1991-819 NO
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CERTIFICATE OF COMPLIANCE
TOWN OF QUEENSBURY
WARREN COUNTY, NEW YORK
Date `%,,e7/ 1,t.iL st% ;) 19 9,/
This is to certify that work requested to be done as shown by Permit No. 91 819
has been completed.
This structure may be occupied as a Septic Alteration
Location Lizerne Rd
Owner Homestead Village
By Order Town Board
TOWN OF QUEENSBURY
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Director of Bldg. & Code Enforcement
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BUILDING PERMIT
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TOWN OF QUEENSBURY "
No. 91-819
WARREN COUNTY, NEW YORK
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PERMISSION is hereby granted to Homestead Village w
OWNER of property located at 114 Homestead Village Street, Road or Ave.
1-1
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
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approved and in compliance with the Town of Queensbury Building and Zoning Ordinance. a
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1. OWNER'S Address is
Luzerne Rd
Queensbury, NY
2. CONTRACTOR or BUILDER'S Name
Ivan Belltth
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3. CONTRACTOR or BUILDER'S Address
4. ARCHITECT'S Name
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5. ARCHITECT'S Address
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6. TYPE of Construction—(Please indicate by X)
( )Wood Frame ( I Masonry ( I Steel ( )
7. PLANS and Specifications
Septic Alteration to include:
No. 1000 gal tank with 200' of tile field using #2 stone, 1' thickness
as per plot plan specifications and application
8. Proposed Use -'
Septic Alteration
$ 25.00 PERMIT•FEE PAID -THIS PERMIT EXPIRES November 19, 19 93
(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 19th D y f November 19 91
SIGNED BY for the Town of Queensbury
uilding and ning Inspector
PIP 111%ii
lippry TOWN OF QUEENSBURY p� p
APPLICATION FOR SEPTIC DISPOSAL PERMIT Permit # 9/D 1
Fee Paid Fay
Date: (au /9, 5/ Reviewed .01u?/
P .)W OF QU _ENSBL.
LOCATION OF PROPERTY FOR INSTALLATION: j ci /�69`s-7-z. ,_S'fcc , (,,'I/q 3 CEIVED
Owner' s Name: Non/ 'c-,Sf-e-G (I/li97---- nv 1 ) 1991
Owner's Mailing Address: 1 --
{f �y-y,--� , f'(,( 0�- N.r',�v 1
.1 > i f"_oa & COL,)E DEPT.
Installer' s Name: U4w /3-vll Phone #: ? W/ij9
Number of bedrooms (if residential) : 3
Total daily flow (residential-compute @ 150 gal . per bedroom): 1/,5�0
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Topography-Circle One: Rolling Steep Slope % of Slope
Soil Nature-Circle One: ktpIe Loam Clay Other /Depth:
Ground Water-At What Depth? ? Feet
Bedrock or Impervious Material-At What Depth? � Feet
Percolation Test-Circle One: Not Required Required/Rate Z Min. Per Inch
Domestic Water Supply-Circle One: unicipal Well Other
If domestic water supply is a we 1- -
Separation: Water supply from any septic absorption feet
PROPOSED SYSTEM: Septic Tank ./9(> gal . (Minimum size: 1,000 gal . )
Tile Field: Each Trench `5'O feet//Total System Length p5 feet
Seepage Pit(s) : Number of 77/9 / Size each: ft. x ft.
Size of Stone to be used: # 2 / Depth or Thickness / feet
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HOLDING TANK SYSTEM IF REQUIRED
No. of Tanks. ,4 Size of Each Gal .
Alarm system and associated electrical work to be inspected by a certified
agency.
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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: ��.- �-�('J' DATE: 04/ /9, 9/
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 lot lines
3) location and distance to structures
4) location and distance to any water supply
5) size and dimensions of all tanks, distribution boxes, tile 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:
, . . c0001A--t- I P IYI
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-,1-..---:-. awn 4Queensburty
BUILDG INand ZONING DEPARTMENT
Bay and Haviland Road, R.D. 1 Box 98
Queensbury,.New York 12801
SEPTIC DISPOSAL SYSTEM INSPECTION
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NAME . 0 « .� �i I (,,,,,,,e_.,,,
LOCATION t l q 61kw et r.0 i1 / ,
DATE i i /XPERMIT NO. 9I Fie)
SOIL TYPE Sa Loam - Clay -
Percolation Test Required? YES - NO
Percolation rate:- Min/Inch
TYPE of SYSTEM:,'.
Absorption fiel , total,rlength
Length of each rench ,`lc')`
Depth of trench s D.-5'
Size of gravel . 2_,,,
SEEPAGE PITS4Number •6f) •
• Size- ft. X ' /ft.
Gravel size , V.
PIPING: Sizey e
Bldg. to tank C
Tank to dist. box if\
,` S r/
Dist. box to field/pit <,1 '' V
Openings seal/d? YEAS NO Partial
LOCATION/SE ARATIONS:
Foundation o tank /0 ft.
Foundatio to absorption \ ic) ft.
Absorptio1n to lot line \/5' ft.
Separation of pits ( ft.
LOCATION OF SYSTEM ON PROPERTY(circle one)
Front / Rear - eft s' - Right side -
COMMEN�PS
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SYSTEM USE APPROVED all NO
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B/lding .nspector
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SOWN OF QUEENSbu.
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- . PECEIVED
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NOV 1 9 1991
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& CODE DEPT. •
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REVIEWED
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