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2014-154 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: P20140154 Date Issued: Monday, December 08, 2014 This is to certify that work requested to be done as shown by Permit Number P20140154 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 183 & I84 Adirondack St. 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 Building& Code Enforcement Planning Board or Zoning Board of Appeals. Fora TOWN OF QUEENSBURY { a 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201 ir Community Development- Building&Codes (518) 761-8256 BUILDING PERMIT Permit Number: P20140154 Application Number: A20140154 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. Type of Construction Value Owner Address: HOMESTEAD VILLAGE L P 4294 ROUTE 5 Septic Alteration Residential CALEDONIA,NY 14423 Total Value Contractor or Builder's Name /Address Electrical Inspection Agency SANITARY SEWER GEORGE DRELLOS 792-7257 PO BOX 224 GLENS FALLS NY Plans&Specifications 2014-154 183 & 184 Adirondack St. Res. Septic Alteration $40.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Friday,May 01,2015 (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.) bury Dated at the Town Quee eh i 7. May 01, 2014 i SIGNED BY for the Town of Queensbury. Director of Building&Code Enforcement 1111111 of Queensbti'ry Buffing & Code Enforcement Office No. (518) 761-8251 Septic Inspection Report Inspection request received: Name: Inspected on: l 2 — �—_ Location: ( g 3 a— s g At cAfrfve: . -,./p.m Permit No.: ) y— IJs'y Inspector's Initials: iler Co;'- and/or dia.ram 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] Absorption Field: Total length ft. 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 Separation of Pits Conforms as per Plot PlanEngineer Report and As-Built ETU Maintenance Contract provided Y_N Location of S stem on Prr.e : Front R::r Left Side Right Side Middle Front Middle Rear S stem Use Sta 's: Approved Partial Approved and needs to be re-inspected, please call the Building&Codes Office Disapproved Septic Inspection Report � . o 1IIIIIIIIIIIII! �Illillllllll� Ili ENVIRONMENTAL DESIGN PARTNERSHIP,LLP May 21, 2014 Queensbury Building & Code Enforcement 742 Bay Road Queensbury, NY 12804 Via email john@queensbury.net Attn: John O'Brien Re: Homestead Village Mobile Home Park Lot 183/184 Adirondack Dear John: • On May 20, 2014 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 April 25, 2014. 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. Please contact me should you have any questions regarding this system. Sincerely, James E. Mitchell, P.E. cc: NYSDOH Michael Hallock, P.E. 900 Route 146, Clifton Park, New York 12065 phone(518)371-7621 -fax(518)371-9540 1 T� a ;� - 3 Septic Inspection Repo l� Office No. (518) 761-8256 Date Insn req - I [ -C Queensbury Building&Code Enforcement Arrive: ',OVAL-)• &, ifarpart: = Z a .11 742 Bay Rd., Queensbury, NY 12804 Inspector's Initials: _ NAME: ✓, N, \w d21-3etcRn L,4IT NO.: _ f LOCATION: I34- ct r e c( R* ON: //Yl/ RECHECK: Comments and/or diagram Soil Ty.; r..m/Clay Type of Water. . unidpa ell Water Waterline separation distance 172 ft. '.. Well separation distance ft. Other wells: ft. Well Casing Length 50' +/- _Y N_N/A [150'to well required if NO] Absorption Reld: Total length T C ft. Length of each trench--ff. Depth of trenches zj ft. Size of Stone Seepage Pits: Number Size: x Stone Size: Piping Size Type Building to tank 9i; t Tank to Distribution Box Distribution Box to Reid/ Pit tc 4,0 P-35 y t`� Opening Sealed: .N End Cap _ _N Iniet/Outlet Pipes&Baffles '.2'� N Manholes 12"or less below grade vl Wj [provide extension collar if Yes] Y Location/Separations Foundation to tanL7 ft. trr-c-- ‘qy y� OFF-\$ Foundation to absorption ft. Separation of Pits /ft. 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