1991-865 • -- =0, j
_N.
CERTIFICATE OF COMPLIANCE
TOWN OF QUEENSBURY'
WARREN COUNTY, NEW YORK
Date am' Z q •19 '12-
This is to certify that work requested to be done as shown by Permit No. 91-865
has been completed.
This structure may be occupied as a Septic Alteration
Location 7 Indiana Avenue
Owner Barbara aiL Mallanpy
By Order Town Board
TOWN OF QUEENSBURY
A
/://a.". Via h,t) ///i
Director of Bldg. & Code Enforcement
BUILDING PERMIT
TOWN OF QUEENSBURY No 91-865 ,.
WARREN COUNTY, NEW YORK
i.
PERMISSION is hereby granted to Barbara J. Mallaney
OWNER of property located at 7 Indiana Avenue 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
Same
2. CONTRACTOR or BUILDER'S Name
John C. Mallaney
3. CONTRACTOR or BUILDER'S Address
4. ARCHITECT'S Name
5. ARCHITECT'S Address
6. TYPE of Construction—(Please indicate by X)
( 1 Wood Frame ( ) Masonry ( )Steel ( ) - -
7. PLANS and Specifications
Septic Alteration to include:
N°. 1000 gal septic tank with 1 seepage pit 8' x 10' using #3 stone, '
2' thickness as per plot plan specifications and application
8. Proposed Use
Septic Alteration
$ 25.00 PERMIT•FEE PAID —THIS PERMIT EXPIRES December 27, 1993
(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 Day o ' December 19 91
SIGNED BY \ /Jl.(/,f - i 4 for the Town of Queensbury
Building and Zonir 'l nspector
alt
"Pite r TOWN OF QUEENSBURY (� (�/
APPLICATION FOR SEPTIC DISPOSAL PERMIT Permit # `"I/-' 15CQ
Fee Paid 5"
Date: / - ci6•-9/ Reviewed By 4Aga
LOCATION OF PROPERTY FOR INSTALLATION: 7 ..z7r/r4n/,4 /91/-e i/(I{
Owner' s Name: Rip Ak,R MA/Jei yu.e y
Owner' s Mailing Address: 7 Z-,Ap-/,Riim_ ,g1. (/
Installer' s Name: gOhn 0._ f\nni l rxyl.ey Phone #: T '9 _: j%}5v��,.•-
Number of bedrooms (if residential ) : Z } ,, =' S ,1y !rvl ' ".
p'i S `•
Total daily flow (residential-compute @ 150 gal . per bedroom) : tc.. ; pr y': r.17 4e91 -d/
Topography-Circle One: 100 Rolling Steep Slope % of Slope, s-. 0013E 1301%
Soil Nature-Circle One: Sand Loam Clay Other /Depth:
Ground Water-At What Depth? 7 Feet
Bedrock or Impervious Material-At What Depth? 7 - Feet
Percolation Test-Circle One: Not Required Required/Rate Min. Per Inch
Domestic Water Supply-Circle One: ( I cipal) Well Other
If domestic water supply is a well -
Separation: Water supply from any septic absorption feet
PROPOSED SYSTEM: Septic Tank 1(f? gal . (Minimum size: 1,000 gal . )
Tile Field: Each Trench feet//Total System Length feet
Seepage Pit(s): Number of / / Size each: ft. x /0 ft.
Size of Stone to be used: # 3 / Depth or Thickness a feet
**************
HOLDING TANK SYSTEM IF REQUIRED
No. of Tanks Size\of Each 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: flAM , 7J DATE: JZ-o -47//'
i jel
rRl'�
ll ii,)
awn o/ Queenitury
BUILDING and ZONING DEPARTMENT Pri)
Bay and Haviland Road, R.D. 1 Box 98
• Queensbury, New York 12801 .
SEPTIC DISPOSAL SYSTEM INSPECTION •
NAME J( r ifi-o f, oJ1 cvn .�
LOCATION 7 ld q.(9Ma1 Z
DATE l21,2Q/ 91 PERMIT NO. /—(f 47.5
SOIL TYPE - Sand - Loam - Clay -
Percolation Test Required? YES - NO
Percolation rate - Min/Inch
TYPE of SYSTEM:
Absorption field, total length
Length of each trench
Depth of trenches '
Size of gravel'
SEEPAGE PITS*Number of)ij ,f
Size- Q ft. X 'j ft4
Gravel size t
PIPING: 5iz Type
Bldg. to tank
Tank to dist. box ' '/ 4-„
Dist. "box 'to field ' " -
Opehings sealed? YES : NO Partial
LOCATION/SEPARATIONS:
Foundation to tank _ f . (7 6
Foundation to absorptio f . ''� W �' }
Absorption to lot lint ftJ��
Separation of pits ft.
LOCATION OF SYSTEM 0 PROPERTY(circle one)
Front - Rear - Left ide - Right side -
COMMENTS:
;-\0706-
110,40,
5+
•
,fir-Avcovip
mi
SYSTEM USE APPROVED Y S NO
Building nspe for
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