1992-217 CERTIFICATE (JF - COMPLIANCE
TOWN OF QUEENSSURY
WARREN COUNM NEW YORK
Date `•�`. • i C'. 19
This is to certify that work requested to be done as shown by Permit No. 92-217
has been completed.
Thin structure may be occupied as a Septic Alteration
Lxation
Luzerne Rd Homestead Park Lot #69
Owner Homestead Villa
By Order Town Hoard
TOWN OF QUEENSBURY
Director of Bldg. do Code Enforcement
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BUILDING PERMIT �^ �
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TOWN OF QUEENSBURY No- 92-217 o
WARREN COUNTY, NEW YORK
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PERMISSION is hereby granted to Haiiiiestead VillAge
OWNER of property located at _ Luzerne Road Lot #89 Street, Road or Ave,
in the Town of Queensbury, To Construct or place a Srepti C 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.
t. OWNER'S Address is
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2_ CONTRACTOR or OUI LOER'S Name 'C
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Ivan BellINOW
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3_ CONTRACTOR or B'UILDER'S Address
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4. ARCHITECT'S Name 'l
5, ARCHITECT'S Address
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fi. TYPE of Construction — (Please indicate by X)
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I I Wood Frame [ ) Masonry 1 } Steel t } P6
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7. PLANS and Specifications O
Septic Alteration to include :
No.1000 Gal . Tank with 1281 of Tile Field using #2 stone , V Thickness
as per plot plan specifications and application
S. Proposed Use
Septic Alteration
$ 25_ UO PERMIT FEE PAID — THIS PERMIT EXPIRES Kav 11 . 1994
(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 y May 19 92
SIGNED BY r 1GZ for the Town of Queensbury
Building and Zoni 1 nspector
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TOWN OF QUEENSBURY
APPLICATION FOR SEPTIC DISPOSAL PERMIT ermit # r 'vC1
Fee Paid r
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Date : -
,rf _ Reviewed By
D k-OWN OF UE h 4
LOCATION OF PROPERTY FOR INSTALLATION : _ e. �iEf RECEIVED
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�Owner ' s Name : ,�'�m -� s���dr r'� Y"'1'� �j�,` .�'- � uA�; ;. 992
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Owner ' s Mailing i ng Address : � � ..h-'rl "`�'
B DG, S. �C1C1E DEFT.
Installer ' s Name : �1P r } c � Phone # :
Number of bedrooms ( if residential ) :
Total daily flow ( residential - compute @ 150 gal . per bedroom ) :
Topography-Circle One : Q5 Rolling Steep Slope % of Slope
Soil Nature-Circle One : an Loam Clay Other /Depth :
Ground Water-At What Depth ? . 2 'y Feet
Bedrock or Impervious Material -At What Depth ? Feet
Percolation Test- Circle One : Not Require Required/Rate Min . Per Inch
Domestic Water Supply- Circle One : unzc pad] Well Other
If domestic water supply is a we
Separation : Water supply from aM septic absorption feet
PROPOSED SYSTEM: Septic Tank gal . ( Minimum size : 1 , 000 gal . )
Tile Field : Each Trench 3 ,z feet//Total System Length _�P14 feet
Seepage Pit ( s ) : Number of _ d%' / Size each : ft . x ft .
Size of Stone to be used : # 2 f Depth or Thickness _ / feet
HOLDING TANK SYSTEM IF REQUIRED
No . of Tanks ;4r Size of Each Gal ,
am
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 : DATE : . i /'r ✓�
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Septic System Inspections :
A . All applications for septic system installation , alteration or repair ,
as required by the Town of Queensbury Sanitary Sewage Ordinance , shall
be submitted to the Building Department at least 24 hours before start
of construction and shall include a plot plan showing :
1 ) the proposed location of the system
2 ) location and distance to Tot Tines
f 3 ) location and distance to structures
4 ) location and distance to any water supply
5 ) size and dimensions of aTT tanks , distribution boxes , the fields
and/or drywells
B , No system shall be covered before inspection and approval by the Building
Inspector . Failure to comply with this requirement may result in the
uncovering of the system by the installer and a fine of up to $ 250 . 00 .
C . An approved copy of the plot plan shall be available on the construction
site . Failure to produce said plot plan at time of inspection may result
in an immediate work stoppage .
D . Should unforeseen problems during construction prevent proper installation ,
alteration or repair of an approved system , a new proposal must be submitted
to the Queensbury Building Department before further construction .
Town of Queensbury
Building & Code Enforcement
Department
531 Bay Road
Queensbury NY 12804
Remarks .
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BUILDING and 7-QNING DEPARTMENT
Bay and Haviland Road, R.O. 1 Box 9
Queensbury, New York 12801
SEPTIC DISPOSAL SYSTEM INSPECTION
NAME
LOCATION
PERMIT NO .
"ELATE ��IX�
SOIL TYPE - Sand - Clay -
Percolation 'Test Required? YES - No
percolation rate - Min/Inch
TYPE of SYSTEM:
AbsorPtiOn field , total lertgth �2�—
Length of each trend �-- —�
Depth of trenches
Size of gravel
SEEPAGE 'PITS-(Number of)
size- ft' X -
Gravel size Size Type
PIPING :
Bldg . to tank Cr-
Tank to dirt . box
Dist* box to field/ PArtial
Openings sealed? E8
NO F
LC)CATI0N/SEP^ARATICN S f t.
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Foundation to tank Lion fIt 0 � '
Foundation to absarp ft .5
Absorption to lot line f
separation of pits RTY (circle once)
NATION OF SYS i ht side -
Front - Rear Left side - g
CCNiMENTS
SYSTEM USE APPROVED Y
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Building In a or
01/86 and vl
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91
Of �,uh .
i UWN REGEWED
MAY 11
BLDG, & CCH3e .