2002-717 TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development-Building&Codes (518)761-8256
CURT IFICATE OF COMPLIANCE
Permit Number: P20020717 Date Issued: Tuesday,August 27,2002
This is to certify that work requested to be done as shown by Permit Number P20020717
has been completed.
Tax Map Number: 523400-302-017.0001.023-000.0000
Location: 41 Arbutus Dr
Owner: DAVID&LEESA STILLER
Applicant: DAVID&LEESA STILLER
This structure may be occupied as a:
By Order of Town Board
Septic Alteration Residential TOWN OF QUEENSBURY
Director of Building&Code Enforcement
TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
kwt
Community Development-Building&Codes (518) 761-8256
BUILDING.PERMIT
Permit Number: P20020717 Application Number: A20020717
Tax Map No: 523400-302-017-0001-023-000-0000
Permission is hereby granted to: DAVID &LRF,SA STILLF,R
For property located at: 41 Arbutus 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 Queensbury Zoning
Ordinance. Type of Construction - Value
Owner Address: DAVID & LEESA STILLER
16 MOORWOOD Dr Septic Alteration Residential
Total Value
QUEENSBURY,NY 12804
Contractor or Builder's Name/Address Electrical Inspection Agency
JAY SWFRT
NY 12904-0000
Plans&Specifications
2002-717
Residential septic alteration per plot plan and specifications.
$25.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Saturday,August 23,2003
(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 TowDof
uee u4rt,--l
ugust 23,2002 7 ? L
SIGNED BY for the Town of Queensbury.
Director of Building&Code Enforcement
Application for Permit—Septic Disposal System
Town of Queensbury 742 Bay Road Queensbury,IVY 12804 (518) 761-8256
1. OWNER INFORMATION:
Office Use
Location of installation:
Z' File Permit No.
Tax Map No.
P .4
Owner's Name:
Address: AUG:p 3 20p2
r®lt11f�!OF n r��� �
F-Q1LG�14C I 0'U�yf
2. INSTALLER'S NAME .
3. RESIDENCE INFORMATION: (circle year of dwelling,indicate#bedroom(s) and multiply# of
bedrooms with applicable gallons per bedroom to equal total dailyflow)
Year of House: No of Bedrooms x- ` -Computation - Total Daily Flow
1980 or older x 150"gaUbdrm = _
x . 130 gal/bdrin
1991-present x 110 gallbdrm =
Garbage Grinder Installed- yes
Spa or Whirlpool Installed yes_ - -
4. PARCEL INFORMATION: • (circle applicable information measurements)
Tonoaraphy Soil Nature Ground Water Bedrock or I ervious Material Domestic Water Supply
at what depth at what depth municiP iaii.
oiling loam feet feet -w--eff
Steep slope clay. ifwell;water supply
_/slope other - from any septic system
depth: -----"_ ___--__... --__-_ absorption is fi
other .
Percolation Test:- (To be completed Iry licensed professional engineer or architect)
Rate: minute per inch
5. 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). Add 250.,gallons to the size
of the septic and leach field for each Garbage Grinder,Spa or Whirlpool Tub.
Septic Tank:�cC) gallon(min. size 1,000 gal.)
Tile Field: each trench v�7J -ft. Total System Length:
Seepage Pit(s): number.of size ofeach: fi by tt
Size of Stone to be.used: # f depth or thickness feet
Bed System Size: x
Alternative System: l length and/or size , dZ. •'�
6. HOLDING TANK SYSTEM: (if required)
Number oftanks: / Size of each: gallons /TOTAL Capacity: gallons .
Note. Alarm System and associated electrical work must be inspected by a Town approved
electrical inspection agency.
7'. SIGNATURE INFORMATION FOR RESPONSIBLE PERSON(please read)
IFor your protection,please note that pursuant to Section 136 29 ofthe Code ofthe 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 ofthe Town of Queensbury Sanitary Sewage Disposal Ordinance.
Date
Si at re f responsib a person
TOWN OF QUEEKSBURY
BC/XUDING- &,--CODE ENFORCEMENT
742 Bgk_y Rcojl4d
MY 124304
(:5 18) 745 1-&2-56
SEPTIC DISPOSAL SYS-TEN INSPEC-TION '
N am e- �+_J (
Loc a -t-f on -f 1 14-t-6
Date 2-7/10 -Z__ P o r-rn i -t _7 ZL_
SOIL TYPE: <! a�noam-cl a_y-
Rosul -ts of Por-cala-tion Test-
( i -f applicable ) Ra-tt-_-M1nuf_-e/1nch -
TYPE OF SYSTEM=
ABSORPTION FXEID: To-tal Length
Length o-F each trench 6SD_
Depth OF -trenches
Size O-F stone
SEEPAGE PI-US : Numt>o-_ r
Size - -F-t _ X _Ft_
Stone size
PIPING : Size Type
Bldg - to Tank
Tank- -to Dist _ Box
Dis-t - Box to e- Fie-ld/pi LA W-C-11
ti
Openings Saled ? P a Y- al
t_OCA_VIOJqZSEPARATIOJqZi
Founda-tion -to Yank -Fte--a-t
Founda-tion -to A b s c>,rp "t i on %2_C:> -F e-a't
Separ-ation o-F Pi is 0't
Con-Forms as pet- PI of plan es 0
LOCATION_ OF sys-rEN ON PROPERY
C"
a
Front (ZR n - Left Side Igh-t Sid
r ir�_
Middle Front - Middle Rea r.
CONMEN-VS
SYSTEM USE APPROV YE no
A r-r-i
REVIEWED 8Y DEPT.
DATE
` d
ECE _
a
AUG P 3 2002
TOWN OF ENSBUIRY
"{ have seen ar a' ser�1ed, or believe I sal' evidence Of,
e4 v e61s t"ees fences, etc.,
, ,~ ave
hi ,t
shown are #; ! � cf .E i�r , fln the tliUgrant.
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