BOTH-000304-2015 TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5904 (518)761-8201
Community Development-Building&Codes (518)761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: BOTH-000304-2015 Date Issued: Wednesday, August 10, 2016
This is to certify that work requested to be done as shown by Permit Number BOTH-000304-2015
has been completed.
Tax Map Number: 239.15-1-3
Location: 8 ROCKY SHORE RD
Owner: David Kelly,Sally Kelly
Applicant: SALLY KELLY
This structure may be occupied as a: Residential Septic Alt.
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 Enforcement
Planning Board or Zoning Board of Appeals.
TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5904 (518)761-8201
Community Development- Building& Codes (518)761-8256
— i
BUILDING PERMIT
Permit Number: BOTH-000304-2015
Tax Map No: 239.15-1-3
Permission is hereby granted to: SALLY KELLY
For property located at: 8 ROCKY SHORE 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
Tyne of Construction
Owner Address: 30 OAKWOOD DR Septic Disposal $0.00
Queensbury,NY 12804 Total Value $0.00
Contractor or Builders Name/Address Electrical Inspection Agency
Hutchins Engineering
169 HAVILAND RD
Queensbury,NY 12804
Plans&Specifications
Residential Septic Alt.
PERMIT FEE PAID-THIS PERMIT EXPIRES: Thursday,November 3,2016
(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 the Town of ens g, / ) paond , o ,2015
SIGNED BY: G•tfy_�I�// for the Town of Queensbury.
Director of Building&Code Enforcement
is S�5 1Cr3 ih rD
SEPTIC DISPOSAL PERMI l5 � `l- zedOffice Use Only
IS
DATE 9/3/2015 Received
Tax Map ID
Tax MAP l0 239.15-1-3j Permit No. S '
Permit Fee
LOCATION OF INSTALLATION 8 Rocky Shore Road Approvals:
APPLICANT DAVID AND SALLY KELLY PHONE/E-MAIL KELLY.DAVID56@GMAIL.COM
ADDRESS 30 OAKWOOD DRIVE,QUEENSBURY NY 12804
INSTALLER/BUILDER: (TO BE DETERMINED) PHONE/E-
ADDRESS: An - 07'- - — 11
du JC
WNER (SAME AS APPLICANT) PHoNEIE-&4iL
TOWN hRl
Address I BUILDINGC0 FR
CONTACT PERSON FOR BUILDING&CODES COMPLIANCE: TOM HUTCHINS,HUTCHINS ENGINEERING PHONE 518-745-0307
RESIDENCE INFORMATION
Year Built #of bedrooms X Gallons per bedroom =Total Daily Flow
1980 or older Garbage grinder installed Y ✓N
1981-1991 Spa or Hot Tub installed Y ✓N
1992-Present 3+1 NEW 110 440
PARCEL INFORMATION
Topography Flat rolling ✓ Steep slope _%slope
Soil Nature Sand _Loam Clay _Other SEE PRIOR FIELD DESIGN
Groundwater At what depth? SEE PRIOR FIELD DESIGN
Bedrock/Impervious Material At what depth? SEE PRIOR FIELD DESIGN
Domestic Water Supply Municipal ✓ Well(if well,water supply from any septic system absorption is—ft.)
Percolation Test Rate: N/A per minute per inch(test to be completed by licensed engineering/architect)
PROPOSED SYSTEM FOR NEW CONSTRUCTION
Tank Size 1,000 gallons(minimum size i,000 gallons,add 250 gallons to size for each garbage grinder or spa or hot tub)
System Type Absorption field with#2 stone Total length ft.;Each trench x
Seepage Pit with#3 stone How many: ;size
Alternative System Bed or other type? EXISTING TO REMAIN
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 r approval granted which is based upon or is granted in reliance upon any material representation or
failure to make a mate f ct or circumstance know by or on behalf of an applicant, shall be void. I have read the regulations
and agree to abide b the e a d all requirements of the Town of Queensbury Sanitary Sewage Disposal Ordinance.
Print Name: G.T AS TCHIq P.E. AG Date: 9/3/2015
Signature: Date:
Town of Oue sbury Building&Codes Septic Disposal Permit July 2014
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DEPARTMENT OF HEALTH AND SHALL BE OF.. PRECAST CONCRETE ''AS .
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- (TABLE CRUS ED STONE SHALL ;BE. q DATED 212712015, PREPARED 8Y. OAWD F. BARRASS, 1 .
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Dig With Care ALL.JOINTS MUST BE SEALED WITH BUTYL SEALANT. JOINTS BELOW THE LIQUID . 4 M.D.,""_DATED 91812004, LAST REVISED .611712008 PREPARED :.Queensbury, NY 1280412 9904 _ -.
LEVEL MUST BE TESTED BEFORE BACKFILLING. • _ _ ,.
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, JAMS
BY.• S_E. HUTCH NS, P.E., NORTH CREEK,' NY -
Phone
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= PANEL INSIDE Hous£IN ACCESSIBLE LOCATION. FORCE
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500 GALLOP PRECAST CONCRETE PUMP STATION INSTALL POWER&CNCE W WIRING TO TuRERgS fli MiH ALARM IN
ALL UNITS T OF COMPLY MOH THE REQUIREMENTS OF THE NEW YORK STATE HOUSE IN ACCORDANCE WITH MANUFACTURERS INSlRUCi1OV5 AND prepared WOG
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MANUFACTURED 8Y UTORA ENTERPRISES OR EQUIVALENT. BASE SURVEY INFORMATION TAKEN FROM: "MAP OF GARAGE David&Sally Kelly
PUMP CONTROL AND FLOAT LEVELS TO BE INSTALLED TO PROVIDE A LOCATION FDR DAVID R. KELLY, M.D. AND SALLY N. KELLY,
Dig Safely. ALL STRUCTURES SHAH BE PULED ON FIRM,COMPACT Cl SAND ST GRAVEL BASE 50�LON DOSE. 8 Rocky Shore Rd
WHERE EXISTING SSA TO ACHIEVE
ARE UNSUITABLE, CRUSHED STONE SHALL BE DARED 2/27/2015, PREPARED BY: DAVID F. BARRASS Town of Queensbury,Warren Count),NY
New York PLACED AS NECESSARY TO AOBEVE A STABLE BASE EFFLUENT PUMP TO BE GQUCDS 3885 MODEL WF03L,230V,SINGLE CORINTIi,NY
O O.n B.1—Yen D16 PHASE,20 CPM PUMP AT 20 FT ROH
OW.KTh.Regwr.e nm. SEPTIC TANKS INSTALLED IN TRAFFIC AREAS SHALL BE OF EXTRA HEAVY
Oconnrm trtnWY BesPorn. CONSIRUCTIOM DESIGNED FOR H-20 WHEEL LOADING EXISTING WASTEWATER COMPONENTS TAKEN FROM Drawn:LW9 Checked:GTH Scale:NOTED OOIe:6/11/15
VERIFY EXISTING ELECTRICAL SERVICE PRIOR TO PURCHASING PUMP. 169 HOW d ROOd
E3 R.sP.otTM M.rT1. 'WASTEWATER REPLACEMENT PLAN SALLY & DAVID KELLY, Oveensbur NY 17804
13 D1v wWW c... ALL JOINTS MUST BE SEALED W IN BUTYL SEALANT. JOINTS BELOW THE UOUID MD.,'DATED 9/8/2004, LAST REUSED 6/17/2008 PREPARED Y• 29904-01-Sl
800.962.7962 LEVEL MUST BE TESTED BEFORE BACKFILLING
��� hTMsnonueem BY. JAMES E.HUTCH/NS,P.E.,NORTH CREEK,NY Hutchins En meerin (518)745-0307 Phone
9 9 518 745-0308 Fax