1987-353 BUILDING PERMIT
TOWN OF +QUEENSBURY No, , E17_ 313 »
WARREN COUNTY, NEW YORK �c
PERMISSION is hereby granted to Homestead Village z
0
OWNER of property located at Lots 117-118 Luzerne Road Street, Road or Ave_
.o
w
sewage Alteration
in the Town of Queensbury, To Construct or place a
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.
t. OWNER'S Address is P . O . Box 123
Hudson Falls , New York 12839
x
0
2. CONTRACTOR or BUILDER'S Name m
Sanitary Sewer Service
r-t
m
w
a
3. CONTRACTOR or BUILDER'S Address
P . 0 . Box 224
Glens Falls , New York 'J
w
ac
m
d. ARCHITECT'S Name
r
0
5, Af;CHITECT S Address00
M
4^'
W
1
6_ TYPE of Construction — (Please indicate by X) ~
l-+
07
( ) Wood Frame I I 'Masonry I l Steel
N
N
N
7. PLANS and Specifications
No. 1000 gallon septic tank , dist . box 2 6 ' x8 ' dry-wells per plot
and application °
m
a
$. Proposed Use
Sewage system for Lots 117-118 in mobile home park
ra
E
w
10 . 00 PERMIT FEE PAID — THIS PERMIT EXPIRES June 15 19 $9 M
(If a longer period is required an application for an extension must be made to tfie BuiIdina and Zoning inspector of the
town of Queensbury before the expiration date.)
rt
Dated at the Town of Queensbu ry this 15 th Day of June e y9 $7
a
SIGNED BY f� --- for the Town of Queensbury
Suilding and Zoning 1���
SEPTIC DISPOSAL PER D Wm 1�;,1
APPLICATION FOR
JUN 8 II v
Ia °-- t
BUILDINt-v 8c COE>E DE T-
DATE I
LOCATION OF PROPERTY FOR INSTALL TION }
Owner's Name : Telephone: ! (�Id - e: -(/Z)
Address: U
Installer's Name: � � Telephone: rtyf
Number of bedrooms (residential only)
Total daily flow (compute @ 150 gal per bedroom)
Topography: circle one: is boiling Steep Slope %o of slope
Soil Nature: circle onew. lGnV Loam Clay Other . / Depth: feet
Ground Water: At what depth? feet
Bedrock or lmperaious Material: At what depth? feet
Percolation test: circle one: of require required / rate min. inch.
Domestic water supply: circle one: unicipal Well Other
IF domestic water supply is a Well:
Separation: Watersupply* from Septic absorption _ feet
PROPOSED SYSTEM : Septic Tank M) R� gal. (minimum size: 1 ,000 gal,)
TILE FIELD: Each Trench feet / Total system length
+ . feet
SEEPAGE PIT(S) : Number of / Size each feet key GT feet
Size of stone to be used # ^ / Depth or Thickness .3L� feet
IMPORTANT
...P'lease...LIST NEW EQUIPMENT TO BE INSTALL.EI]
Section II Septic System Inspections;
A. All applications for septic system installation, alteration or repair, as
required by the Town of Queensbury Sanitary Sewage Ordinance, shall
be submitted to the Building Department at least 24 hours before start
of construction and shall include a plot plan showing;
1 .) the proposed location of the system
2.) location and distance to lot lines
3.) location and distance to structures
4.) location and distance to any water supply
5.) size and dimensions of all tanks, distribution
boxes, the fields and/or drywalls
Be No system shall be covered before inspection and approval by the building
Inspector. Failure to comply with this requirement may result in the
uncovering of the system by the installer and a fine of up to $250.00.
C. An approved copy of the plot plan shall be available on the construction
site. Failure to produce said plot plan at time of inspection may result
in an immediate work stoppage.
D. Should unforeseen problems during construction prevent proper installation,
alteration or repair of an approved system, a new proposal must be submitted
to the Queensbury Building Department before further construction.
I have read the regulations above gree to hide by these and uireMents
Of the Town of Queensbury Sanit wage c
Signature of r spo sible person:
Date:
Town of Queensbury
Building and Code Department
Bay at Haviiand Road
Queensbury, New York 12801
(518) 79z-5832
SETTLED 1763 . . . HOME OF NATURAL BEAUTY ,. , A GOOD. PLACE TO LIVE