2014-393 TOWN OFQ UEENSBURY
•
742 Bay Road,Quecnsbury,NY 12804-5902 (518)761-8201
Community Development - Building & Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: P20140393 Date Issued: Thursday, September 11, 2014
This is to certify that work requested to be done as shown by Permit Number P20140393
has been completed.
Tax Map Number: 523400-295-010-0002-037-000-0000
Location: 116 MOUNTAIN VIEW Ln
Owner: KEITH KOSINSKI
Applicant: KEITH KOSINSKI
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, Caj/1
Variance, or other issues and conditions as a result of approvals by the Director of Building&Cod• Enfor ent
Planning Board or Zoning Board of Appeals.
TOWN OF QUEENSBURY
` 0 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development-Building& Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20140393 Application Number: A20140393
Tax Map No: 523400-295-010-0002-037-000-0000
Permission is hereby granted to: KEITH KOSINSKI
For property located at: 116 MOUNTAIN VIEW Ln
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. Type of Construction Value
Owner Address: KEITH KOSINSKI Septic Alteration Residential
116 MOUNTAIN VIEW Ln Total Value
QUEENSBURY,NY 12804-0000
Contractor or Builder's Name/Address Electrical Inspection Agency
Plans&Specifications
2014-393
Res. Septic Alteration
$40.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Wednesday, August 26,2015
(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 ue sbury gTue: ' .y'Au'ust 26,2014
/(JJ
SIGNED BY i. FS for the Town of Queensbury.
Director of Building& Code Enforcement
Office Use Only
Town of Queensbury Building & Codes Received:
SEPTIC DISPOSAL PERMIT •
Tax Map ID: Cti ,i0 -�-.3//
2(114Permit No.:
A permit must be obtained before beginning construction Permit Fee: $
Approvals:
Applicant: /V i C. it A /C v S Installer/Builder S -""/4-
Address: //6 /4,L vie r/v Address QO. 8i-L‹ 22
GiaeenJ/9' F,--//c `/ /2f=ir
Phone: 34 7 'I- Phone 7 f2- 72 r7
Owner: Location of Installation //6 /n 6 �a,- z!.,/,-Lc
Address:
Phone G
Contact Person for Building&Code Compliance: �o oyt N'�'- ter Day Phone7 �j60
Residence Information:
Year Built #of Bedrooms x Gallons per bedroom =Total Daily Flow
1980 or older -3 x 150 = (7_5-72) Garbage Grinder installed? l'22
1981 -1991 x 130 = Spa or Hot Tub Installed? c-11
1992-Present x 110 =
Parcel Information:
Topography xl Flat Rolling _Steep Slope %Slope
Soil Nature Sand Loam Clay _Other
Groundwater At what depth?
Bedrock/Impervious Material At what depth?
Domestic Water Supply X Municipal Well(if well,water supply from any septic system absorption is ft.)
Percolation Test Rate- /-5-- 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 engineer or architect
(unless installed in a Planning Board approved subdivision).
Tank size /ZS.'" gallon(minimum size 1,000 gallons),add 250 gallons to size of septic tank for each garbage grinder,spa or whirlpool tub
System Type: Absorption Field(with#2 stone) Total length 24-e) ft. Each trench S-c-7 X .s
Seepage Pit(S)(with#3 stone) How many? ""`' Size?
Alternative System Bed or other type? /"`'
Holding Tank System Total required capacity? . Tank size? #of tanks?
NOTE: 1)Alarm system and associated electrical work must be inspected by a Town approved electrical inspection agency-see Certified Electrical form
on Town website; 2) Effective as of March 23, 2006 Septic System-As Built Plot Plan: The Building Department will no longer allow systems to be
covered until such time as an As-Built Plot Plan is received and approved by the Building Inspector. The installed system must match the septic system
layout on file. There will be no exceptions.
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 by these and all requirements of the Town of Queensbury Sanitary
Sewage Disposal Ordinance Q
Print Name: ' e ---� "2f Date: a -1J---/Y
c� c J"
Signature: � Date: a '� / 17
Town of Queensbury Building&Codes Septic Disposal Permit 518-761-8256
Town of Queensbury Building & Code Enforcement l (A.& S i; ` ,3L -3em
Office No. (518) 761-8256
Septic Inspection Report
Inspection request received:
Name: 1<0.S t r\‘S K i Inspected on: 9 ---(?-/1
Location: /Le f\(14—r‘ \.F t Q W ,INA Arrive: ) . l5..-'' a.m.I p.m.
Permit No.: I I—297 3 Inspector's Initials:
Comments an for diagram
Soil Type: an Loam/Clay
Type of Water: Municipal/Well Water
Waterline separation distance / v '+ 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 ISO ft.
Length of each trench ,5n ft.
Depth of trenches r(j'`-2-41*
Size of Stone 2,
Seepage Pits: Number PIA-
Size: x
Stone Size:
Piping Size Type
Building to tank Ai " -
Tank to Distribution Box
AIDistribution Box to Field/Pit < �T){? T f2—(�f'
Opening Sealed: _V YN
End Cap V N
Inlet/Outlet Pipes&Baffles N
Manholes 12"or less below grade _Y_N
[provide extension collar if Yes] Y_N
Location/Separations
Foundation to tankZ ft.
Foundation to absorptions ft.
Separation of Pits ��� ft.
Conforms as per Plot Plan _ _
Engineer Report and As-Built Y VIVA
ETU Maintenance Contract provided Y N
Location of System-eirProperty:
Front Rear Left Side Right Side Middle Front Middle Rear
S stem Use Statu-.
Approved
Partial Approved and needs to be re-inspected, please call the Building&Codes Office
Disapproved
Septic Inspection Report
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SEPTIC PLOT PLAN
I HAVE SEEN OR OBSERVED ALL OBJECTS GI o c Q
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SU VHS, WELLS, TREES, FENCES, ETC _
6Ar - SH VDOCUMENT.I HAVE PERS.NALLY'M SU ATANCE ET FORTH ON THIS 11RAM.
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Date: --- - . 61 2
116 m4 Vie 141 ZA"e
CENTER PROJECT
SERVICES
73 Sheridan Street, Glens Falls,NY 12801
Phone-518-796-2515
August 28, 2014
Project# 199
George Drellos
Sanitary Sewer Services
Luzerne Road
Queensbury,NY 12804
Re: Proposed Replacement Septic
Keith Kosinski— 116 mountain View Lane, Queensbury, NY
Dear George:
At your request we have reviewed your proposed replacement septic system design of the
existing 4 bedroom house at 116 Mountain View Lane in Queensbury. As per our conversation
the residence has an existing failed septic system.
We have reviewed the proposed replacement septic system design and we agree that a standard
absorption bed is acceptable. Based upon a design flow rate of 440 GPD and a percolation rate of
1 to 5 minutes, you will need a minimum of 184 if of absorption trench. We recommend using 5
— 50 absorption trench laterals which will provide 250 if of absorption trench. The absorption
system can be constructed with the a new 1,250 gallon septic tank, new distribution box, and 4
inch diameter perforated pipe and stone.
Please feel free to contact me at 796-2515 if you have any questions and that you for your
assistance with this request.
Sincerely,
Thomas R. Center Jr, P.E.
Septic Inspection Report
Office No. (518) 761-8256 Date Insion requ-- ,eiv=•
Queensbu Building &Code Enforcement Arrive: L"r I am•(ff P- art: �' U a m ,
rY � ., P 3
742 Bay Rd., Queensbury, NY 12804 Inspector's Initials:
NAME: 0bl K) 1 ' • ITNO.: — Q
LOCATION: \ \ Co t-'1\000-1-A14 \i 1 LiVV SPECT ON:
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. bTn- t
Size of Stone C ��
Seepage Pits: Number � t• C--AC\-'\ \EviD
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 _Y N
Inlet/Outlet Pipes&Baffles Y T N
Manholes 12"or less below grade _Y_ N
[provide extension collar if Yes] Y T 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 Property:
Front Rear Left Side Right Side Middle Front Middle Rear
System Use Status*
Approved
Partial Approved and needs to be re-inspected, please call the Building &Codes Office
Disapproved
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