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2012-447 TOWN OF QUEENSBURY 742 Bay Road,Queensbury,NY 12804-5902 (518) 761-8201 } Q rl, Community Development - Building & Codes (518) 761-8256 CERTIFICATE OF COMPLIANCE Permit Number: P20120447 Date Issued: Tuesday, January 14, 2014 This is to certify that work requested to be done as shown by Permit Number P20120447 has been completed. Tax Map Number: 523400-296-010-0001-034-000-0000 Location: 58 WINCREST Dr Owner: JAMES & CONSTANCE CULLUM Applicant: JAMES & CONSTANCE CULLUM 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&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: P20120447 Application Number. A20120447 Tax Map No: 523400-296-010-0001-034-000-0000 Permission is hereby granted to: JAMES & CONSTANCE CULLUM For property located at: 58 WINCRES'T 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 Queensbury Zoning Ordinance. Tie of Construction Value Owner Address: JAMES&CONSTANCE CULLUM Septic Alteration Residential 58 WINCREST Dr Total Value QUEENSBURY,NY 12804-0000 Contractor or Builders Name/Address Electrical Inspection Agency COOK SEPTIC SERVICE 518-696-7109 194 HALL HILL Rd LAKE LUZERNE NY 12804-0000 Plans&Specifications 2012-447 Res. Septic Alteration $40.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Saturday,September 14, 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; Friday,September 14,2012 SIGNED BY for the Town of Queensbury. Director of Building&Code Enforcement For an EPA homeowner's guide: htto://www.epa.clov/nodes/pubs/homeowner guide long customize.odf OFFICE USE ONLYu hco TAX MAP NO" '1� ,I D'1 -3 PERMIT NO. I / / PERMIT FEE (/ SEP 1 3 2012 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 OF A VALID PERMIT. OWNER: James Cullum INSTALLER: Cook Septic Service ADDRESS: 58 Wincrest Drive Queensbury NY ADDRESS: 194 Hall Hill Road Lake Luzerne PHONE NOS. 792-1792 PHONE NOS. (518) 696-7109 LOCATION OF INSTALLATION: 58 Wincrest Drive Queensbury NY RESIDENCE YEAR BUILT NO.OF X COMPUTATION= = TOTAL DAILY FLOW INFORMATION: BEDROOMS _ 1980 or older ] X 150 gallon per bedroom = 0 GARBAGE GRINDER INSTALLED? I 1981 -1991 X 130 gallon per bedroom = 0 1992-present 3 X 110 gallon per bedroom = 330 SPA OR HOT TUB INSTALLED? (House will be retrofitted with water saving fixtures/inserts) PARCEL INFORMATION: ✓ TOPOGRAPHY: FLAT ROLLING ✓ STEEP SLOPE SLOPE 2-7 % ✓ SOIL NATURE: SAND I LOAM CLAY OTHER ✓ GROUNDWATER: AT WHAT DEPTH? > 9' BEDROCK/IMPERVIOUS MATERIAL: AT WHAT DEPTH? > 9' ✓ DOMESTIC WATER SUPLY: MUNICIPAL I WELL (If well:water supply from any septic system absorption is:( ft) ✓ PERCOLATION TEST: RATE IS 3 min 45 sec PER MIINUTE PER INCH(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: existing 1500 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: Infiltrator Systems Inc 112 ft equivalent 28 feet "Quick 4 Equalizer 36" ❑ABSORPTION FIELD "Quick 4 Equalizer 36" Total length to 138 ft ft. Each trench long X chambers ❑SEEPAGE PIT(S) (WITH NO. 3 STONE) How many? Size? ❑ALTERNATIVE SYSTEM Bed or other type? ❑HOLDING TANK SYSTEM Total required capacity? Tank size? Number of tanks? 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 with respect to this application and agree QUESTIONS? CALL 761-8256 OR EMAIL to abide by these and all requirements of the Town of Queensbury codes aOqueensburv.net Sanitary Sewage Disposal Ordinance. VISIT OUR WEBSITE FOR MORE INFORMATION (At l 2012.09.13 11:37:28-04'00' www.queensbury.net Signature of Person Responsible Date Town of Queensbury • Community Development Office • 742 Bay Road, Queensbury, IVY 12804 Septic Inspection Report Office No. (518) 761-8256 Date Inspection reque •el • Queensbury Building &Code Enforcement Arrive: ' '-oc� am •L� o-►.rt: am/pm 742 Bay Rd., Queensbury, NY 12804 Inspector's Initials: 11101 NAME: ERMNO.: / /40 LOCATION: Y)/*(1:74A''5-- ()if n(.r29-Sf -• CT ON: 1—\17---11-1 RECHECK: Comments and/or diagram Soil Type: Sand/ Loam/ Clay Type of Water: Municipal/ Well Water Waterline separation distance ft. t 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 _YN 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 _ Foundation to absorption ft. Separation of Pits ft. Conforms as per Plot Plan _ —N Engineer Report and As-Built Y_ N ETU Maintenance Contract _Y N provided Location of System on Property: Front Re• Left Side Right Side Middle Front Middle Rear stem Use Stat•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 Report_03 29 10.doc JARRETT Engineers, PLLC Civil&Environmental Engineering January 13, 2014 John O'Brien Town of Queensbury, Building & Codes 742 Bay Road Queensbury,NY 12804 Re: Cullum Wastewater Disposal 58 Wincrest Drive Queensbury,NY 12804 JE 12-044 Dear John, This letter is to certify that representatives from this office visited the Cullum residence during construction of the wastewater disposal system. Based on our observations, we believe that the system has been constructed substantially in conformance with plans prepared by this office that were issued for construction on September 13,2012. If you have any questions,please do not hesitate to contact us at 792-2907. Sincerely, JARRETT Engineers, PLLC cr+eir 2014.01.13 11:44:07 -05'00' H. Thomas Jarrett, P.E. Principal Copy: J. Cullum S:kArch,ved Files12012 Projects112-044 Cullum WWVTechnicallWork Does 12044131112 Ceri Ltr.doc 12 East Washington Street 518 792-2907 Glens Falls,NY 12801 Fax 518 798-1864 Septic Inspection Report Office No. (518) 761-8256 Date Inspection r-. 4- :jived: Queensbury Building &Code Enforcement Arrive: *.-3L), .•• •5'Depart: am/pm 742 Bay Rd., Queensbury, NY 12804 Inspector's Initial NAME: 0 U LCrn PERMIT NO.: I 3N y 7 LOCATION: C % i J1 n @ r a;S1 INSPECT ON: .-_1 Zo RECHECK: Comments and/or diagram Soil Type: g•:__- - lay Type of Water: _ .. _.1 - ' .ter y- - Waterline separation distance ft. Well separation distance ft. Other wells: ft. Well Casing Length 50' + / - Y N N/A Absorption Field: Total length t t Z ft. Length of each trench 1--1r 7 , ft. Depth of trenches z— ft. Size of Stone Seepage Pits: Number Size: _x Stone Size: • Piping Size Type Building to tank ' Tank to Distribution Box 1-{i '— Distribution Box to Field / Pit f ' ' 'c- tdt� L1 k Opening Sealed: NEnd CapInlet/Outlet Pipes &Baffles _ N , , Location/ Separations • Foundation to tank ft. Foundation to absorption Separation of Pits ---7/ tt. 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