2010-568 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: P20100568 Date Issued: Monday, April 02, 2012
This is to certify that work requested to be done as shown by Permit Number P20100568
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
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.
TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development-Building&Codes (518)761-8256
BUILDING PERMIT
Permit Number: P20100568 Application Number: A20100568
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 Constructio Value
Owner Address: HOMESTEAD VILLAGE L P Septic Alteration Commercial
4294 ROUTE 5 Total value
CALEDONIA,NY 14423
Contractor or Builder's Name/Address Electrical Inspection Agency
SANITARY SEWER
GEORGE DRELLOS 792-7257
PO BOX 224
GLENS FALLS NY
Plans&Specifications
2010-568
55 & 56 Windsong Dr
$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 Town of Queensbury; Wednesday,December 08,2010
SIGNED BY for the Town of Queensbury.
Director of Building&Code Enforcement
Septic Inspection Report_
Office No. (518)761-8256 Date Ins•-.1• , oast '- - ed:
Queensbury Building&Code Enforcement Arrive: $ 4." am •�"'� •- : -� e a, •m
742 Bay Rd., Queensbury, NY 12804 Inspector's In - 4/
NAME: b u in I* ' • • REMIT NO.: —5(0
LOCATION: "� .1♦ F V.INSPECT ON: Z.—1 "7,
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 ft.
Foundation to absorption ft.
Separation of Pits ft.
Conforms as per Plot Plan Y N
Engineer Report and As-Built Y—N
ETU Maintenance Contract _Y_N
provided
Location of System on Property:
Front • -.r Left Side Right Side Middle Front Middle Rear
tem _ - S. s:
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 Repork_03 29 10.doc
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\\, Septic Inspection Rep• •
•
Date Inspection r-• est r•,- -s
Office No. (518) 761-8256 Arrive:
or"----s Initial
Ip Depart: am/pm
Queensbury Building&Code Enforcement ctor's Initial • v
742 Bay Rd., Queensbury, NY 12804 / Pe
i I, PELT ON: C �
LOCATION: ,'�- �l , r-.:
"^
RECHECK: •
j ph{t' 'i fL.. I C Comments and/or diagram
Soil Type: Sand/ Loam / Clay
Type of Water: Municipal/ Well Water e '0 j red
Waterline separation distance ft.
Well separation distance ft.
Other wells: ft. 1 a f l
Well Casing Length 50' + / - Y N N/A
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 67.
Distribution Box to Field / Pit
Opening Sealed: _Y N
End Cap Y N
Inlet/Outlet Pipes&Baffles _Y N
Location/ Separations
• Foundation to tank ft.
Foundatio tion ft.
Separation of Pr ft.
Conforms as per Plot Plan _Y_ /
Engineer Report and As-Built _Y
Location of System on Property:
Front Rear Left Side Right Side Middle Front Middle Rear
Approved
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 Reportdoc
cirscr
Septic Inspection Report
Office No. (518) 761-8256 Date I •- ion r-•uest •=2% ed:
Queensbury Building &Code Enforcement Arrive: le = -� '--,rt: '` 6417 a •r.
742 Bay Rd., Quee bury, NY 12804 Inspector's Initials: —
NAME: f ime,) -(':„-ofP• ' G/)
MIT NO.: S
LOCATION: SSS - SPECT ON: — -
RECHECK: a
Comments and/or diagram
SoilTy•-• n•- ••m/Clay
Type of Wate r •.. t. ell Water
Waterline separation distance n4— 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 Z ft.
Size of Stone
Seepage Pits: Number
Size: x
Stone Size:
Piping Size Type
Building to tank 9 " 6c4k 4r
Tank to Distribution Box y" hi)PN: 5F
Distribution Box to Field/ Pit L-;'' 1, TO VEef
Opening Sealed: c N
End Cap t4 N
Inlet/Outlet Pipes&Baffles IX—N
Manholes 12"or less below grade ✓:N
[provide extension collar if Yes] Y N
Location/ Separations
Foundation to tank I ft.
Foundation to absorption ft.
Separation of Pits 1�Yft.
Conforms as per Plot Plan Y � F�v
Y\
Engineer Report and As-Built Y N
ETU Maintenance Contract _Y_N
provided
Location of System on Property:
Front Rear Left Side Right Side Middle Front Middle Rear
st m Use Sta s:
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
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