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2012-564 . 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: P20120564 Date Issued: Monday, December 10, 2012 This is to certify that work requested to be done as shown by Permit Number P20120564 has been completed. Tax Map Number: 523400-309-009-0002-001-000-0000 Location: 200 LUZERNE Rd Owner: HOMESTEAD VILLAGE L P Applicant: HOMESTEAD VILLAGE L P This structure may be occupied as a: Septic Alteration Residential � By Order of Town Board ' 1-'1t( \ �1M��� TOWN OF QUEENSBURY Issuance of this Certificate of Compliance DOES NOT relieve the property owner of the responsibility for compliance with Site Plan, Variance, or other issues and conditions as a result of approvals by the Director of BuildingCode forcemeat Planning Board or Zoning Board of Appeals. TOWN OF QUEENSBURY 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201 Community Development-Building&Codes (518)761-8256 BUILDING PERMIT Permit Number: P20120564 Application Number: A20120564 Tax Map No: 523400-309-009-0002-001-000-0000 Permission is hereby granted to: HOMESTEAD VILLAGE L P For property located at: 200 LUZERNE Rd in the Town of Queensbury,to construct or place at the above location in accordance with application together with plot plans and other information hereto filed and approved and in compliance with the NYS Uniform Building Codes and the Queensbury Zoning Ordinance. Tyne of Construction Value Owner Address: HOMESTEAD VILLAGE L P Septic Alteration Residential 4294 ROUTE 5 Total Value CALEDONIA,NY 14423 Contractor or Builder's frame/Address Electrical Inspection Agency SANITARY SEWER GEORGE DRELLOS 792-7257 PO BOX 224 GLENS FALLS NY Plans&Specifications 2012-564 171 & 172 ELMHURST DRIVE Res. Septic Alteration $40.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Saturday,November 30,2013 (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 Queensbury; Friday,November 30,2012 SIGNED BY for the Town of Queensbury. Director of Building&Code Enforcement Community Development Office NOV ¢° Town of Queensbury • 742 Bay Road • Queensbury, New York •12804 9 2012 Office Use Only t / TAX MAP NO. Qq1 -- p).`-' . I PERMIT NO._J�-' cJ)6 I PERMIT FEE__r) 0 L.._,---, APPROVALS: ZONING TOWN CLERK _ _ APPLICATION FOR SEPTIC DISPOSAL SYSTEM ERMIT: A PERMIT MUST BE OBTAINED BEFORORK BEGINS. APPLICATIOp IS SUBJECT TO REVIEW EFORE ISSUANC5e0F A VALlp PERMIT. OWNER:r e_l' _A-t�-_ _/ � - INSTALLE 65 _ ep 4 ADDRESS: V.Z 2 -Q ADDRESS: 72.z.-,e_ ---- f�0 1 PHONE NOS. PHONE NOS. 7%--0 '..6-4-.43 LOCATION OF INSTALLATION:I I I f /7 2' /L h VAc(_ -- _,...._ k---pt-LIP RESIDENCE INFORMATION: YEAR BUILT NO.OF X COMPUTATION = TOTAL DAILY FLOW BEDROOMS (Gallons per bedroom) GARBAGE GRINDER 1980 or older X 150 = INSTALLED? 1981 -1991 X 130 = SPA OR HOT TUB 1992-present X 110 = INSTALLED? PARCEL INFORMATION: / TOPOGRAPHY: FLAT ROLLING 40"1-TEEP SLOPE %SLOPE ✓ SOIL NATURE: SAND LOAMCLAY OTHER ✓ GROUNDWATER: AT WHAT DEPTH? ✓ BEDROCKIIMPERVIOUS MATERIAL: AT WHAT EPTH? ✓ DOMESTIC WATER SUPLY: MUNICIPAL WELL (If well:water supply from any septic system absorption is:. ft) ✓ PERCOLATION TEST: RATE IS PER MIINUTE PER INCH[mpi] (Test to be completed by a licensed professional engineer or architect) PROPOSED SYSTEM FOR NEW CONSTRUCTION: All individual sewage disposal systems must be designed by a licensed professional engineer or architect(unless installe c. )Planning Board approved subdivision). TANK SIZE:1 GALLONA (MIN. SIZE IS 1,000 GAL.)Add 250 gallons to the size of the septic tank for each garbage grinder, spa or whirlpool tub. SYSTEM TYPE: ��jj�y / /- 1 ABSORPTION FIELD (WITH NO. 2 STONE) Total length �,lc,v ft. Each trench 2 X ��❑ SEEPAGE PIT(S) (WITH NO. 3 STONE) How many? Size? ❑ALTERNATIVE SYSTEM Bed or other type? ❑ HOLDING TANK SYSTEM Total required capacity? Tank size? Number of tanks? NOTE: ALARM SYSTEM AND ASSOCIATED ELECTRICAL WORK MUST BE INSPECTED BY A TOWN APPROVED ELECTRICAL INSPECTION AGENCY. PLEASE REVIEW LIST PROVIDED. 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 b or on behalf of an applicant,shall be void. ave ad the regulations .ith -spect to this application and agree to Sanit Sewage/epos. Or. abide b these and •��req rem r.ar is ,Town7ueensburY NS?odesTOUR WEBSITE FOR MORE INFORMAON www.queensbur .net Y Septic Inspection Report Office No. (518) 761-8256 Date Inspection -s u- -•- ved: Queensbury Building &Code Enforcement Arrive: D-..rt: am/pm 742 Bay Rd., Queensbury, NY 12804 p�Inspector's Initials: NAME: \`V MF�hE C1D 1 LLPtLF ',ERMIT NO.: I Z-'J- OI t LOCATION: LZ1 1111177._ ELt-1N ) T L INSPECT ON: I Z—(0-17 RECHECK: Comments and/or diagram Soil Type: Sand/ Loam/ Clay Type of Water: Municipal / Well Water Waterline separation distance ft. Well separation distance ft. Other wells: ft. Well Casing Length 50' + / - Y N N/A [150'to well required if NO] B Absorption Field: Total length ft. AS UILT Length of each trench ft. Depth of trenches ft. Size of Stone Seepage Pits: Number Size: x Stone Size: Piping Size Type Building to tank Tank to Distribution Box Distribution Box to Field/ Pit Opening Sealed: _Y_N End Cap _Y_ N Inlet/Outlet Pipes&Baffles Y N Manholes 12"or less below grade _Y_ N [provide extension collar if Yes] _Y_ N Location / Separations Foundation to tank ft. Foundation to absorption ft. Separation of Pits ft. Conforms as per Plot Plan _ N Engineer Report and As-Built Y N ETU Maintenance Contract _Y_ N provided Location of System on P operty: Front • •ar Left Side Right Side Middle Front Middle Rear S stem Use S . us: Approved Partial Approved and needs to be re-inspected, please call the Building &Codes Office Disapproved L:\Pam Whiting\2010\Building Codes Forms\Inspection Forms\Septic Inspection Report 03 29 10.doc „„„„„,„ ,,„ ,i ,” 1IIIIIIIIIIII ENVIRONMENTAL DESIGN PARTNERSHIP, LLP December 5, 2012 Queensbury Building & Code Enforcement 742 Bay Road Queensbury,NY 12804 Via email johno@queensbury.net Attn: John O'Brien AS BUILT Re: Homestead Village Mobile Home Park Lot 171 / 172 Elmhurst Dear John: On December 5, 2012 our office inspected the above referenced Homestead Village Mobile Home Park lot. The purpose of this visit was to observe the installation of the new septic system designed by EDP dated November 28, 2012. Based on my review of the plans and observation of the installation it is my opinion that the system was installed substantially in compliance with the intent of the design plans. It should be noted that new septic tank serving lot 171 was shifted to the west by a few feet as shown on the AS-BUILT drawing being mailed under separate cover. Please contact me should you have any questions regarding this system. Sincerely, dc:7417 James E. Mitchell, P.E. 900 Route 146, Clifton Park, New York 12065 phone (518)371-7621 -fax(518) 371-9540 9i --3C--( 16` ,34-) , Septic Inspection Report Office No. (518) 761-8256 Date Inspection -•ue eivz.•: Queensbury Building &Code Enforcement Arrive: 'A �, - rt: I D-j a n m 742 Bay Rd., Queensbury, NY 12804 Inspector's Initial • _ NAME: 0 ,M C 3-4-eld PERMIT NO.: 1 : 5 Lc 7 LOCATION: f-ii Q- .od INSPECT ON: /,9— 5 /A RECHECK: I LS- .')a - 1 ✓ \ b 8/' Comments and/or diagram Soil T •-:� •.�=."!� oam/ Clay T .- of Water: unici - Water Waterline separation distance ft. Well separation distance ft. Other wells: ft. Well Casing Length 50' + / - Y_ N N/A [150'to well required if NO] Absorption Field: Total length 7--ri t ft. Length of each trenchft. Depth of trenches 7 —3 ft. Size of Stone -7 Seepage Pits: Number Size: x Stone Size: Piping Size Type Building to tank LI/ it ,, -} 1._,) Tank to Distribution Box -j " 6c)? _•z,4-- Distribution Box to Field/ Pit //-.-4 ', -, (7p.--2,2 .� Opening Sealed: VY .__ N End Cap N Inlet/Outlet Pipes& Baffles Manholes 12"or less below grade J(_ N [provide extension collar if Yes] _Y— N Location / Separations Foundation to tank i ft. Foundationto absorption lTh ft. t— !) Searation of Pits ft. E- \ 1,Q.5 - .'?-1 I-C � O � S Conforms as per Plot Plan Y _ . e Engineer Report and As-Built N L_1 1 ETU Maintenance Contract Y_ N provided Location of System on Property: Front Rear eft Si" •: