011'1\0?-?--1::: l,� Piping Size Type c- C lusC� \ x� Building to tank 9 s` ,6c a �c) Tank to Diatribigtiyiniilok Qmp�, mnotJ tJ -\- - \1i5TFILL Distribution Box to Field / Pit Opening Sealed: Y 14 End Cap _N Inlet/Outlet Pipes &Baffles Y,�• N Location/ Separations • Foundation to tank . Foundation to absorption ft. Separation of Pits ft. Conforms as per Plot Plan Y N Engineer Report and As-Built �•Y N 4 :1-0 V?16V—V-F 1 LL System on Property: E�'1�� Location of S Y Front Rear Left Sid 'ght Side Middle Front Middle Rear S 1-1 Us- . . Approved Partial Approved and ne ds 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: JPS c-ep tt c P I c — "i 4// 163 SHEET NO.:P4 OF CALCULATED lik.kBY: DATE: SEP 2012 Everett J.Prescott, Inc. SCALE: BiCA1PcIKWcA "I have seen or observed, or believe I saw evidence of, all obiects such as houses, wells, trees, f{n."t's, shoe o or, this I circieriL I also ren? - e f thst nce< diagram." a� riaa✓�, 0- DATE 15(0 Bc;t1 Pc%k 0 Kr 3SN GoA N e - (7. I4CU5e 5 cb a" p)er r o -foi4cAti a r Df ,^K'"� W ale r IS TOWN OF QUE. ` •`/' r(8 W 1� �/'orv- BUILDING & CoDf ''711 � u Rev ewed By: /d/ ,I%11 Date: AMMO N Q Wells �v'y i n S0 u t • I