1999-103 ..
VIllalteirtAW
Certificate of Compliance
•
Town of Queensbury
Warren County,New York
April 6 99
Date
3(9 ,
99103
This is to certify that work requested to be done as shown by Permit No.
has been completed.
SEPTIC ALTERATION
This structure may be used as a •
25 mALLoRy AVE.
Location
Owner GAUTHIER, WILLIAM &
•
TAX MAP NO, 11 7 . -2-12
By Order Town Board
• (T.0 - OF QUEENSBURY
•
Director of Build ig &Code Enforcement
BUILDING PERMIT
VALUE $ .0 TOWN OF QUEENSBURY No 99103
TAX MAP NO. 117 . —2-12 _ WARREN COUNTY, NEW YORK
•
PERMISSION is hereby granted to GAUTHIER, WILLIAM &
OWNER of property located at 25 MALLORY AVE._ 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
ELIZABETH 25 'MALLORY AVE. '
QUEENSBURY, NY 12804 .
2. CONTRACTOR or BUILDERS Name '
QUEENSBURY SEWER
3.
JAY CONTRACTOR
or BUILDERS Address
0
4. ARCHITECT'S Name ,
5. ARCHITECT'S Address
6. TYPE of Construction—(Please indicate by X)
SEPTIC.
( )Wood Frame ( I Masonry ( I Steel ( )
7. PLANS and Specifications . • .
SEPTIaALTERATION AS PER PLOT PLAN SPECIFICATIONS
8. Proposed Use
SEPTIC ALTERATION
25 . . April 6 19 2001
$ PERMIT FEE PAID —THIS PERMIT EXPIRES
(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.)
6 April . 1999
Dated at the Town of Queensbury this Day of 19
SIGNED BY for the Town of Queensbury
'" Building and Zoning.Inspector - ,
Application for SEPTIC DISPOSAL PERMIT
r
Town of Queensbury {' s r`i
Permit No.
Dept. of Community Development °''' � — 1��
Building &Codes Office 00
742 Bay Road APR 0 5 1999 Fee Paid $
Queensbury, NY 12804 TOWN OF QUEENSBURY
BUILDING AND CODE .
Location of property for installation: ? (5 ith C . c 10 ire y a _,
I
Property Owner's Name: I/1/0 t C a 1,K_ l r a u rk 1,e v-
Property Owner's Mailing Address: S a _Q_.
Installer's Name: C,e e_i,.._<=p u. 1 J-e -,^ Phone # i oc ‘4er
Number of bedrooms (if residential): - Total daily flow:
(residential - compu e @ 150 gal./bdrm.) `
Topography: )<' flat, rolling, steep slope % of slope
Soil Nature: X sand, loam, clay, other / depth:
Ground water: at what depth? feet / Bedrock or Impervious Material: at what depth? feet
Percolation test: X' not required, required [ rate min. per inch
Domestic water supply: A municipal, well, other
If domestic water supply is a WELL, water supply from any septic absorption is feet. .
PROPOSED SYSTEM
Septic,tank: /de 0 gallon (minimum size: 1,000 gal.)
Tile field: each trench ,6 U feet / Total system length: 0.. &z) feet
Seepage pit(s): number of / size each: ft. by ft.
Size of stone to be used: # 21. / depth or thickness ,"r feet
HOLDING TANK SYSTEM: (if required)
Number of tanks: Size of each: gallons
CA1atm system and associated electrical work to be inspected by a certified agency.
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 read the regulations with respect to this application and agree to abide by these and all requirements of the Town of
Queensbury Sanitary Sewage Disposal Ordinance.
Sig Po
Signature of responsible person:�1—r7J,... Date: s,-q
111L-' ., )1j))) '
TOWN OF QUEENSBURY
BUILDING & CODE ENFORCEMENT
531 Bay Road
Queensbury NY 12804
518-745-4447
SEPTIC DISPOSAL SYSTEM INSPECTION
Name ("--;ei, /��
Locationa5 (,,\1 r�0 )`� Q_
f �
1k
Date J-4--i,sil Permit # qC1 — i()
SOIL TYPE: Sand-Loam-Clay-
Results of Percolation Test- -
(if applicable) Rate-Minute/Inch'
TYPE OF SYSTEM:
ABSORPTION FIELD: , otal ength
Length of each tr: ch Pam►
Depth of trenches =_ 'z_.
Size of stone -- 7 _
SEEPAGE PITS: N iiU ''-
Size - fr. x • ft.
Stone size
PIPING: • Size Type •
Bldg. to Tank qa C.iv4-r- casz --
Tank to Dist. Box 14" \\c
Dist. Box to Fi -ld/P _ <<
Openings Seal : ? Y No Partial
LOCATION/SEPARATIONS:
Foundation to Tank \C. , feet
Foundation to Absorption 2.r- feet
Separation of Pits fe-
Conforms as per Plot Plan Ye. No
LOCATION OF SYSTEM ON PROPERTY:
(circle one
Front Left. Sid i ht Si
Mi dd' - • .: - Middle R
COMMENTS:
UP \ .
VI
t •' -•-- -\\D 1\i_a7%1L-F3R-1
SYSTEM U E APPROVED: YE NO
Arrived: - ..
Departed:
B d''ng Inspec r'
i
TOWN OF QUEENSBURY
BUILDING & CODE ENFORCEMENT
742 Bay Road
Queensbury NY 12804
(518) 761-8256
SEPTIC DISPOSAL SYSTEM INSPECTION
Name C;IR ,
Location Z6 EV Rl t c 1E
Date Ai —&_99 Permit # 91—Ai."l,
SOIL TYP- . an.- •am-Clay-
Results of Percolation Test-
(if applicable) Rate-Mi .te/Inch
TYPE OF SYSTEM:
ABSORPTION FIELD: Tota Le gth
Length of each trench
Depth of tree. hes
Size of stone
SEEPAGE PITS: umber-
Size - f.. x ft.
Stone size
PIPING: Size Type
Bldg. to Tank
Tank to Dist. Box
Dist. Box to Field/Pit
Openings Sealed? Yes No Partial
LOCATION/SEPARATIONS:
Foundation to Tank feet
Foundation to Absorption feet
Separation of Pits -et
Conforms as per Plot Plan
LOCATION OF SYSTEM ON PROPER
(circle one)
Front - Rear - Left Side - Right Side
Middle Front - Middle Rear
COMMENTS:
6 Ok-1 C�
SYSTEM USE APPROVED: „411141211P0
Arrived:
Depart:.:. _
r
Airr
:u,r ping Tp:ctor
r
sue :
STh --j
I 03
6
- r
I have Wee Of Alleried.e►believe I saw evidence of,
ap objectiwehaiot*,
wells,trees,fences,etc.,
shown on Vie decommtI she represent that I have
- ,. IMIGININd dil ielt.at forth on ((diagram."
6 A Jam' L .
7r; DATE
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d y/ /t v1 y--.,-Pu ci _Acst)
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2 S .i
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Toot ANCCOD
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TOWN OF UEE ' .RY
BUILDING C .;, % DT.
REVIEWED Bs ../ . , ,,iti
` DATE ro...it/WOW
i II
--j)ri (/e cc.i 44-1
"I have seen or observed, or believe I saw evidence of,
all objects such as houses, wells,trees,fences,etc.,
shown on this document. I also represent that I have
p r iI f(illy measured the distances set fo on the diagram."
1 ' —.0 -)A-5 e?
L SI -NATURE DATE /