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CERTIFICATE OF COMPLIANCE
TOWN OF QUEENSBURY
WARREN COUNTY, NEW YORK
Date :. 41/h14/%J4°/l_ .7 19 itij
This is tel certify that work requested to be done as shown by Permit No. 91-750
has been completed.
This structure may be occupied as a Septic Alteration
Location 30 Arbutus Drive
Owner Keith 3l ofskv
By Order Town Board
TOWN OF QUEENSBURY
Director of Bldg. do Code Enforcement
BUILDING PERMIT
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TOWN OF QUEENSBURY
No. 91-750
WARREN COUNTY, NEW YORK
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PERMISSION is hereby granted to Keith Slofsky
OWNER of property located at #30 Arbutus Drive Street, Road or Ave.
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 ' r+
Same
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2. CONTRACTOR or BUILDER'S Name Pc—
Ivan Bell
3. CONTRACTOR or BUILDER'S Address
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4. ARCHITECTS Name
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5. ARCHITECT'S Address
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6. TYPE of Construction—(Please indicate by X) c
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( )Wood Frame ( ) Masonry ( )Steel ( )
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7. PLANS and Specifications
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No. Septic Alteration to include: 200' of Tile Field using #2 Stone, •
1' Thickness As Plot plan specifications and application
8. Proposed Use
Septic Alteration
$ 25.00 PERMIT FEE PAID —THIS PERMIT EXPIRES October 22, 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 22nd Da of' October 19 91
SIGNED BY lC , for the Town of Queensbury
BuildingancrZoni Inspector
41:111
soi j TOWN OF QUE �S`�J 9UEENSBUR r/
APPLICATION FOR SEPTIC DISPOSAL 1PEtA' E® Permit #
Fee Paid ,
OCT 2 2 1991
Date: Qe±2 9( BLDG. eviewed
� CODE DEP�
LOCATION OF PROPERTY FOR INSTALLATION: ,.r"'d /94,UftD'S'
Owner' s Name: ( -.)_oc , kb ),
Owner' s Mailing Address: -,31? "r,h✓ftiS L7y—
Installer' s Name: 7%/ei 11 /3-ALL. Phone #: 7c,2650
Number of bedrooms (if residential ) : 3
Total daily flow (residential-compute @ 150 gal . per bedroom) : 4'S O
Topography-Circle One: Cot Rolling Steep Slope % of Slope
Soil Nature-Circle One: an? Loam Clay Other /Depth:
Ground Water-At What Depth? 07® 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: unite c p Well Other
If domestic water supply is a wel
Separation: Water supply from any septic absorption .yam} feet
PROPOSED SYSTEM: Septic Tank r4900 gal . (Minimum size: 1,000 gal . )
Tile Field: Each Trench se feet//Total System Length ex, feet
Seepage Pit(s): Number of 14 / Size each: /1,9 ft. x J?/ ft.
Size of Stone to be used: # / Depth or Thickness / feet
**************
HOLDING TANK SYSTEM IF REQUIRED
No. of Tanks '' .' Size of Each c 9 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: `�� �� DATE: �d,,,Z2-1/
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 drywells
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:
eiry)cc77 /
awn, of Queenaburcy
• BUILDING and ZONING DEPARTMENT
Bay and Haviland Road, R.D. 1 Box 98 •
Queensbury, New York 12801
SEPTIC DISPOSAL SYSTEM INSPECTION
NAME 51< Pit'-'1.1
LOCATION 3n
DATE 70 /o?� PERMIT. NO. C? 'l — 95O
SOIL TYPE Sa - Loam - Clay -
Percolation Test Required? YES - NO
Percolation rate - Min/Inch
TYPE of SYSTEM:
Absorption field, total length
Length of each trench ' 57
Depth of trenches -ll •
Size of gravel t- _
' SEEPAGE PITS{Number of)
Size- rN. ft. X ft.
Gravel size
`
PIPING: Size Type
Bldg. to tank 9 ).1
Tank to dist. box
Dist. box to f ielNd/,,pit 4 `' &
Openings sealed? YES NO Partial
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LOCATION/SEPARATIONS: `•
Foundation to tank ft.
' Foundation to absorption. ?7) ft.
Absorption to lot line / )9 ft.
Separation of pits 4P ft.
LOCATION OF SYSTEM ON PROPERTY(circle one)
Front Re - Left side -Ckght- -
COMMENTS: •
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SYSTEM USE APPROVEI® NO
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B ding I74pector
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- RECEIVED
• OCT 2 1991
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