97-648 • CLI�,`I'IFIC, 1' ' OF COMPLIANCE•
TOWN OF q-UEENSBURY
WARREN COUNTY; NEW YORK
Date xio„.�, hc,,:. 197
;OCIt
This is to certify that work requested to be done as shown by Permit No. 97648
has been completed.
This structure may be used as a SEPTIC ALTERATION
Location LOT 62 HOMESTEAD VILLAGE
Owner HOMESTEAD VILLAGE L e P a-
TAX MAP NO. �3. — � o }By Order of Town. Board
TOWN OF QUEENSBURY
Director of Building & Code Enforcement
BUILDINGi'PERMIT
TOWN OF QUEENSBURY
. VALUE : s G. No.
. , , -
TAX MAP NO. 1 . WARREN COUNTY NEW YOR K.
PERMISSION is hereby granted to HOMESTEAD VILLAGE L.P.
OWNER of property located at LOT, 62 HOMESTEAD VILLAGE Street,Road or Ave.
in the Town of Queensbury,To Construct or place a
SEP I/C ALTE TIQN
at the above location in accordance to application togeer witn plot piansRf tn na otner infOrMation hereto filed and
approved and in compliance with the Town of Queensbury Building and Zoning Ordinance.
1. OWNER'S Address is
n.4294 ROUTE:1S
C MiEDONIA; NYc 14423
2. CONTRACTOR or BUILDER'S Name.
SEPTIC.
3. CONTRACTOR or BUILDERS Address
2-AiOWERO,'WARREN: STREET:
.1f4011/EINSBURY,4.4.19HY. 4-280 4;
4. ARCHITECT'S Name
5. ARCHITECT'S Address
6. TYPE of Construction—(Please indicate by X)
siePERVC
( )Wood Frame ( )Masonry
7. PLANS and Specifications
SEPTIALTERATION,ASPER PLOT PLAN
t ;
.2, 8. Proposed Use
SEPTIOWILTERATTOILif:.,
$ 254 CY--L.-TH IS PERMIT-- R ES Oetaabt.V431agg&agif,4i;i499
(If a longer period is required an application for an extension must be made to the Building and Zoning inspector of the ,541
town of Oueensbury before the expiration date.)
I ;
Dated at the Town of Queensbury
SIGNED BY
f for the Town of Queensbury
Building a Zoning Inspector
Application for SEPTIC DISPOSAL PERMIT
Town of Queensbury —�,,, �
Dept. of Community Development I C P j Permit No. q -l/
am
Building &Codes Office
742 Bay Road OCT 3 01997 Fee Paid $
Queensbury, NY 12804 jI TOWN.T ,p p s W:.�
lO r E ri:',:,.i::i3URy
BUILD!
Location of property for installation: oAC, / t.,( ,--),c
Property Owner's Name: 11 yS Jr-cif' fiirec,
Property Owner's Mailing Address: C Ce 7x PA y- cl (L
Installer's Name: _,PP. S S'V: a < Phone # 2?t-T(9-
Number of bedrooms (if residential): 3 Total daily flow: I/S-0
(residential - compute @ 150 gal./bdrm.)
Topography: ' at, rolling, steep slope % of slope
Soil Nature: K
d, loam, clay, other /depth:
Ground water: at what depth?/v4 feet / Bedrock or Impervious Material: at what depth? feet
Percolation test: / 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(adv gallon (minimum size: 1,000 gal.)
r Tile field: each trench feet / Total system length: feet
eU $ PlA`J 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
CAlarm system and associated electrical work to be inspected by a certified agency.J
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
, i � „.. m- O -9 2
alki,
TOWN OF QUEENSBURY
BUILDING & CODE ENFORCEMENT
742 Bay Road
Queensbury NY 12804
(518) 761-8256
SEPTIC DISPOSAL SYSTEM INSPECTION
Name 3 (?fie
Location d ke o—
Date "j Permit #R-7—I,48
SOIL TYPE • Loam-Clay-
Results of Pe colation Test- . (
(if applicable' Rate-Minute/Inch
TYPE OF SYSTEM .
ABSORPTION FIELI: Total Length
Length of each french
Depth of trenche
Size of stone
SEEPAGE PITS: Num•er-
Size - ft. , ft.
Stone size
PIPING: Si a Type
Bldg. to Tank '
Tank. to Dist. Box
Dist. Box to Field/Pj,s
Openings Sealed? 41110,
No Partial
LOCATION/SEPARATION .
Foundation to Tank feet
Foundation to Absorpti - feet
Separation of Pits eet
Conforms as per Plot an No
LOCATION OF SYSTEM ON PROPER' l
11111
(circle one) r- ,
Front - Rear - Left ide - Rivht Side
Middle Front - Middle Rea
COMMENTS:
I 13ta) K tiJeD1 ALL A`CI 0 ' 6��(11
OK 4> ( tic
SYSTEM USE APPROV : IIP
NO
Arrived: l : iO
Departed: / ; /6
\ef
' Building Inspector
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