2010-567 41" TOWN OF QUEENSBURY
742 BayRoad, eensb NY 12804-5902 (518)761-8201
Qu ury�
Community Development- Building &Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: P20100567 Date Issued: Monday, December 13, 2010
This is to certify that work requested to be done as shown by Permit Number P20100567
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 �41
property owner of the responsibility for compliance with Site Plan, (?)(441-(/ .\
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.
TOWN OF QUEENSBURY
F4742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
0
Community Development- Building&Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20100567 Application Number. A20100567
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
2010-567
14& 15 Windsong- Septic Alteration
$35.00 PERMIT FEE PAID- THIS PERMIT EXPIRES: Thursday,December 08, 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,wQueensbury; / Wei4ne day,December 08,2010
/1
SIGNED BY LIZ,/) j ,°v` xf. f-.`Y' for the Town of Queensbury.
Director of Building°& .>Enforcement
sitg„, _
, , Community Development Office
Town of Queensbury • 742 Bay Road • Queensbury;
Septic Inspection Report
Office No. (518)761-8256 Date Inspectio -"T•
Queensbury Building&Code Enforcement Arrive: L- 1doo .**��..rt: am/pm
742 Bay Rd., Queensbury, NY 12804 Inspector's Initial. /_
NAME: t-t M '‘3 t` .LLE ' RMTT NO.: 10 —, �
LOCATION: LC5`5i Ia 1S �J��J��Go`,� ��' r NSPECTON: 1 Z —1 '��\C�
RECHECK:
Comments and/or diagram
Soil Type: Loam/Clay
Type of Water: unici I Water
Waterline separation distance 10 _ft.
Well separation distance ft.
Other wells: ft.
Well Casing Length 50'+/- Y N N/A
[150'to well required if NOl
Absorption Field: Total length ft.
Length of each trench ft.
Depth of trenches ft.
Size of Stone
Seepage Pits: Number
Size:
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 Yesj Y N
Location/Separations
Foundation to tank ft.
Foundation to absorption ft.
Separation of Pits
t Plan N
As-BuitY—N
ETU Maintenance Contract Y_ N
provided
Location of System on Property:
Front Rear Left Side Right Side Middle Front Middle Rear
em ..t _ .
Approved
Partial Approved and needs to be re-inspected, please call the Building&Codes Office
Disapproved
L:\Pam Whitingt2010\Building Codes Forms\Inspectlon Forms\SepUc Inspection Report_03 29 10.doc
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ENVIRONMENTAL DESIGN
PARTNERSHIP,LLP
December 13, 2010
Queensbury Building& Code Enforcement
742 Bay Road
Queensbury,NY 12804
Via email johno@queensbury.net
Attn: John O'Brien
Re: Homestead Village Mobile Home Park
Lot 14 & 15 Windsong
Dear John:
On December 10, 2010 our office inspected the 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 December 2, 2010.
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,
674r/Vb425
James E. Mitchell, P.E.
900 Route 146,Clifton Park, New York 12065 phone(518)371-7621 -fax(518)371-9540
(7c:OoYT/i i;;)(4?
Septic Inspection Report
Office No. (518) 761-8256 Date Ins•- ion -'u-: -•= -ed:
Queensbury Building &Code Enforcement Arrive: t S f ri S . De.. ": eleilDern..
742 Bay Rd., Queensbury, NY 128Q4 Inspector's Initials:
NAME: - ? '►'1P 5�`�`/' ' RMIT NO.: C9-
LOCATION: / � S' j 1-N-44-5 �i�- INSPECT ON: _ ' _ C
RECHECK: J
Comments and/or diagram
Soil Type: Loam/Clay
Type of Water: nici ell Water
Waterline separation distance 11-> 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 asin ft.
Length of each trench !-4)ft.
Depth of trenches 2r -- ft.
Size of Stone
Seepage Pits: Number
Size: x
Stone Size:
Piping Size Type
Building to tank y 1% )0_,(-\ U
Tank to Distribution Box 1. " !v p e-2 5
Distribution Box to Field/ Pit 4 tik 4, R ;2>-, '�p��_ c 0
v
Opening Sealed: / N
End Cap <Y, N
Inlet/Outlet Pipes&Baffles v Y/ N
Manholes 12"or less below grade jZY_N
[ n Ilar
Location/ Separations
H Foundation to tank ft.
C'114 Foundation to absorption ft.
Separation of Pits ft.
Conforms as per Plot PlanY
Engineer Report and As-Built —Y r
—�
ETU Maintenance Contract _Y N ��� — �\ t3 _9-I'a
provided
Location of System on Property:
Front Rear Left Side Right Side Middle Front Middle Rear
st m Use Status:
Approved
Partial Approved and needs to be re-inspected, please call the Buildin Codes Office
Disapproved
L:\Pam Whiting\2010\Building Codes Forms\Inspection Forms\Septic Inspection Report03 29 10.doc
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