1991-836 • y �9
CERTIFICATE OF COMPLIANCE
TOWN OF QUEENSBURY
WARREN COUNTY, NEW YORK
Date /0r.dlB/Y3 i-lk-, 19
This is to certify that work requested to be done as shown by Permit No. 9 836
has been completed. -
This structure may be occupied as a Septic Ml ter'ati'n
Location 270 Pinello Rd
Owner Ronald Raynor
By Order Town Board
TOWN OF QUEENSBURY
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Director of Bldg. do Code Enforcement
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BUILDING PERMIT
TOWN OF QUEENSBURY pi
No. 91-836
WARREN COUNTY, NEW YORK
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PERMISSION is hereby granted to Ronald Raynor 'I
OWNER of property located at 370 Pinello Rd Street, Road or Ave. w
in the Town of Queensbury,To Construct or place a Septic Alteration
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
20 Fox Hollow Rd
Queensbury, NY 12804 0
2. CONTRACTOR or BUILDER'S Name
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Jack Hall
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3. CONTRACTOR or BUILDER'S Address
CA)
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4. ARCHITECT'S Name
-I.
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5. ARCHITECT'S Address 0
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6. TYPE of Construction— (Please indicate by X)
( )Wood Frame ( ) Masonry ( ) Steel ( )
—I•
C,
7. PLANS and Specifications
Septic Alteration to include:
No. 1000 gal tank with 200' of tile field using #2 stone, 1' thickness rD
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as per plot plan specifications and application
8. Proposed Use
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Septic Alteration
$ 25.00 PERMIT FEE PAID —THIS PERMIT EXPIRES December 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 D o / December 19 91
SIGNED BY1j�/ for the Town of Queensbury
Buildin and Zoning I ctor
_ / /Li `7i 1 - ' , 1 TOWN OF QUEENSBURY
� `3 APPLICATIi 'i FOR SEPTIC DISPOSAL PERMIT
DATE: Dec P. q 1 i�Sk�. qf0
LOCATION OF PROPERTY FOR INSTALLATION r. - ,�_-.•--�n-e- -6-�
Owner' s Name: Rid Rewoo✓' t.G 21991
Address: Jv ga-} cri . DEt Z ee4�i oi/
Installer' s Name: u qe* 9Iq/l Telephone: 79-2 -7//'2( •
Number of bedrooms (residential only) '3
Total daily flow (compute @ 150 gal per bedroom) • ''J3�
Topography: Circle one: 4110 Rolling Steep Slope %.of Slope
Soil Nature: Circle one: Sand . Loam _Clay Other /Depth:
Ground Water: At what depth? Feet
Bedrock or Impervious Material : At what depth? Feet
Percolation test: Circle one: now require required
Rate - Min. Per Inch
. -..:Domestic water supply: Circle one: .Municipal JP Other .
If 'domestic water supply is a well :
Separation: Water supply from any septic absorption /db feet. .
PROPOSED SYSTEM: Septic Tank ,t OOo gal . (minimum size: 1,000 gal )
TILE FIELD: Each Trench S' feet/Total system length ao feet
SEEPAGE PIT(S): Number of /Size each feet
by feet .
Size of stone to be used it... Z /Depth or Thickness 1 feet
HOLDING TANK SYSTEM IF REQUIRED
NO. of Tanks Size of Each Gal .
*Alarms system and associated electrical work . to be inspected by an approved
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: e`/� 2(2 DATE: /,2, /
Ses+tiC System Inspections:
tic system installation, alteration or repair,
A. All applications for sop
as required by' che Town of Queensbury Sanitary Sewage Ordinance, shall
be submitted co 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.) locecion and distance co lot lines
3.) location and discance co structures
4.) location and distance co any wacer supply
S.) size and dimensions of all tanks, distribution boxes,
cite fields and/or drywalls
B. Nu system shall be covered before inspection and approval by the
building Inspector. Failure co comply with this requirement may
r►:sulc in the uncoverinb of cht system by the installer and a fine
of up co $250.00.
C. An approved copy of the plot plan shall be available on the construction
site. Failure co produce said plot plan at time of inspection may
result in an immediacy work stoppage.
•D. Should unforeseen problems during construction prevent proper installs-
cion, alteration or repair of an approved system, a new proposal must
be submitted co the Queensbury Building Department before further
construction.
Town of Queensbury
BUILDING and CODES DEPARTMENT
Bay and Haviland Roads
Queensbury, New York 12804
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awn o� QueeniAury
BUILDING and ZONING DEPARTMENT
Bay and Haviland Road, R.D. 1 Box 98
Queensbury, New York 12801
•
SEPTIC DISPOSAL SYSTEM INSPECTION
NAME e.01 . POLI +'Y421
LOCATION 3 4Ate_M
DATE 44/ g/ PERMIT NO. . 91 -'3i,
- SOIL TYPE - as d - Loam - Clay -
Percolation Test Required? YES - NO
Percolation rate - Min/Inch
TYPE of SYSTEM: .
Absorption field,(total lengthd
Length of each trench 551'' p
Depth ,of trenches{ - . '•
Size of gravel # -
SEEPAGE PITS4NuMber of) '
Size- ft. X � ft. 1
Gravel size k '
PIPING: Sizf+ Type;
Bldg. to tank
Tank to dist. box 'H
Dist. box to field/pit ;1 A (/('/
Openings sealed? YES ' NO Partial
LOCATION/SEPARATIONS:
Foundation to tank
Foundation to absorptionsa-ft.
Absorption to lot line ,).,yk,ft.
Separation of pits 6 ft.
LOCATION OF SYST :, ;OPERTY(c'irc1e one)
Front - Rear - eit sid- - Right side -
COMMENTS:
("f
SYSTEM USE APPROVED 11111g, NO
Bui ing I pector
01/86 and vl - .
. • . .
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%TOWN or. QUEENSBURY .5
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BUILDLNG at CODES DEPT.
REVIEWED B
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