97-736 4F,
CERTIFICATE OF COMPLIANCE
.T9WN OF QUEENSBURY
WARREN.,CQUNTY, NEW YORK
Date Mn re!), A 19 9
3CP\ 01
9773E
This is to certify that work requested to be done as shown by Permit No.
has been completed.
This structure may be used as a SEPTIC ALTERATION
Location LOT *113 HOMESTEAD VILLAGE
Owner HOMESTEAD VILLAGE LP .
By Order of Town Board
TAX MAP NO. 93 -2-11 . 1 TOWN OF QUEENSBURY
Director of Building & Code Enforcement
, 5 q • ,
BUILDING :..: PERMIT
TOWN OF QUEENSBURY No:
VALUE $ 0
TAX MAP NO. 93. —2-11. 1 WARREN COUNTY, NEW YORK
PERMISSION is hereby granted to HOMESTEAD L7a .W
OWNER of property located at Street, Road or Ave.
in the Town of Queensbury,Tol.Construct or place a -
at the above location in accordance to application together waglIIt PlitnAtiqVtformation hereto filed and
approved and in compliance with the Town of Queensbury Building and Zoning Ordinance.
1. OWNER'S Address is
4294 ROUTE 5
CALEDONIA; . NY:._:;: 14423
2. CONTRACTOR or BUILDER'S Name
I.B.S , SEPTIC:,=, :._;.
3. CONTRACTOR or BUILDER'S Address
r 2 LOWER. WARREN: STREET.
:,-;:= :2UEENSBURY4,-NY.:._ 12804
4. ARCHITECT'S Name
5. ARCHITECT'S Address
6. TYPE of Construction—(Please indicate by X)
SEPTIC( )Wood Frame ( 1 Masonry ( )Steel
7. PLANS and Specifications
_SEP IBC-::ALTERA.T.ION.-AS_v:PER>> PLOTr;PLAN SPECIFLCAT:ION$ �;
8. Proposed Use
SEPT•IC:zALTERAT:I.QN.ki ,;
(If a longer period is required an application for an extension must be made to the Building and Zoning inspector of the
town of Oueensbury before the expiration date.)
i
I
aditle
Dated at the Town of Queensbury this Day o +
SIGNED BY _ Al'eAkA)\- EI for the Town of Queensbury
Building and Zoning Inspector
Application for SEPTIC DISPOSAL PERMIT
Town of Queensbury Permit No. 7 73
Dept. of Community Development 6
Building &Codes Office
742 Bay Road Fee Paid
Queensbury, NY 12804
_ /
Location of property for installation: (.b T /1) ' ('�/k(f7ta I (4/6.7 C 6 v 2e,n r t r/
Property Owner's Name: WP"-c f 7(,c/ ( i (C -iL,(—
Property Owner's Mailing Address: CL l r n c i 1
Installer's Name: , , /3. sl. > ,%i C Phone # 72r" i- 9 c
Number of bedrooms (if residential): 3 Total daily flow: K.
(residential - compute @ 150 ga1./t�c�i nl� ; rr
Topography: ( /tl , rolling, steep slope,• % of slope
DEC 1.7 1997
Soil Nature: sand, loam, clay, other /depth: Y
Ground water: at what depthM_ feet / Bedrock or Impervious Material: at what tli?' :.feet "='--.
Percolation test:Tot req ' ed, 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 C) gallon (minimum size: 1,000 gal.)
Tile field: each trench feet / Total system length: feet
Seepage pit(s): number of / size each: r ft. by e ft.
Size of stone to be used: # 3 / depth or thickness feet
HOLDING TANK SYSTEM: (if required)
Number of tanks: Size of each: gallons
CA1m system and associated electrical work to be inspected by a certified agency.)
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 applic 'on and agree to abide by these and all requirements of the Town of
Queensbury Sanitary Sewage Disposal Ordinance
Signature of responsible person: r C Date:AL".(17/
TOWN OF QUEENSBURY
BUILDING .& CODE ENFORCEMENT
742. Bay Road
Queensbury NY 12804
(518) 761-8256
SEPTIC DISPOSAL SYSTEM INSPECTION
Name .42C�C`�Ql_�J-,(;r1.\ o 1\.Vo
Z..._
Location J zQA/- n_ e
Date )-`0 '9 ' Permit #(=):7 -736
SOIL TYPE: Sand-Loam-Clay-
Results of Percolation Test-
(if applicable) Rate-Minute/Inch
TYPE OF S TE .
ABSORPTION F LD: Total Length
Length of v. h t ench
Depth of t •nche-
Sizeofs • e
SEEPAGE P T ° umber-
Size - ft. x ft.
Stone .ize
PIPI . Size Type
Bid,9. to Tank .
Tank to Dist. Box
Dist. Box to Field/Pit
Openings Sealed? Yes No Partial
LOCATION/SEPARATIONS:
Foundation to Tank feet
Foundation to Absorption feet
Separation of Pits _ feet
Conforms as per Plot Plan Yes No
LOCATION OF SYSTEM ON PROPERTY:
(circle one)
Front - Rear - Left Side - Right Side
Middle Front - Middle Rear.
COMMENTS:
Q) eQ ,,le__a Avix)^\\-\-.
•
si:2_,qc.c.___„-.
........_
(2) ic NA--c _L5s (L, L12 .
c—ic
SYSTEM USE APPROVED: NO
I%)
Arrived:
Departed:
Buildi Inspector
TOWN OF QUEENSBURY 21F7U)
T BU
ILDING & CODE ENFORCEMENT
742 Bay Road
Queensbury NY 12804
(518) 761-8256
SEPTIC DISPOSAL SYSTEM INSPECTION
if jName �SYY�. ) [QO
Location /13 nomwtetovi f
Date 3-Li - Permit # 9 -
SOIL TYPEZI_Sand oam-Cl ay-
Results of Percolation Tes
(if applicable) Rate-Minu - Inch
TYPE OF SYSTEM:
ABSORPTION FIELD: . otal - .th
Length of each tren, 141,
Depth of trenches _iaggiumm„
Size of stone `71101v
SEEPAGE PITS: Number 7
Size - 1.3 ft. x c - ft.
Stone size
PIPING: Size Type
Bldg. to Tank ems,—ri0En
Tank to Dist. Box Li" V\I
Dist. Box to Field/Pit ". P J
Openings Sealed? o Partial
LOCATION/SEPARATI .
Foundation to Tank t140grafeet
Foundation to Absorption L - feet
Separation of Pits feet
Conforms as per Plot Plan Ye
LOCATION OF SYSTEM ON PROPERTY:
(circle one)
Front - Rear - Left Side - Right Side
Middle Front - Middle Rear
COMMENTS:
•
SYSTEM USE APPROVED: YE NO -
Arrived:
Depart
it ing ct r
•
< . i.1 in9
"I have seen or observed,or beNevol l'evidence oft ;
all objects such as houses,walk - : : ;
shown on this document. I also to •
person measured the distances set �01t#te dla . __
.
.._, ) .,5
SJGNAT DATE r t®001 i. ••• • • . . : . , _ .• . .----
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MAR 0 b 1998
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