1992-114 1
CERTIFICATE "it, CC31VI1 IA TCE
TOWN OF QUEENSBURY
WARREN COUNTY , NEW YOR.K i
4 Date � f T 19 �-
L� � �- -
ested to be done as shown by Permit No.
This is to certify that work requ �
has been camplctcd.
This Se tic A] tera
structure may be occupied as a
ti n
Location 17 Arbutus Drive
{ Ch ner Ric Constant
BY prder Town Board
T(^]LVN OF' QLIEENSBURY
Director of Bldg. & Code Enforcement
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BUILDING PERMIT �
TOWN OF QUEENSBURY � a
No. 92- 114 �
WARREN COUNTY, NEW YORK
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d Constant
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PERMISSION is hereby granted to Ric I�a
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OWNER of property located at 17 Arbutus Drive Street, Road or Ave.
in the Town of Oueensbury, To Construct or place a Septic Alteration �
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at the above location in accordance to application together with plot plans and other information hereto filed and d
approved and in compliance with the Town of +Queensbury Building and Zoning Ordinance. a
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1 . OWNER'S Address is
�.
Same r+
2. CONTRACTOR or 6UILDER S Name
Sanitary Server
3. CONTRACTOR or BUIL_DER'5 Address
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4. ARCHITECT'S Name G
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5. ARCHITECT'S Address 'C
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6_ TYPE of Construction — (Please indicate by XI
( I Wood Frame { I Masonry L I Steel ( 1 ,fir,
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7. PLANS and specifications —4
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No. Septic Alteration to include : 200 ' of Tile field using #2 stone
V Thickness as per plot plan specifications and application V'
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8. Proposed Use
Septic Alteration
$ 25-00 PERMIT FEE PAID — THIS PERMIT EXPIRES April 2, 19 94
(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 2nd Day of Agri 1 19 92
SIGNED BY Z A for the Town of Queensbury
Buildirg nd Z&nino Inspector
-TOWN OF QUEENSHURY �
/ - APPLICATI Orl FOR SEPTIC DISPOSAL PERMIT
DATE :
LOCATION OF PROPERTY FOR INSTALLATION_
Owner ' s Name : 1 C 1n A d- Q ry s ,*0%/ ?�
Address :
Installer ' s Name : r _A,,00UZ7- ,��L4, �_ - Telephone : - 2ZJ7'
Number of bedrooms ( residential only )
Total daily flow ( compute @ 150 gal per bedroom ) � s° b
Topography : Circle one : Fl Rolling Steep Slope % of Slope
Soil nature : Circle one : Sand Loam Clay Other /Depth :
Ground Water : At what depth? - Feet TC► v;� a
Bedrock or Impervious Material : At what depth? jr
Percolation test : Circle one : requ� ire required
Rate - Min . Per Inch
Domestic water supply : Circle one unicipal Well Other BUILDING & CODE DEPT.
If domestic water supply is a w
Separation : dater supply from any septic absorption feet .
EX (S7-& <�
PROPOSED SYSTEM : Septic Tank 140 C> 1Z) gal . ( minimum size : 1 , 000 gal )
TILE FIELD : Each Trench 6V feet/Total system length <> c7 feet
SEEPAGE PIT( S ) : Number of /Size each feet
by feet
Size of stone to be used /Depth or Thickness ,/+ feet
rw,�rsdr�elr,krr,e,k*�,W!►,h,t,ksr,h*snhtie sr*ytyr ye
HOLDING TANK SYSTEM IF REQUIRED
NO . of Tanks Size of Each Gat .
*Alarm systaar 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 : �. TE : _ � ' ---.__
Sestie sYNCSm Inspections :
Moo
A. All applications for septic SYNC*= installacion , alteration or repair ,
as required by Che Town of Que&nsbury Sanitary Savage Ordinance . shall
br submictdd to Cho Building Department at least 24 houry before $ cart
of construccion and shall, include a pioC plan showing :
i . ) Cho proposed location of Cho SysCem
2 . ) locacion and distance to lot lines
3 . ) location and distance to scructuras
4 . ) location and distance to any water supply
S . ) size and dimensions of all rankso distribution boxes ,
cilr fields anJ / or dryvells
8 . No system shall be covered before inspection and approval by the
uuilJing Inspuccor . Failure to comply with Chia requirement may
ruoult in the uncovering or Cho system by the installer and a fine
of up cc $ 250 . 00 .
Co An approved copy of Cho ploc plan shall be available on the conscruccioit
. ice . Failure to produce said plat plan at alas of inspoccios say
r4sulc in an ismadiste work stoppage ,
D . Should unforeseen problems during construction praveot proper iasCaila—
cion , alteration or r4p+air of an approved system . a new proposalo must
bu submiccsd to the QuGeansbury building, aapartmont before further
� atiiac C rut c ion .
Town of Queensbury
BUILDTNC and CODES DEP"ARTHM
Say and Haviland Roads
Queenabury . Now York L2804
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�^� �wn 0 // iU es �lr��
Ury
BUILDING and ZONING DEPARTMENT
Bay and Haviland Road, R. O. 1 Box 98
Oueensbury, New York 12801
SEPTIC DISPOSAL SYSTEM INSPECTION
NAME AMC` t i ram'
LOCATION
BATE l PERMIT NO.
SOIL TYPE - Sand - Loam - Clay -
Percolation Test Required? YES - NO
Percolation rate - Min/Inch
TYPE of SYSTEM:
Absorption field , total length " ( 3 Cs
Length of each trench :t o
Depth of trenches - .5 T
Size of gravel Zr-
SEEPAGE PITS4Number of)
Size- ft. X . -
Gravel size
PIPING : S.1z ype
Bldg , to tank.
Tank to list. box I/ �-
Dist. box to field/p� �. �-
Openings sealed? ES Partial
LOCATION/SEPARATIONS :
Foundation to tank t. S ,
Foundation to absarpti n f 010 -y
Absorption to lot lin ft
.h
LOCATION OF SYSTEM PROPS TY (circle one)
Front - ear - Lef side fight si e -
C{YKMEldT S
"- ,} IiF d L xZ� f�✓
x. � ;Irv{ `T � Al /C
SYSTEM USE APPROVED ES NO
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8ui ding ns ctor
01/86 and vl
1992 Lui
BUILDING $e CODE DEPT.
sU
TOWN OF QUEENSBURY
R.EY#,EVVED BY
DATIE--