2001-478 TOWN OF QUEENSBURY
742 BayRoadQueensbury,NY 12804-5902 (518) 761-8201
Community Development - Building & Codes (518) 761-8256.
CERTIFICATE OF COMPLIANCE
Permit Number: P20010478 Date Issued: Tuesday, July 03, 2001
This is to certify that work requested to be done as shown by Permit Number P20010478
has been completed.
Tax Map Number: 523400-302-017-0001-004-000-0000
Location: 19 ARBUTUS Dr
Owner: TRUSTCO BANK NATIONAL ASSOC.
Applicant: STEVE PALMER
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
Fob
Community Development- Building& Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20010478 Application Number: A20010478
Tax Map No: 523400-302-017-0001-004-000-0000
Permission is hereby granted to: STEVE PALMER
For property located at: 19 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: TRUSTCO BANK NATIONAL ASS(
320 STATE St Septic Alteration Residential
SCHENECTADY,NY 12305 Total Value
Contractor or Builder's Name/ Address Electrical Inspection Agency
I.B.S. SEPTIC
2 LOWER WARREN STREET
OUEENSBURY,NY
Plans &Specifications
2001-478 STEVE PALMER
SEPTIC ALTERATION AS PER PLOT PLAN SPECIFICATIONS
$25.00 PERMIT FEE PAID - THIS PERMIT EXPIRES: Thursday,July 03,2003
(If a longer period is required,an application for an extension must be made to the code Enforcement Officer
of the Town of Queensbury before the expiration date.)
Dated at the Town nsbu iues , my 03,2001
SIGNED BY for the Town of Queensbury.
Director of Building&Code En rcement
• ' Application for Permit— Septic Disposal System
Town of Queeltsbu/y 742 Bay Road Queensbury, NY 12804 (518) 761-8256
1. OWNER INFORMATION: f_t_. .
/ d ...cUse- Location of installation: ( ArX, h , .r (I
Filo Permit No.C t 4
Tax Map No. / / ,ea ��
Owner's Name:7r
5 c-c d C'Crrrc. Fee Paid
�S l c/J /Ztir, / G G,.c i'
Address: t /9 6_,/' r/ tic t s/ 6) y
2. INSTALLER'S NAME : .i• l e I Cr" • ( PHONE NO. 2/, 0
3. RESIDENCE INFORMATION: (circle year of dwelling, indicate I!bedroom(s) and multiply Il of
bedrooms with,applicable gallons per bedroom to equal total daily flow)
Year of House: No, of Bedrooms x Computation = Total Daily Flow C Vt C
1980 or older 3 x 150 gal/bdrm = VS
1980— 1991 x 130 gal/bdrnt = JUL ® 2 2001
1991 —present x 110 gal/bdrm = VI/N OF QUEtr+��,r�y air,
Garbage Grinder Installed yes` / no
Spa or Whirlpool Installed yes / no
4. PARCEL INFORMATION: (circle applicable information & indicate measurements)
CtWhY = to 1l ll[9 0.19.MIC1 Wa.4or.__R90..1.0.Gk.vriilrl)orAOU.S._Mir.tQrifli_. •..1QS I _W t.cy'.$tippty
ln! .%alrrl al ►rha! a/rlh crl tvhrr! eplh rnrr►rlcrlpri
I
Ing am ✓/��'et •� . cc( „
Steep slope clay i f well; water supply
_%slope other from any.septic-system
depth: absorption is fl.
other
Percolation Test: (To be completed by licensed professional engineer or architect)
• Rate: minute per inch
5. PROPOSED SYSTEM: Tor New Construction: All individual sewage disposal systems must be designed by n licensed
professional engineer or architect (unless installed in a Planning hoard approved sulxlivision). Add 250 gallons to the size
of the septic tank and leach field for each Garbage Grinder, Spa or Whirlpool Tub.
Septic Tank: r/OOv grill on (min. size 1,000 gal)
Tile Field: each trench 50 ft. Total System Length: 2.00 ft
Seepage Pit(s): number of size of'each: fl. by fl•
1 Size of Stone to be used: ll `__ / depth or!/rlckrress,__.__._._....___./ire!
Bed System Size: x
Alternative System: length and/or size
6, HOLDING TANK SYSTEM: (if required) .
Number of tanks: / 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)
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 road the regulations with respect to this application end agree to abide by those and all
requirements of the Town of Queensbury Sanitary Sewage Disposal Ordinance.
7..--d'— Dd//
ignature of rt pen bl arson Date
ffll7
TOWN OF QUEENSBURY a►
BUILDING & CODE ENFORCEMENT
742 Bay Road
Queensbury NY I2804 v /1.'
(518) 761-8256
SEPTIC DISPOSAL LS,SYSTEM ECTIO
Name
Location
ckt
D �, -� �ermi t
SOIL TYPE: Sand oam-Clay-
Results of Percolation Test-
(if applicable) Rate-Minute/Inch
TYPE OF SYSTEM: — /
ABSORPTION FIELD \\otal, Length d-ce>
Length of each 'rend
Depth of trench: .
Size of stone JJ -1 D '
SEEPAGE PITS: umber-
Size - f. . x ft.
Stone size --
PIPING: Size Type
Bldg. to Tank �" 5o .
Tank to Dist. Box u • 4
Dist. Box to Fieli /P'` I%
Openings Sealed? Gip No Partial
LOCATION/SEPARATIIN
Foundation to Tan , / 5 feet
Foundation to Absorption . -C feet . .
Separation of Pit- ,.. feet
Conforms as per Plot Plan No
LOCATION OF SYSTE: ON PROPS
(circle .1
Front - Rear - Le t Side Right Side
Middle . - Middle Rear
COMMENTS:
•
SYSTEM.USE APPROVED: YES NO
Arrived: �,/
Departed: 3p(
Building Inspector
1.
S,
I ....,..
"I have seen or observe&or believeI saw eaidence o, .
all objects such as houses,wetstrees,fences,etc.,
shown-on-this_document!also represent that I have
person measured t ista set fob en the diagram."
i- , .., tr.
SIGNATURE A"a'
r.---c -
Y . ' / 4 . . _ we,342°LerwAm...:
• c;2— elpl- il 7 8
` • 4
EC RJ J ' 4
Li iA I- 'i�� . (r�.i'':..�:1�__:� " Y JUL 2 200 j
-� w N-OF QUEEN
REVIEWED BY i� DE_
DATE .�.._� 9 .
r
f
31))
" () c \ .
• ar
-
cc(
• 076{ rv ( 13 d riv6
IN/5/ co / Nk ( ic'GGri-cr I