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2002-558 TOWN OF QUEENSBURY 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201 Community Development-Building&Codes (518)761.8256 CERTIFICATE OF COMPLIANCE Permit Number: P20020558 Date Issued: Tuesday,July 02,2002 This is to certify that work requested to be done as shown by Permit Number P20020558 has been completed. Tax Map Number: 523400-309-009-0002-001.000-0000 Location: LUZERNE Rd t Owner; HOMESTEAD VILLAGE L P Applicant: HOMESTEAD VILLAGE L P This structure may be'occupied as a: By Order of Town Board Septic Alteration Residential TOWN OF QUEENSBURY Director of Building&Code Enforcement TOWN OF QUEENSBURY 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201 Community Development-Building&Codes (518) 761-8256 BUILDING PERMIT Permit Number: P20020558 Application Number: A20020558 Tax Map No: 523400-309-009-0002-001-000-0000 Permission is hereby granted to: HOMFSTEAD VILLACIF 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 pl6t plans and other information hereto filed and approved and in compliance with the NYS Uniform Building Codes and the Queensbuiy 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 GLEN BATTEASE NY 12904-0000 Plans&Specifications 2002-558 Homestead Village Lot 142 Adirondack St. Septic Alteration $25.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Wednesday,July 02,2003 (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 Town of Qu(ens 002 SIGNED BY for the Town of Queensbury. Director of Building&Code Enforcement Application for Permit—Septic Disposal System Town of Queensbury 742 Bay Road Queensbury,IVY 12804 (518) 761-8256 1. OWNER INFORMATION: Office Use Location of installation: 410,,e5jej- 40-/ I.Y--2— File Permit No. :AoaA-s-nio, Tax Map No. Fee Paid Owner's Name: ................. .............................................. ............... Address: ,e lr�f 1�2. INSTALLER'S NAME 4114 PHONE NO. 3. RESIDENCE INFORMATION: (circle year of dwelling, indicate 4 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 gaIJbdrm = 1980-1991 x 130 gaYbdrm = 1991 -present x 110gaYbdrm = RPCEIVED Garbage Grinder Installed yes_ no JUL 1 2002 Spa or Whirlpool Installed yes no TONNN OF QUEENSBURY 4. PARCEL INFORMATION: (circle applicable information &indicate measurements)- BUILDING AND CODE v SoiLN-ature Ground Water Bedrock or Impervious Material Dgyre'stic Water Su FlatAnd--) at what depth at what depth %49unicipal 67&Ing -17 5am feet —feet well Steep slope -lay if welt; 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 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. I Septic Tank: �660 gallon (min. size 1,000 gal.) Tile Field: each trench Total System Length: -2 C Seepage Pit(s): number of size ofeach: ft. by_,ft Size of Stoneto be used: # depth or thickness feet Bed System Size: x Alternative System: length andlor 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 abide by these and all requirements of the Town of Queensbury Sanitary Sewage Disposal Ordinance Signature of responsible person Date - - y. •ii�wti Of E2aicc�t_tslniry ,`sewers all l Disposal t:it.tittr:- Altp(nitli e A13ti()ItI''1'I()N FIt;;lA) SI:I'f1ItA'1'I(>N ltF,(j lltFA%1 l:N'I'S n Wit Lt'.a••! f 1 l+l�1tTttP1Kl L i'tii>_L7 7. SIGNATURE &INFORMATION FOR l {U ►r, to N 0 z 1C Iry H ° 4d I � � '4 �► U Q U 4-) , W w 0 w z 410 w m ©►O� -P0 V3 k 0 'r r; r UI Q r TJ z z C U Iw E 0 WWx I 0 1 Ps t 4 cn 0 w V) 0) . 'r 0 0 U a) Q, U IL � C nw , r a. 0 -PP 0 cI: M �, 0 ro4a � ro 0.Y0 ��- v w {� 00 _J r LL t► S- v1 Op ;! r- I�►i C: o Opp. m LI. U. 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