1991-723 •
CERTIFICATE OF COMPLIANCE
TOWN OF QUEENSBURY
WARREN COUNTY, NEW YORK
Date eodyr, 9 19 2_e
This is to certify that work requested to be done as shown by Permit No. 91-723
has been completed.
Septic Alteration
This structure may be occupied as a
40 Montray Rd •
Location
Owner Reginald Rheubottom •
By Order Town Board
• TOWN OF QUEENSBURY
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Director of Bldg. & Code Enforcement
BUILDING PERMIT
TOWN OF QUEENSBURY a
No. 91-723
WARREN COUNTY, NEW YORK a
IA
PERMISSION is hereby granted to Reginald Rheubottom
OWNER of property located at 40 flontray Rd Street, Road or Ave.
in the Town of Queensbury,To Construct or place a Septic Alteration ro
at the above location in accordance to application together with plot plans and other information hereto filed and
approved and in compliance with the Town of Queensbury Building and Zoning Ordinance.
1. OWNER'S Address is
Same
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2. CONTRACTOR or BUILDER'S Name e+
Jack Hall Plumbing & Heating
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3. CONTRACTOR or BUILDER'S Address �.
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4. ARCHITECT'S Name
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5. ARCHITECT'S Address
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6. TYPE of Construction—(Please indicate by X)
( )Wood Frame ( ) Masonry ( )Steel (
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7. PLANS and Specifications
No. Septic Alteration to include: 189' of Tile Field using #2 Stone
1' Thickness as per plot plan specifications and Applicationsmma
8. Proposed Use fD
;y
Septic Alteration
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$ 25.00 PERMIT FEE PAID —THIS PERMIT EXPIRES October 9, 19 93
(If a longer period is required an application for an extension must be made to the Building and Zoning inspector of the
town of Queensbury before the expiration date.)
Dated at the Town of Queensbury this 9th Day "f October 19 91
SIGNED BY //' � for the Town of Queensbury
Building and ning Inspector
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TOWN OF QUEENSBU'R'l' QC f :j -91r
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� APPLICATION FOR SEPTIC DISPOSAL PERMIT �`�Is P 't # / /— 7 3
BIMIDINGA
Date: 0071: 919/ Reviewed B3964!!;77/
LOCATION OF PROPERTY FOR INSTALLATION: 4/ ( ,l/Lrec ! '1 C} u&pe,25- /'a,/
Owner' s Name Rep y i\_� 9) R.ke v bolta9-wt
Owner's Mailing Adress: A/C 0-n1re, Rai, aUee00S./bar/ nu
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Installer' s Name: JR e)r 146'7/ Pipinhiv� liady, 3ne #: 99,7-71/7
Number of bedrooms (if residential ) : 3 7
Total daily flow (residential-compute @ 150 gal . per bedroom) : -4/D 6
Topography-Circle One: Flat ` Rolling Steep Slope % of Slope
Soil Nature-Circle One: ,.and Loam Clay Other /Depth:
Ground Water-At What Depth? feet
Bedrock or Impervious Material-At What Depth? Feet
Percolation Test-Circle One: Not Required Required/Rate —Min. Per Inch
Domestic Water Supply-Circle One: druTnicipa Well Other
If domestic water supply is a well -
Separation: Water supply from any septic absorption feet
PROPOSED SYSTEM: • Septic Tank 1.;-)0 0gal . (Minimum size: 1,000 gal . )
Tile Field: Each Trench 63 feet//Total System Length f?-1 ' feet ,
Seepage Pit(s) : Number of / Size each: ft. x ft.
Size of Stone to be used: # / Depth or Thickness l feet
**************
HOLDING TANK SYSTEM IF REQUIRED
No. of Tanks Size of Each Gal .
Alarm system and associated electrical work to be inspected by a certified
. agency.
****************
I have read the regulation on the reverse side of this sheet and agree to abide
by these and all requirements of the Town of Queensbury Sanitary Sewage Disposal
Ordinance.
SIGNATURE OF RESPONSIBLE PERSON: el-e..--: DATE: /D-5-9/
Septic System Inspections:
A. All applications for septic system installation, alteration or repair,
as required by the Town of Queensbury Sanitary Sewage Ordinance, shall
be submitted to the Building Department at least 24 hours before start
of construction and shall include a plot plan showing:
1) the proposed location of the system
2) location and distance to lot lines
3) location and distance to structures
4) location and distance to any water supply
5) size and dimensions of all tanks, distribution boxes, tile fields
and/or .drywel l s
B. No system shall be covered before inspection and approval by the Building
Inspector. Failure to comply with this requirement may result in the
uncovering of the system by the installer and a fine of up to $250.00.
C. An approved copy of the plot plan shall be available on the construction
site. Failure to produce said plot plan at time of inspection may result
in an immediate work stoppage.
D. Should unforeseen problems during construction prevent proper installation,
alteration or repair of an approved system, a new proposal must be submitted
to the Queensbury Building Department before further construction.
Town of Queensbury
Building & Code Enforcement
Department
531 Bay Road
Queensbury NY 12804
Remarks:
\'
_Jown o1 Queeniurc� I1
BUILDING and ZONING DEPARTMENT
_ / Bay and Haviland Road, R.D. 1 Box 98
Queensbury, New York 12801
SEPTIC DISPOSAL������ SYSTEM INSPECTION
NAME �\rle tA2-1► 1 qe)InctO
LOCATION �() \--yam, c�
DATE / 7 PERMIT NO. 9 j _
12,9-3
SOIL TYPE - Sand - Loam - Clay -
Percolation Test Required? YES - NO,
Percolation rate - Min/Inch
TYPE of SYSTEM:
Absorption field, total length j -
Length of each trench AS '
Depth of trenches C5 `_4 .
Size of gran I f 2___
SEEPAGE PITS{. umber of) .
Size- ft. X ft. /
Gravel size
PIPING: 6 Size/ Type
Bldg. to tank
Tank to dist. box </" /0J/C
Dist. box to field/pit ,9 )' /fiC.
.Openings seal d? YES/ NO Partial
LOCATION/SEPA, TIONS/
Foundation to tank 4` /n ft.
Foundation to absorption - ft.
Absorption to lot line ft.
Separation -of. pity p.i-ft.
LOCATION OF S STEM ON PROPERTY(circle one)
Front-� / eft side)- Right side -
COMMENTS: 4
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SYSTEM USE A•PROVED firiP' NO
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