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98-338 i CLR,TIFICKrE OF COMPLIANCE TOWN OF QUEENSBURY i WARREN COUNTY , NEW YORK 0a to , 1 y 1 19 _.�198. 98338 This is to certify that work requested to be done as shown by Permit No . has been completed . This structure may be used as a SEPTIC ALTERATION Location 33 MALLORY AVE , Owner CROSSE , JOHN & KATHRYN By Order of Town Board TAX MAP NO , 117 . - 2 -- 9 TOWN Of QUEENSBURY �r _ �..rw•rrw�e"n Director of Building & Code Enforcement BUILDING PERMIT VALUE fa TOWN OF QUEENSBURY No, _ 98338 TAX MAP NO . 117 . - 2 - 9 WARREN COUNTY, NEW YORK PERMISSION is hereby granted to CROSSES_-„ OIFM & KATUR'Y114 OWNER of property located at 33 MALLORY AVE Streeta Road or Ave. in the Town of Oueensbury, To Construct or place a SEPTI ' 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 Oueensbury Building and Zoning Ordinance. 1. OWNER"S Address is P . Oa BOX 3297 GLENS FALLSr NY 12801 2. CONTRACTOR or 13UILOER05 Name SANITARY SEWER 3. CONTRACTOR or BUILDER'S Address DAN DRELLOS PO BOX. 224 GLENS FALLS NY 12801 4. ARCHITECT'S Name 5. ARCHITECT'S Address 6. TYPE of Construction — (Please indicate by M SEPTIC i I Wood Frame i I Masonry I l Steer I i 7. PLANS and Specifications SEPTj,C ALTERATION AS PER PLOT PLAN SPECIFICATIONS B. Proposed Use SEPTIC ALTERATION 25 Junes 16 2000 PERMIT FEE PAID — THIS PERMIT EXPIRES 19 fit a longer period is required an application for an ertention Host bo made to the Building and Zoning inspector of the town of Oueensbury before the e.gp€ration date.! 16 June 1998 Dated at the Town of Clueensbury this Day of 19 SIGNED BY U1 ! OP5 W for the Town of Gueensbury 001ding and Zoning i nap+ctdr , Application for SEPTIC DISPOSAL, PERMIT "town of Queensbury Dept. of Community Development Permit No. y 38 Building & Codes Office 00 742 Bay Road Fee Paid $ Queensbury, NY 12804 Location of property for installation: J13 B+A L.L e1 N\)T,,,. Property Owner's Name: Property Owner's Mailing Address: Installer's Name: _t64 RQ frAIZr� jj� t'� � 4hone # Number of bedrooms (if residential) : Total daily flow: (residential - compute 0 150 galJbdrm.) Topography: * ' flat, rolling, steep slope % of slope Soil Nature: `sand, loam, clay, other 1 depth: JUN 17 1998 Ground water: at what depth? '16> feet 1 Bedrock or Impervious Material: at what depth? ____ feet Percolation test: 40 not required, required [ rate min.. per inch Domestic crater supply: �unicipal, well, other If domestic water supply is a WELL, water supply from any septic absorption is 6`�feet. PROPOSED SYSTEM Septic tank: [gallon (minimum size: 1 „000 gal.) Tile field: each trench feet / Total system length: feet Seepage pit(s): number of 2. ! size each: *4�A_ ft. by - 4 ' — ft. Size of stone to be used: # -- I death or thickness _ feet HOLDING TANK SYSTEM: (if required) Number of tanks: Size of each: gallons Alarm system and associated electrical work to be inspected by a certified agency. For your protection, please note that pursuant to Section 136r29 of the Code of the Town of Queembury, any permit or approval granted which is based upon or is granted in reliance upon any materiel misrepresentation or failure to makes a material fact or circumstance known by or on behalf of an applicant, shall be void. I have read the regulations with �ea to appli 'on and agree a e by these and all requirements of the Town of Queewbury Sanitary Sewage his sal '.Signature of responsible person: Date: �/ J TORN OF QUEENSBURV BUILDING, 5 CODE ENFORCEMENT 742 Say Road Queensbury NY 12804 (518) 761-8256 SEPTIC DISPOSAL SYSTEM INSPECTION Name Locati on i �`�►AI-LE�[�`'` ����. Date [� -- 1(crqL<L, Permit # fi?) SOIL TYP an - oam-Clay- Resul is of Percolation Test- ( if applicable) Rate-Minute/ Inch TYPE OF SYSTEM ABSORPTION FIELD : Total Length Length of each trench Depth f trenches Size o stone SEEPAGE ITS : N r" f t . Size - ft . x Stone s ' ize ype Bldg . to Tank +. Tank to Dist . Sax _ _ Dist . Sox to Field/Pi t V �ti a openings Sealed? s o LOCATION/SEPARATI r ' � feet Foundation to Tank � feet Foundation to Absorption fe et Separation of Pits -- et Conforms as per Plat P lanLOCATION OF SYSTEM ON PROPERTY : ( circle one )Fr r Right Side ddl e� Fron - Middle Rear SYSTEM USE APPROVED: YES i Arrived: Departed' i nag r TOWN OF QUEENSBURY BUILDING A CODE ENFORCEM MT 742 Bay Road Queensbury My 12804 (5Is) 761-8256 SEPTIC DISPOSAL SYSTEM INSPECTION Name Location Date 5 , Permit # Wt SOIL TYPU oam-ClaY-� Results of Percolation Test- ( if applicable ) Rate-Minute/Inch TYPE OF SYSTEM: ABSORPTION FIELD : Total Length Length of each Depth of tr Size of stone SEEPAGE PITS : Number- ft . Size - �{ - ft . x __ Stone size PIPING : yyy� _ ■ � i'rti Bldg . to Tank s� Tank to Dist . x Dist . Box to iel L; rtia Openings Sealed ? o LOCATION/SEPARATIONS : feet Foundation to Tank � feet 'Foundation to Absorption feet Separation of Pits .No Conforms as per Plot Plan LOCATION OF SYSTEM ON PROPERTY : ( circle one ) Front - Rear Left Side dear Right Side Middle Front Middle COMVgENTS % 0_51 A 20D t ) S]{.TrMWUSE APPROVED : Arrived : Depart y ding p ctor TOiM OF QUEENSBURY BUILDING a CODE ENFORCEWNT 742 Say Road QueensburY NY 12804 (518) 761-8256 SEPTIC DISPOSAL SYSTEM INSPECTION Name Location _ Date +LA �22� Permit # L `�-• SOIL TYPE : Sand-Loam- Clay- Results of Percolation Test- ( if applicable ) Rate-Minute/Inch TYPE OF SYSTEM= ABSORPTION FIELD: Total Length Length of eac trench Depth of trenc s Size of stone SEEPAGE PITS : Num - Size - _ ft , . Stone size -.z" Size hype PIPING: Bldg . to Tank Tank to Dist . B — -- ----� Dist , Box to Field/Pit Openings Sealed? Yes'NO Vartial LOCATION/SEPARATIONS : feet Foundation to Tank --- - feet Foundation to Absorption -- feet Separation of Pits - -ems N o Conforms as per Plot Plan LOCATION OF SYSTEM ON PROPERTY : ( circle one ) Front - Rear - Left Side - Right Side Middle Front - Middle Rear COMMENTS : tie A SYSTEM USE APPROYE'D = YES O Arrired : : Depa ". i ding actor TORN OF 04JEENSBURY 3C BUILDING & CODE ENFORCEKENT 742 Bay Road Que+ensbury NY 12804 (518) 761-8256 SEPTIC DISP�O`S`ALL SYSTEM INSPECTION Name i Location Date4"Q) Permit #_ ► � SOIL TYPE: Sand- Loam-Clay- Results of Percolation Test- ( if applicable ) Rate-Minute/ Inch TYPE OF SYSTEM: ABSORPTION FIELD : Total Length Length of each trench Depth of trenches Size of stone SEEPAGE PITS : Number- ft . Size - ft . x Stone size ize typlu PIPING: Bldg . to Tank — ------ Tank to Dist . Box Disto sox to Field/Pit Openings Sealed? NSYes� p artia LOCA feet Foundation to Tank feet Foundation to Absorption feet Separation of Pits nforms as per plot oOCATION OF S P YSTE14 ON lan 0 L PROPERTYN No ( circle one ) Front - Rear - Left Side - Right Side Mi ddl e F r nt - Middle Rear COMMENTS :C'� Pr % L..E-,v> [ D TI SYSTEM USE APPROVED: YES No Arrived : Depa uilding ector li F Lopmw- CROSSE SEPTIC SYSTEM 117,2 7 -- 117.-2-9 fox" 4" To �,.5cy 'ate f 117-2-10 11 1 SCALE. 1 =20 ro all ob*ft a de a Mmft Wft *aft hne t T TOWN C.; s. . • ,_s spawn on 9ft drpeftinerE. 1 ales eepesed ad t ire 1personaft mreMrerrwd the distances set forth are the diagrampp - i:. RevlEVV ED VY SIGNATURE DATE DATE J