2002-418 t
TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development-Building&Codes (518)761.8256
CE".Dft'J.'IFI%.rili.TLEOF COMPLIANCE
Permit Number: P20020418 Date Issued: Friday,May 24,2002
This is to certify that work requested to be done as shown by Permit Number P20020418
has been completed.
Tax Map Number: 523400-309-006-0001-053-000-0000
Location: 39 MALLORY Ave
Owner: KEITH&KATHLEEN SWEET
Applicant: KEITH&KATHLEEN SWEET
This structure maybe 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
Community Development-Building&Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20020418 . Application Number: A20020418
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Tax Map No: 523400-309-006=0001-053-000-0000
Permission is hereby granted to: KF,ITH &KATHLEEN SWF,FT
For property located at: 39 MALLORY Ave
in the Town of Queensbury,to construct or place i
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. TTVe of Construction Value
Owner Address: KEITH &KATHLEEN SWEET
26 SOUTH WESTERN Ave Septic Alteration Residential
Total Value
QUEENSBURY,NY 12804
Contractor or Builder's'Name/Address Electrical Inspection Agency
OIJFF,NSBURY SFWFR
JAY SWF,FT ; .
Plans&Specifications
2002-418
SEPTIC ALTERATION AS PER PLOT PLAN SPECIFICATIONS
"
$25.09 PERMIT FEE PAID-THIS PERMIT EXPIRES: Friday,May 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 T n of een da May 23,2002 1
1
SIGNED BY for the Town of Queensbury.
Director of Building&Code Enforcement
Application for Permit—Septic Disposal System
Town of Queensbury 742 Bay
Queensbury,Iff 12804 (S18) 761-8256
1. OWNER INFORMATION: ......
Office Use
Location of installation: 'D V
File Permit N
Tax Map No. I
CC)
Fee Paid
Owner's Name:
Address:
2. INSTALLER'S NAME PHONE NO.
3. RESIDENCE INFORMATION: (circle year of dwelling, indicate 9 bedroom(s)and multiply# of
bedrooms with applicable gallons per bedroom to equal total daily flow)
Year of House:' No.of Bedrooms x Computation = Total Daily Flow
1980 or older x 150 gaVbdrm =
1980-199-L, x 130 gal/bdrm =
L- e x 110gal/bdrm =
Garbage Grinder Installed yes no MAY 2 3
Spa or Whirlpool Installed yes no
TOWN OF()UEENISBURY
BUItLRDING AND QOQ-
4. PARCEL INFORMATION: (circle applicable information&indicate measurements) L
To _
Rogray-hy , Soil Nature Ground Water Bedrock or impervious Material Domestic Water Sg=ly
:ILS- at what depth at what depth <::m:: a
Rolling loam feet -feet well ,
Steep slope clay tfwell;water supply
_V6 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: 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 a size
of the septic tank and leach field for each Garbage Grinder,Spa or Whirlpool Tub.
Septic Tank: gallon(min. size 1,000 gal.)
Tile Field: each trench Total System Length: ft
Seepage Pit(s): number of size of each: ft by c 5 131-C
Size of Stofie to be used: # depth or thickness feet
Bed System Size: x
Alternative System: length and/or size
6. HOLDING TANK SYSTEM: (if required)
Number oftanks: I 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 13629 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.
Sidp!!�t ,e of responsible person Date
TOWN OF QUEENSBURY
BUILDING A CODE ENFORCEMENT
Qucu--msbuir_V MY M2804
SEPYIC DISPOSAL SYS-rEM INSPECTION
N a m a
C�A
Date-te
..................................................................Solt- n c C I a_y-
Rosul -ts of Pt-ar-cola-tian Yes-t-
( 1 -F applicable ) Ra-to-a- Minu-te/ Inch
FYPE OF SYSIrE-F4=
ABSORPTION FIEILD -. -To-tal Length
Leng-th o-F each -ty-e-nch
Depth of tr-enchos
Size o-F stone
SEEPAGE PXYS : Numt>t-- v--
Size - -Ft _ x -Ft_
Stone size
PIPING: -S-i-z Type
Bldg - to Tank 1-12 1�&- !AT--
Tank to Dist— B o x
Dist - Sox to Field/Pi -t
Open ings Se-alect? Yes No ar-t-.1al
EOCA-TION/SEPARAIFIONS : <- -
Founda-tion to Tank 1�,e 4e i-- �- N
Founda-ti on to -Absor-p -tic3n -Feet .
Sepal-al--Ion o-V Pits et
Can-for-ms as pe-r Plo-t Plan e s
1LOCA-1-X ON OF - -'SYS-FEM ON PROPER-1-
c 1 r-c-1 e one )
a �- - Le-Ft. Side ' R-Jght 1 de
ii�dd 1�e I eo n Middle Rear
COMMENYS.
SYSTEM USE APPROV� YES 0
D C--p cim
12,t
M 4d
A1,
1dr,.��1 ate
"I have seen or observed,or believe I saw evidence of',
all objects such as houses,v�,ells,trees,fences,etc.,
shops on this docnrent, I also reprps'ent that i have
personally measured the distances set forth on the diagram,"
IGNATNRE DATE
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