2010-168 TOWN OF QUEENSBURY
^w 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development- Building &Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: P20100168 Date Issued: Friday, August 27, 2010
This is to certify that work requested to be done as shown by Permit Number P20100168
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 Commercial
By Order of Town Board
TOWN OF QUEENSBURY
Issuance of this Certificate of Compliance DOES NOT relieve the ( > / d
property owner of the responsibility for compliance with Site Plan, ° P
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.
4111 ` TOWN OF QUEENSBURY
FoN 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development- Building&Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20100168 Application Number. A20100168
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 Commercial
CALEDONIA, NY 14423 Total Value
Contractor or Builder's Name/Address Electrical Inspection Agency
SANITARY SEWER
DAN DRELLOS
PO BOX 224
GLENS FALLS NY
Plans &Specifications
2010-168
SEPTIC ALTERATION COMMERCIAL- lots 121 & 122 Adirondack Ave
$35.00 PERMIT FEE PAID- THIS PERMIT EXPIRES: Wednesday,April 20, 2011
(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 T eensbiry;;i / u /' • =-April 20, 2010
r`
SIGNED BY ,41:4 4 \ for the Town of Queensbury.
Director of Building&Code Enforcement
OFFICE USE ONLY
TAX MAP NO. / '
PERMIT NO.�,,%6,5 PERMIT FEE ; )
APPROVALS: ZONING / # �, 2 "() }� �
TOWN CLERK
•
•
APPLICATION FOR SEPTIC DISPOSAL SYSTEM PERMIT:
A PERMIT MUST BE OBTAINED BEFORE WORK BEGINS.APPLICATION IS SUBJE T TO REVIEW BEFORE ISSUANCE OF A VALID
PERMIT. r
OWNER: I`- 6/404/ -e11-1) (�// f INSTALLER %)/''`7 744'
� -
��s��
ADDRESS: Z. :2-2-42-10 Z i7 ADDRESS: 0 ,CdJ�C P Y 61F
y
PHONE NOS. / 72 PHONE NOS. ` `� OF�J
LOCATION OF INSTALLATION: C-01J 0,-)D f}. A-vi-
YEAR BUILT NO.OF X COMPUTATION= RESIDENCE INFORMATION:
BEDROOMS TOTAL DAILY FLOW
1980 or older X 150 gallon per bedroom = GARBAGE GRINDER
INSTALLED? VO
1981 -1991 X 130 gallon per bedroom =
1992-present X 110 gallon per bedroom = SPA OR HOT TUB -
INSTALLED?
PARCEL INFORMATION:
✓ TOPOGRAPHY: Flat rolling ` Steepslope p %Slope
✓ SOIL NATURE: Sand Loam
Clay Other
✓ GROUNDWATER: At what depth?
✓ BEDROCK/IMPERVIOUS MATERIAL: At at depth?
✓ DOMESTIC WATER SUPLY: Municipal Well (If well: Water supply from any septic
system absorption is ft.)
✓ PERCOLATION TEST: Rate is per minute per inch.
(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 installed in a Planning Board approved subdivision).
TANK SIZE: (C)°°<--
GALLON (MIN. SIZE IS 1,000 GAL.)Add 250 gallons to the size of the septic tank for
each garbage grinder, spa or whirlpool tub. p
SYSTEM TYPE:
ABSORPTION FIELD (WITH NO. 2 STONE) Total length ;5)-ft. Each trench 9 X 1..
O 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 misreoresentatinn nr
OF W YORK
PTE_,
Dom DEPARSTATETMENT NEOF HEALTH
Glens Falls District Office
77 Mohican Street Glens Falls,New York 12801 (518)793-3893 Fax(518)793-0427
Richard F. Daines,M.D. James W. Clyne,Jr.
Commissioner Executive Deputy Commissioner
April 27, 2010
Mr.James E. Mitchell,P.E.
EDP,LLP
900 Route 146
Clifton Park, NY 12065
Re: Letter of Approval
Homestead Village MHP Septic Replacement
Lots 121/122 Adirondack Drive
Town of Queensbury, Warren County
DOH Facility Code: 56-9611
Dear Mr. Mitchell,
We have approved the septic system replacement for the'Homestead Village MHP in the Town of Queensbury,
Warren County. The approved design is described on plans designed by your office and titled Septic Design
Prepared for Lots /21 and 122 Adirondack Avenue, Homestead Village and most recently dated April 15,
2010.This approval is conditioned on the following:
• Construction is completed in accordance with the approved plans.
• Construction is inspected by a design professional and certified to this office and the applicable code
enforcement office.
• Construction is completed within two years of the date of this approval. After that time, plans must be
resubmitted to the Department of Health for review and approval prior to any construction.
The responsibility for the design of the sanitary system lies solely with the design professional and the proper
operation of the sanitary system lies solely with the owner. The purpose of the Department of Health review is
for compliance with the New York State Sanitary Code and in no way guarantees proper system operation.
Enclosed you will find two sets of the approved plans,one copy should be made for your records. Please
forward a copy to the owner/applicant and a copy to the code enforcement office. An additional set of the plans
will remain on file in the Glens Falls District Office. Please contact me if you have any questions.
Respect ully,
Ike Shaw
Senior Sanitary Engineer
cc: Anita Gabalski
Town of Queensbury
Kristen Sayers
P/Data/Becky D/Plan Reviews/OWTS/Approvals/Homestead Village 121 122
Septic Inspection Re• •it
Office No. (518) 761-8256 Date Inspectio • •- iv:.:
Queensbury Building&Code Enforcement Arrive: '?j • • i �•�a• : am/pm
742 Bay Rd., Queensbury, NY 12804 Inspector's Initial• •�
NAME: _ ` p711 NO.: 1 D — a
LOCATION:[ IL 171 (P n t i.nn�DA[ I CT ON: -- 1 S— \r)
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]
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
Foundation to absorption ft.
Separation of Pits ft.
_Confertus-ac,per Plo • - • N
�•ineerRe.• •n: -:uilt VYlN
'aintenance Contract _Y N
provided
Location of System on Property:
Front Rear Left Side Right Side Middle Front Middle Rear
System Use Stag
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
11111111111111 .44
IIIIIIIIIIIII
ENVIRONMENTAL DESIGN
PARTNERSHIP,LLP
August 24, 2010
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 124 & 121-Adirondack
Dear John:
On August 10, 2010 I visited above referenced Homestead Village Mobile Home Park lots. The
purpose of this visit was to observe the installation of the new septic system designed by EDP
dated April 15, 2010.
Based on my review of the plans and observation of the installation it is my opinion that the
installation of the system is in compliance with the intent of the design plans. I would like to
note that 5 lines at 50 feet each were installed in lieu of 4 lines at 63 feet as indicated on the
original plan. I am mailing a revised plan.
Please contact me should you have any questions regarding this system.
Sincerely,
4C)94640b2:
James E. Mitchell, P.E.
900 Route 146, Clifton Park, New York 12065 phone(518)371-7621 -fax(518)371-9540
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Septic Inspection Report
Office No. (518) 761-8256 Date Inspection request received:
Queensbury Building&Code Enforcement Arrive: am/ m Depart: 4:__111,_
am/pm
742 Bay Rd., Queensbury, NY 12804 Inspector's Initials: 1Li`.
NAME: \ikt-1-- PERMIT NO.: 2 _Q
LOCATION: 1 i *� _ r k '' INSPECT ON: - r► r
RECHECK:
",---- Comments and/or diagram
Soil Type / Loam/ Clay
Type of Water: v l ick/ Well Water
Waterline separation distance ft.
Well separation distance va—ft.
--i-----
Other wells: ft.
Well Casing Length 50' +/ - Y N N/A
Absorption Field: Total length 21 t ft.
Length of each trench cr ft.
Depth of trenches 2•* ft.
Size of Stone
Seepage Pits: Number
Size: N x
Stone Size:
Piping Sze Type
Building to tank ` �)_-5k
Tank to Distribution Box ``
- )1'7-' 6
Distribution Box to Field/ Pit 4-
5(13),1_
Opening Sealed: Y_N �-�
End Cap /�_N �� �\ �
Inlet/Outlet Pipes&Baffles V Y—N
Location/ Separations
• Foundation to tank 'f ft.' �
Foundation to absorption ft. --,,c4 A_
--k.,-4.. /Lie
Separation of Pits ft.
Conforms as per Plot Plan V Y--
Engineer Report and As-Built Y A! N
Location of System on Property:
Front Rear Left Side Right Side Middle Front Middle Rear
-, U .
Approved
�.�V Partial Approved and needs to be re-inspected, please call the Building &Codes Office
Disapproved
Last revised 06/18/07 L:\Building&Codes Forms-OLD\Building&Codes\Inspection Forms\Septic Inspection Report.doc