2010-456 eakiTOWN OFQ UE E NSBURY
Fora742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development- Building &Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number. P20100456 Date Issued: Tuesday, September 21, 2010
This is to certify that work requested to be done as shown by Permit Number P20100456
has been completed.
Tax Map Number. 523400-297-010-0001-030-000-0000
Location: 46 SHERATON Ln
Owner. ROBERT L RAINWATER
Applicant: ROBERT L RAINWATER
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
A
` � 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
S
Community Development- Building& Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20100456 Application Number: a20100456
Tax Map No: 523400-297-010-0001-030-000-0000
Permission is hereby granted to: ROBERT L RAINWATER
For property located at: 46 SHERATON 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: ROBERT L RAINWATER
46 SHERATON Ln Septic Alteration Residential
QUEENSBURY,NY 12804-0000 Total Value
Contractor or Builder's Name /Address Electrical Inspection Agency
IBS SEPTIC & DRAIN
ATTN: IVAN BELL
2 LOWER WARREN St
OUEENSBURY.NY 12804
Plans&Specifications
2010-456
septic alteration residential
$25.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Thursday, September 15, 2011
(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 ueensbu ; We n• day, September 15, 2010
for the Town of ueensbu
SIGNED BY Queensbury.
Director of Building& ode E,•rcement
Revised 4/14/2010
OFFICE USE O LY
TAX MAP O. � _ r_ PERMIT NO. /c / PERMIT FEE 45200 '
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. T rl
OWNER: (ZO 6Cr� C4 t 4, !.#(2J INSTALLER: j I iJ .5-,5-97( / C
ADDRESS: It- K-6 S ( r Gl.(O /v Cti ADDRESS: A").-
; Q- (C�O GA c r! lit- /G.%f 1
PHONE NOS. / 65--07L�/. PHONE NOS. // r- c f p y
LOCATION OF INSTALLATION:
RESIDENCE INFORMATION:
NO.OF COMPUTATION
YEAR BUILT X = TOTAL DAILY FLOW
BEDROOMS (Gallons per bedroom) GARBAGE GRIND R A
1980 or older 3 X 150 = il S U INSTALLED? V
1981 -1991 X 130 = SPA OR HOT TU"''fit/
1992-present X 110 = — INSTALLED?
�
PARCEL INFORMATION: ��/tttJ//
✓ TOPOGRAPHY: FLAT ROLLINGSTEEP SLOP %SLOPE
,/ SOIL NATURE: SAND r LOAM CLAY /jJ 4 OTHER
,/ GROUNDWATER: AT WHAT DEPTH?_AJ1
✓ BEDROCK/IMPERVIOUS MATERIAL: AT WHAT DEPTH/VA'
✓ DOMESTIC WATER SUPLY: MUNICIPAL(WE (If well:water supply from any septic system absorption is: ft)
✓ PERCOLATION TEST: RATE IS /V\ PER MIINUTE PER INCH[mpi]
(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: LIS"0 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/1'4' ft. Each trench 1/4 X
❑SEEPAGE PIT(S)(WITH NO.3 STONE) How many? V� SizeWA
0 ALTERNATIVE SYSTEM Bed or other type?
0 HOLDING TANK SYSTEM Total required capacity?W 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 by these and all requirements of the Town of Queensbury QUESTIONS? CALL 761-8256 OR EMAIL
Sanitary Sew isposal Ordinance. codes{a?_queensburv.net
6" 91/Y 4016 VISIT OUR WEBSITE FOR MORE INFORMATION
Signature of Person Responsible Date www.queensburv.net
Town of Queensbury* Community Development Office * 742 Bay Road, Queensbury NY 12804
Septic Inspection Repo
Office No. (518) 761-8256 Date Inspections •'' -•:
Queensbury Building&Code Enforcement Arrive: Z-°:,Z!-�a ii• i'4ae rt: am/pm
742 Bay Rd., Queensbury, NY 12804 Inspector's Initials:� 'ir
R
NAME: R i 003 PETE M IT NO.: —y
LOCATION: t(s) lD NA PTC t 'SPECT ON: C 17
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.
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 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 : _N
Engineer Report an. -: Y—N
ETU Maintenance on•act Y_ N
provided
Location of System on Property:
Front Re Left Side Right Side Middle Front Middle Rear
st m Use Sta 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 Reporx_03 29 10.doc
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Septic Inspection Report
Office No. (518) 761-8256 Date Inspection req - =,0- -.: /�L
Queensbury Building &Code Enforcement Arrive: j `4") - 'V, 'art: m/pm
742 Bay Rd., Queensbury, NY 12804 Inspector's Initials.
NAME: a iIT NO.: t —"LIS
LOCATION: L-R c l`c-2"/ T O/V L AN-Q__ INSPECT ON: c// 31/G'
RECHECK:
Comments and/or diagram
Soil Type: oam
Type of Water: Muni_ci ell Water
Waterline ration distance
Well separation distance ft.
Other wells: ft.
Well Casing Length 50' + / - Y N N/A
Absorption Field: Total length *- ft.
Length of each trench s
k/ ft.
Depth of trenches /� _ft.
Size of Stone
Seepage Pits: Number
Size: x
Stone Size: 6J7tt _�
Piping Size Type 61t _ p� yJ�\� �e�T.
Buildingto tank "�
Tank to Distribution Box +-� LTi I ( Lk" k)\/C_
Distribution Box to Field/ Pit
Opening Sealed: Y N
End Cap _N
Inlet/Outlet Pipes&Baffles Y_N
Location/ Separations
• Foundation to tank I t ft.
Foundation to absorption :., -.
Separation of Pits s^ �
Conforms as per Pl. .n Y 1!j
Engineer Report an. As-Built Y N
Location of System on Property:
Front •ear Left Side Right Sid Middle Front Middle Rear
Approved
Partial Approved and needs to 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
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