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2002-435 TOWN -OF QUEENSBURY 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201 Community Development-Building&Codes (51$),761.8256 C ER�llIF,ICATE ,OF' COMPLIANCE t Permit Number: ,,P20020435Date Issued: Thursday, June 271 2002 This is to°.certify that work requested to be done as shown by Permit Number P20020435 has been completed. Tax Map Number; 523400.309-009.0002.001-000-0000 Location: LUZERNEI Rd Owner: HOMESTEAD VILLAGE L P Applicant: HOMESTEAD VILLAGE L P .4 5 This structure may be occupied as a: ' By Wet of Town Board Septic Alteration Residential �'� ' TOWN OF QUEENSBURY Ante or f o e nt A TOWN OF QUEENSBURY 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201 Community Development-Building&Codes (518) 761-8256 BUILDING PERMIT Permit Number: P20020435 Applicatio' n Number: A20020435 Tax Map No: 523400-309-009-0002-001-000-0000 Permission is hereby granted to: HOMESTEAD VILLAGE I.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. TVe 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 J Address Electrical Inspection Agency I.B.S. SEPTIC 2 LOWER WARREN STREET OUFFNSBURY.NY Plans&Specifications 2002-435 LOT 74 HOMESTEAD VILLAGE SEPTIC ALTERATION AS PER PLOT PLAN SPECIFICATION $25.06 PEitMff FEE PAID-THIS PERMIT EXPIRES: Friday,May 30,2003 (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 expiration date.) Dated at the Tow eensb r ay,May 30,2002 SIGNED BY _ z — for the Town of Queensbury. Director of Building SvcCode forcement Application for Perntit—Septic Disposal System Town of Queensbuty 7424ayltocrd Queensbury,NY 12804 (5I8) 761-8256 1. OWNER INFORMATION: Location of installation: /d/`� C �✓ /c rl ... ........ . ...........................fric...... ................ .......... ..... Off' a Use Fite Permit Noc�J Li � Tax Map No. r- � Fee Paid Otter's:Name:; j1 r� -C �r�r ( t fir"vv ..................................................................................._.......... Address: _£ 6 7 r r S`c.J Lf " ... . 2. INSTALLER'S NAME ': - ..�.-°t/ PHONE NO. ls' i I 3. RESIDENCE INFORMATION: (circle year of dwelling, indicate 9 bedroom(s)and multiply N of bedrooms with applicable gallons per bedroom to equal total dal/yfluiv) Year of House: No. of Bedrooms x Computation = Total Daily Flow MAY 2.4 20p2 1980 or older x 150 gal/bdnn = �t S�� a'avVAJ p.- _ 1980— 1991 X. 130 gal/bdrnt = 1991 =present ' x 110 gal/bdrttt = � �� Garbage Grinder Installed yes_ / no _ Spa or Whirlpool Installed yes_ / no 4. PARCEL INFORMATION: (circle applicable information &indicate measurements) f P,.. .t vI t depth tit Wurl plh ltolling mow✓/2ftet iE et well Steep slope clay if well; water supply. �%slope other from any septic-system, depth: absorption is other Percolation Test:. (To be completed by licensed professional engineer or architect) Rate: minute per Inch 5. PROPOSED SYSTEM: For NiW Construction: All individual sewage disposal systems must be designed by n licensed profcssioniil engineer or architect(unless installed in a Planning Board approved subdivision). Add 250, gallons to the sire of the septic tank aiid leach field for cacti Garbage Grinder,Spa or Witirlpool Tub. Septic Tank:la00 gallon (min.size 1,000 gat.) Tile Field: each trench��} J1. Total System Length: 9 9 fi. Seepage.Pit(s): number-of' size ofeach J1. by Jt. f i Size of Stone to be used: II / depth or thickness�___•______Ject Bed System Size: x Alternative System; length and/or size 6. HOLDING TANK SYSTEM: (if required) Number of tanks: t Size of each: gallons /TOTAL.Capacity: gallons Note; Alarm System and associated electrical work must be inspected by a Town approved j 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 Queonsbury, any permit or approval granted which is based upon or is granted in reliance upon any material ini-reprenctitation or failure to tnako a inateriat fact or circtinistance 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. gnature of responsib -pe on Date -J•10 0 0 0 0 0 R (D '0 a- � -4 M c+ a. M-:.0 tD IX-4 a,tD 0 a 0 CD(10 -J,O:3VCC 00Q. '70NMNV0 (APU-ho M r+ n all CL0 '1 >-h0) 3Z >� 077ua �+ ZcDIVfDCHO0m c f (D pi M rt 0 �0 -1 CL CL + a;" � (D `� 0' ct � 0) 0 ID M N 01 01 N:3 c+ 0 M 0 :r'C3 0-0 c+ -J' c+ ct R LO Co 0 C+ (P. 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