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1999-104 CERTIFICATE OF COMPLIANCE TOWN OF QUEENSBURY WARREN COUNTY, NEW YORK Date April 5 19 99 3Mt 99104 This is to certify that work requested to be done as shown by Permit No. has been completed. SEPTIC ALTERATION • , This structure may be used as a Location LOT 103 HOMESTEAD VILLAGE HOMESTEAD VILLAGE L.P — Owner TAX MAP NO. 93. -2-11 . 1 By Order of Town Board TOWN OF QUEENSBURY. Director of Building & Code Enforcement BUILDING PERMIT TOWN OF QUEENSBURY VALUE $ 0 No. 99104 TAX MAP NO. 93. -2-11 . 1 WARREN COUNTY, NEW YORK PERMISSION is hereby granted to HOMESTEAn VTT,T,M L.P. OWNER of property located at LOT 103 HOMP STFnn VILLAGE Street.Road or Ave. 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 approved and in compliance with the.Town of Queensbury Building and Zoning Ordinance. 1. OWNERS Address is • 4294 ROUTE 5 CALEDONIA, NY 14423 2. CONTRACTOR or BUILDERS Name I .B.S. SEPTIC 3. CONTRACTOR or BUILDERS Address 2 LOWER WARREN STREET QUEENSBURY., NY 12804 4.:ARCHITECT'S Name 5. ARCHITECT'S Address 6. TYPE of Construction—(Please indicate by X) SEPTIC ( )Wood Frame ( I Masonry ( )Steel ( ) 7. PLANS and Specifications . SEPT20 'ALTERATION AS PER PLOT PLAN SPECIFICATIONS 8. Proposed.Use SEPTIC ALTERATION 25 PERMIT FEE PAID—THIS PERMIT EXPIRES Apr i l- 5 tg 2001 $ (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.) 5. . April �g 1.999 Dated at the Town of Queensbury this Day of: SIGNED.BY it) for the Town of Queensbury Building and Zoning Inspector. • • Application for SEPTIC DISPOSAL PERMIT r Town of Queensburyc)ct — U Dept. of Community Development Permit No. /0 J Building &Codes Office o° - J-S 742 Bay Road - Fee Paid $ Queensbury, NY 12804 Location of property for installation: 6 /.d, 3 go,C 1iC"6,1G��j Property Owner's Name: /(0 tIL 6 S Ire. r.2 t.. r Z. 7 ( Property Owner's Mailing Address: (L .2 r r' c ro/ t:y Installer's Name: J I C, ,f /� /, � C Phone # r � 9 � // 7� � Number of bedrooms (if residential): ? Total daily flow: VJ -e) (residential -compute @ 150 gal./bdrm.) Topography: ( ' 1 at, rolling, steep slope % of slope Soil Nature: ` sand, loam, clay, other /depth: Ground water: at what depth?Aeet / Bedrock or Impervious Material: at what depth? feet Percolation test: 444 4 not required, required [rate min. per inch] Domestic water supply: /municipal, well, other If domestic water supply is a WELL, water supply from any septic absorption is feet. . PROPOSED SYSTEM Septic tank:/D Ott gallon (minimum size: 1,000 gal.) Tile field: each trench 5-0 feet / Total system length: (ID 0 feet Seepage pit(s): number of / size each: . ft. by ft. , Size of stone to be used: # )---. / depth or thickness / feet HOLDING TANK SYSTEM: (if required) Number of tanks: - Size of each: gallons ( Alarm system and associated electrical work to be inspected by a certified agency.)work ' For your protection, please note that pursuant to Section 136-29 of the Code of the Town of Queensbury, any permit or appiuval granted which is based upon or is granted in reliance upon any material misrepresen#ation 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:c�f !P • TOWN OF QUEENSBURY BUILDING & CODE ENFORCEMENT 531 Bay Road Queensbury NY 12804 518-745-4447 SEPTIC DISPOSAL SYSTEM INSPECTION 15 ' Name e �L • Location 3 Udh) Date" �9 permit # — )Li SOIL TYP • and • Results of Percolatio Test} (if applicable) Rate-iinute/Inch TYPE OF SYSTEM: ABSORPTION FIELD: . To 'al Length 7 Length of each renc, d Depth of trenches i Size of stone SEEPAGE PITS: Numbe - Size - ft. x ft. Stone size PIPING: • Size Type Bldg. to Tank Tank to Dist. Box Dist. Box to Field/Pi ; �\ f- Openings Sealed? 40(.-© No Partial LOCATION/SEPARATION . Foundation to Tank -���j feet Foundation to Absorp ion Q feet Separation of Pits / , feet Conforms as per Plot P1 an Yes LOCATION OF SYSTEM ON PROPER : (circle one) Front —Rear eft Sid— Right Side Middle Front - Middle Rea COMMENTS: • SYSTEM USE APPROVED: YE 0 Arrived: ► Depart, ��� ilr/ .r00e;; • ! 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