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2003-430 TOWN OF QUEENSBURY 742 Bay Road,Queensbury,NY 12804.5902 (518)761.8201 Community Development-Building&Codes (518)761.8256 CERTIFIC.,f1l'IrE fvllro rC' 0MPL1AN"" Permit Number. P20030430 Date Issued: Monday, December 11, 2006 This is to certify that work requested to be done as shown by Permit Number P20030430 has been completed, Tax Map Number, 523400-309-009-0002-001.000-0000 Location; 200 LUZERNE Rd Owner, HOMESTEAD VILLAGE L P Applicant: HOMESTEAD VILLAGE L P This structure may be occupied as a; Septic Alteration Residential By Order of Town Board TOWN OF QUEENSBURY Issuance of this Certificate of Compliance DOES NOT relieve the property owner of the responsibility for compliance with Site Plan, 'r Variance,or other issues and conditions as a result of approvals by the Director of Building&Code Enforcement Planning Board or Zoning Board of Appeals, TOWN OF QUEENSBURY 142 Bay Road,Queensbury,NY 12804-5902 (518)761-8201 Community Development-Building&Codes (518) 761-8256 BUILDING PERMIT Permit Number: P20030430 Application Number: A20030430 Tax Map No: 523400-309-009-0002-001-000-0000 Permission is hereby granted to: HOMESTEAD VILLAGE L P For property located at: LUZERNE Rd in the Town of Queensbury,to construct or place 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. Type of Construction Value Owner Address: HOMESTEAD VILLAGE L P Septic Alteration Residential 4294 ROUTE 5 Total Value CALEDONIA,NY 14423 Contractor or Builder's Name/Address Electrical Inspection,Agency Plans &Specifications 2003-430 136 ADIRONDACK STREET,HOMESTEAD VILLAGE SEPTIC ALTERATION AS PER APPLICATION $25.00 PERMIT FEE PAID—THIS PERMIT EXPIRES: Thursday;June 17,2004 (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 expiratio date.) Dated at th To Qu sbry, esday,June 17,2003 SIGNED BY �t for the Town of Queensbury. Director of Building&Code Enforcement Application for Permit—Septic Disposal System Town of Queensbury 742 Bay Road Queensbury,NY 12804 (518) 761-8256 OWNER INFORMATION: .............................................................................................................................. Office Use Location of installation: co CT i Tax Map No. File Permit No. Fee Pair Owner's Name: .......... ........................ ............................................. .................... V Address: 2. INSTALLER'S NAME PHONE NO. '7_ _?2 ? (fo o 3.• RESIDENCE INFORMATION: (circle year of dwelling, indicate#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 gal/bdrin = 1980- 1991 x 130 gal/bdrin = 1991—present x . 110 gal/bdnn = J(pv Garbage Grinder Installed yes— no 77 Spa or Hot Tub Installed yes— no 7NA/ -2003 qylt�Of Qt � D 3�ENseu�'UNd AND Ry 4. PARCEL INFORMATION: (circle applicable information&indicate measurements) TWoWWhy Soil Nature Ground Water , Bedrock or Impervious Material Domestic Water Supply Flat 1:-��- at what depth at what depth municipal Rolling loam feet —feet well Steep slope clay if well; water supply %slope other from any septic-system depth: absorption is_j?. 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 the 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_ft.' Total System Length: Seepage Pit(s): number of size of each: ft. by Size of Stone to be used: # depth or thickness feet Bed System Size: x Alternative System: length and/or size 6. HOLDING TANK SYSTEM: (if required) Number of tanks: 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 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 abi.de','�y these and all requirements of the Town of Queensbury Sanitary Sewage Disposal Ordinance. Signature of�responsible person ate '1ONIVn Of Q1L14--t!11S aui•y sq%vors utstl Scwa>>tc Di:TIMSUt2 t:lttt��tt•:• S1: IARA'1'14)N, ItI;6Zi.31 itI i1]Tt:N'I`�i PoNo Ttt►MA, -: rl u'w•t •I t•P:lY�. tittiTtttmt$Ill It 1 ; 7. SIGNATURE &SIF©RMATIoTt FOkt Yt�rt tfiss. x� •,,. �., -.......•:; (lDO o f� c ce�,�/ - r R ----------------- roJ8 _LC- Y • Y ' Septic Inspection Report Office No. (518) 761-8256 Date Inspection request received: Queensbury Building&Code Enforcement Arrive: a Depart: am/pm 742 Bay Rd.,Queensbury, NY 12804 Inspector`s Initials! NAME: Z) PERMIT NO.: LIl^X1 LOCATION: t INSPECT ON: RECHECK: Comments and/or diagram Soil Type: Sand Loam Cloy Type of Water: Municipal/Well Water Waterline se ration distance ft. Well separation distance • Other wells: • Absorption Field: Total length ft. Length of each trench ft. Depth of trenches ft. Size of Stone Seeppge Pits: Number Size: x Stone Size: Piping Size Type- Building Type- Building to tank Tank to Distribution Box Distribution Box to Feld/ Pit Opening Sealed: Y N Partial End 6p. Inlet/Outlet Pipes&Baffles Y N Location/ SSe: arations Foundation to tank ft. Foundation to absorption ft. Separation of Pits ft. Conforms as per Plot Plan Y N Engineer ReDOrt and As-Built Location of System on Property: Front Rear Left Side Right Side Middle Front Middle Rear stem Use us; Approved Partial Approved and needs to be re-inspected, please call the Building &Codes Office Disapproved Last revised 021006 Last revised 1/6/05 31VO A8 a3M31A3M �. ONICI line n s 4' �5 Cal n } "I have seen or observed, or b6 ve.I saw evidence of, all objects such as houses, wellsf frees, fences,-.etc.,. shown on this document. I also-iepresent that 1 have Personally measured the distances set forth on the diagram:"- ani PA3�b zfo SIGNATURE ATE I 1r