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2009-186 TOWN OF QUEENSBURY 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201 (zt Community Development- Building &Codes (518) 761-8256 CERTIFICATE ("."IVE7 COMPLIANCE Permit Number. P20090186 Date Issued: Tuesday, November 16, 2010 This is to certify that work requested to be done as shown by Permit Number P20090186 has been completed. Tax Map Number. 523400-297-010-0001-042-000-0000 Location: 50 WINCOMA Dr Owner. DAVID & JUDITH COLLINS Applicant: DAVID & JUDITH COLLINS 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 then 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: P20090186 Application Number. A20090186 Tax Map No: 523400-297-010-0001-042-000-0000 Permission is hereby granted to: DAVID & JUDITH COLLINS For property located at: 50 WINCOMA 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 QueensburyZoning Ordinance. Type of Construction Value Owner Address: DAVID &JUDITH COLLINS 50 WINCOMA Dr Septic Alteration Residential QUEENSBURY, NY 12804 Total value Contractor or Builder's Name/Address Electrical Inspection Agency SANITARY SEWER DAN DRELLOS PO BOX 224 GLENS FALLS NY Plans &Specifications 2009-186 SEPTIC ALTERATION RESIDENTIAL $25.00 PERMIT FEE PAID- THIS PERMIT EXPIRES: Wednesday, May 12, 2010 (If a longer period is required,an application for an extension must be made to the code Enforcement Officer of the Town of Queer bury before a ex iratioyk(,late, Dated at theow� r„( aesday, May 12, 2009 SIGNED BY for the Town of Queensbur)7. Director of Building&Code Enforcement %______:_____ OFFICE USE ON _E T_E 2 T 7 MAP NO.} /~ � PERMIT NO. 19CERMIT FEE AX MAY 0 7 2009 APPROVALS: ZONING TOWN CLERK WQUEENSSU ______________ _ BUILD CODES- APPLICATION FOR SEPTIC DISPOSAL SYSTEM P A PERMIT MUST BE OBTAINED BEFORE WORK BEGINS.APPLICATION IS SUBJECT TO REVIEW BEFORE ISSUANCE OF A VALID PERMIT, OWNER: !'it1 r� ± �` INSTALLER:'` Ld ADDRESS: �V /X IC J Ad A- Z^ %l ADDRESS: ? PHONE NOS. PHONE NOS. LOCATION OF INSTALLATION: ' D C M G1- N RESIDENCE INFORMATION: YEAR BUILT NO.OF X COMPUTATION= = TOTAL DAILY FLOW BEDROOMS GARBAGE GRINDER 1980 or older X 150 gallon per bedroom = INSTALLED? 14 0 1981 -1991 X 130 gallon per bedroom = zl SPA OR HOT TUB 1992-present X 110 gallon per bedroom = INSTALLED? An- PARCEL INFORMATION: ✓ TOPOGRAPHY: Flat rolling Steep slope %Slope ✓ SOIL NATURE: Sand Loam Clay Other ✓ GROUNDWATER: At what depth? ✓ BEDROCK/IMPERVIOUS MATERIAL: At what depth? ✓ DOMESTIC WATER SUPLY: Municipal Well (If well: Water supply from any septic system absorption is ft.) ✓ PERCOLATION TEST: Rate is Sec �h�llcffit per�minute 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 n ineer or architect (unless installed in a Planning Board approved subdivision). ,5 i.^�6) TANK SIZE: fl oJ� 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: ❑ ABSORPTION FIELD (WITH NO. 2 STONE) Total length ft. Each trench X ❑ 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 to abide b these and all requirements of the Town of QuesrloNs? CALL nsbur . OR EMAIL g Y q codes�pueensbury.net Queensbury Sanitary Sewa Disposal Ordinance. VISIT OUR WEB SITE FOR MORE INFORMATION Z &- /40 www.gueensbury.net iq ature of Person Re onslble Date Town of Queensbury • Community Development Office • 742 Bay Road, Queensbury, NY 12804 � a Septic Inspection Report Office No. (518) 761-8256 Date Inspection requ ed: Queensbury Building &Code Enforcement Arrive: a J rt: am/pm 742 Bay Rd., Queensbury, NY 12804 Inspector's Initia K NAME: ERMIT NO.: LOCATION: _ inry-, r�.._ _ INSPECT ON: RECHECK: Comments and/or diaaram Soil Type: Sand/ Loam / Clay Type of Water: Municipal/ Well Water Waterline separation distance 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 Ca 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 Separation of Pits ft. Conforms as per Plot Plan N Engineer Report and As-Built :YE N ETU Maintenance Contract Y N provided Location of System on Property: Front R Left Side Right Side Middle Front Middle Rear System 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 09/27/2010 14:10 5187928511 VAN DUSEN AND STEVES PAGE 02/04 169 Haviland Road, Queensbury, NY 12804 Plione-518-745-4400 Fax -518-792-8511 September 23, 2010 Project #49286 1~AXED�-745-443 7 Mr. Dave Hahn Town of Queensbury 742 Bay Road Queensbury,NY 12801 Re: Replacement Septic System- Collins Residence Dear Dave: 50 Wincoma Lane, Queensbury, NY This letter is to inform you that we inspected the completed septic system for the Collins Residence at 50 Wincoma Lane in the Town of Queensbury on 5/13/2009. The septic system as installed was for a 3 bedroom house and consisted of the existing 1,000 gallon septic tank, a new distribution box and 20 ft wide by 20 fl: long absorption bed with 4 - 15 fi long laterals constructed with stone and perforated pipe. The system conforms to t11e requirements of the approved design letter. Please call me if you have any gttestions. Sincerely, Thomas R. Center, PE i -lz 1Ve , �.S47- Septic Inspection Report,,.- Office No. (518) 761-8256 Date Inspection j questa're ed: Queensbury Building &Code Enforcement Arrive: F"-=—bz af)1/pm epart - 742 Bay Rd., Queens Yy,,12804 Inspector's Initials; f NAME: i t�L PE IT NO.: 07 LOCATION: INSPECT ON: - RECHECK: Comments and/or diagram Soil Type: Sand/ o Cta Type of Water: Municipal/Well Wa Waterline se ara 'on {' rce-�' ft. Well separation distance ft. Other wells: ft. Well Casing Length 50' + / - Y N N/A Absorption Field: Total length z::1 ft. Length of each trench ce-� ft. Depth of trenches Size of Stone _. Seepage Pits: Number Size: b x Stone Size: Piping Size Type Building to tank ` Tank to Distribution Box Distribution Box to Field/ PitT, �U Opening Sealed: Y N End Ca Y N Inlet/Outlet Pipes&Baffles N 1 Location/ Separations .° � iv LZ Foundation to tank � ft. IL Foundation to absorption ft. ° l i _ Separation of Pits Z ft. CQnfo &,as._ er.Plot Plan _ N L�--Qngineer Re .and As-Built Y N Location of System on Property: Fro Rear �_ Left Sid ,_ Flight"Side Middle Front Middle Rear System Use Status: pproved Partial Approved and nee/Sto 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 3 r C7 � r f Z� "I have seercbrasihotns,l�Iel�Sl► � i ce of, all objects sucfrearheoek,a ! ItF��n � eve shown on this doc6 dish , ^f 3 �It �,c�a rGrn. d Qo er na measu t dista set f-,,th o j i t m.' �S PP TE SIGNATURE DATE w ► N C ti-c 4 r��