2008-362 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: P20080362 Date Issued: Monday, December 05, 2011
This is to certify that work requested to be done as shown by Permit Number P20080362
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
4 �
Issuance of this Certificate of Compliance DOES NOT relieve the A/
roe owner of the responsibility for compliance )k��Vp �¢Vp p rty p ty p ance 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: P20080362 Application Number. A20080362
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 Septic Alteration Commercial
4294 ROUTE 5
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
2008-362
SEPTIC ALTERATION 137 &138 ADIRONDACK ST
$35.00 PERMIT FEE PAID- THIS PERMIT EXPIRES: Friday,July 03, 2009
(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.)
I '
Dated at the T wn of ee u� rsday,July 03, 2008
f
SIGNED BY for the Town of Queensbury.
Director of Building&Code Enforcement
--"" OFFICE USE ONLY-- ___________ % or_.___Y«
TAX MAP NO. PERMIT NO. ZPERMIT FEE ;
APPROVALS: ZONING TOWN CLERK ;
' + /
------------------------------------------------------------ —. 0---._________________.
APPLICATION FOR SEPTIC DISPOSAL SYSTEM PERMIT:
A PERMIT MU T E OBTAINED BEFORE WORK BEGINS.APPLICATION IS SUBJECT EVIEW BEFORE ISSUANCE OF A VALID
PERMIT. >
OWNER: /�A �%to INSTALLER: `✓
ADDRESS: '"" J �—��/�C- J6
ADDRESS: t
PHONE NOS. 7 2, / O J PHONE NOS, / 96J
LOCATION OF INSTALLATION:
RESIDENCE INFORMATION:
YEAR BUILT NO.OF X COMPUTATION= = TOTAL DAILY FLOW
BEDROOMS GARBAGE GRINDE
1980 or older X 150 gallon per bedroom = INSTALLED?
1981 -1991 X 130 gallon per bedroom = SPA OR HOT TUB
1992-present X 110 gallon per bedroom = INSTALLED?
PARCEL INFORMATION: (' g�1�f,.�',y`j ?L A 7-} f'
✓ TOPOGRAPHY: Fiat rolling Steep slope `J %Slope
✓ SOIL NATURE: Sand Loam Clay Other
✓ GROUNDWATER: At what depth?
✓ BEDROCK/IMPERVIOUS MATERIAL: At what depth?
✓ DOMESTIC WATER SUPLY: Municipal ---,"Wel1 (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: 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.
SYSTEM E:
ABSORPTION FIELD (WITH NO. 2 STONE) Total length -tt. Each trench 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 by or on behalf of an applicant, shall be void.
I have read the regulations with respect to this application and
agree to abide by these and all requirements of the Town of QUESTIONS? CALL codes @ aueensbursbury- OR EMAIL
.net
ZQueensbury Sanitar wage Disposal Ordinance.
VISIT OUR WESSITE FOR MORE INFORMATION
� wwvy.aueensbury.net
ture of Person esponsible Date
a,a , Town of Queensbury • Community Development Office • 742 Bay Road, Queensbury, NY 12804
i�
Septic Inspection Report
Office No. (518)761-8256 Date In req
Queensbury Building&Code Enforcement Arrive: ��� part: _ "L j� a pm
742 Bay Rd., Queensbury, NY 12804 Inspector's Initial
NAME: G' fig RMIT NO.: 4
�--
LOCATION: 13 r t*vzj• ) INSPECT ON:
RECHECK:
Comments n�, d/or diagram
Soil Type: Sand Loam Claya
Type of Water: Municipal Well Water (�5?G�f Ocz 7` 3
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 CaD N
In 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 ft.
Conforms as per Plot Plan N
Engineer Report and As-Built �jfEN
ETU Maintenance Contract Y_N
provided
Location of System on Property:
Front R r Left Side Right Side Middle Front Middle Rear
s:
Approved
Partial Approved and needs to be re-inspected, please call the Building&Codes Office
Disapproved
L:\Pam whiting\2010\Building Codes Formsunspectlon Foms\Septic Irapectlon Report 03 2910.doc
. AL
01
ENVIRONMENTAL DESIGN
PARTNERSHIP,LLP
August 26, 2011
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 137/138 Adirondack
Dear John:
On July 25,2011 our office conducted a review of the septic system installed at the above noted
location on August 5, 2008. Our inspection indicated that the system appears to have been
installed as shown on the design plan dated June 4, 2008.
We have been unable to find our notes related to our field inspection which took place at the time
of installation,however, we are certain that we did perform the inspection and the system was
installed as indicated on the plan.
Please contact me should you have any questions regarding this system.
Sincerely,
James E. Mitchell, P.E.
900 Route 146,Clifton Paris, New York 12065 phone(518)371-7621 -fax(518)371-9540
STATE OF NEW YORKDM �`��
DEPARTMENT OF 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. Wendy E.Saunders
Commissioner Chief of Staff
November 13, 2008
Mr. James Mitchell, P.E.
EDP, LLP
900 Route 146
Clifton Park,NY 12065
Re: Letter of Approval
Homestead Village MHP Septic Replacement
Lot 137/138
Town of Queensbury, Warren County
DOH Facility Code: 56-9611
Dear Mr. Mitchell,
We have approved the septic system replacements 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 Lot 137 and 138 Adirondack Street Homestead
Village and most recently dated June 4, 2008. 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 one set 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.
Respectf(ull�y,
Ajlltiv
Mike Shaw
Senior Sanitary Engineer
cc: Anita Gabalski
Town of Queensbury
OU
Septic Inspection Report
Office No. (518) 761-8256 Date Ins ction r s ed-
Queensbury Building &Code Enforcement Arrive: ,' 9 p rt:
742 Bay Rd., Queensbury, NY 12804 Inspector's Initia
NAME: IT NO.: � 36
LOCATION: �s� , SPECT ON:
RECHECK:
Comments and/or diagram
Soil Ty n /Clay
Type of Water: Well Water
Water a aration distance ft.
Well separation distance ft.
Other wells: ft.
Well Casing Length 50' + / - Y N N/A
Absorption Field: Total length ft.
Length of each trench Ck ft.
Depth of trenches ft.
Size of Stone
See a e Pits: Number
Size: x
Stone Size:
Piping Size Type
Building to tank 1, "
Tank to Distribution Box
Distribution Box to Field Pit
Opening Sealed: N
End Ca _ N
Inlet/Outlet Pipes&Baffles _ N "��
v
Location Separations
Foundation to tank ft.
Foundation to absorption ft.
ration of Pits zft.
nforms as-her Plot Man Y
n ineer Re Dort h --Built Y 5?
Locatio on Property:
Front Rear Left Side Right Side Middle Front Middle Rear
System Use Status:
pproved
Partial Approved and need -ins , peas
Disapproved
Last revised 06/18/07 L:\Building&Codes Forms-OLD\Building&Codes\Inspection Forms\Septic Inspection Report.doc
Septic Inspection Report
Office No. (518) 761-8256 Date Ins ioequest received:
Queensbury Building &Code Enforcement Arrive: am/ D part: am/pm
742 Bay Rd., Queensbury, NY 12804 Inspecto s Initials:
NAME: PERMIT NO.:
LOCATION: A INSPECT ON:
RECHECK:
Comments and/or diagram
Soil Ty Loam/ Clay
Ty of Water: unici Well Water
Waterlin ration distance ft.
Well separation distance ft.
Other wells: ft.
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 Ty e
Buildingto tank �2 3
Tank to Distribution Box
Distribution Box to Field Pit c
Opening Sealed: N
End Ca N
Inlet/Outlet Pipes&Baffles —j�— N
Location Separations
Foundation to tank NIEL
Foundation to absorption ft.
Separation of Pits zft.
Conforms as per Plot Plan Y
Engineer Report and As-Built Y_N
Location of System on Property: o
Front Rear Left Side Right Side Middle Front Middle Rea
System Use VAr
7 proved
Partial Approved and needs to be re-inspected, please call the Building &Codes Office
Disapproved
Last revised 06/18/07 L:\Building&Codes Forms-01-1)\Building&Codes\Inspection Forms\Septic Inspection Report.doc
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