2008-629 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: P20080629 Date Issued: Monday, December 05, 2011
This is to certify that work requested to be done as shown by Permit Number P20080629
has been completed.
Tax Map Number: 523400-309-009-0002-00 1-000-0000
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, "'' r
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: P20080629 Application Number. A20080629
Tax Map No: 523400-3 09-009-0002-001-000-0000
Permission is herebygranted 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
Plans &Specifications
2008-629
37 & 38 Windsong Drive- septic alteration
$35.00 PERMIT FEE PAID- THIS PERMIT EXPIRES: Wednesday, December 02, 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.)
Dated at the To o 7:rl/v
rzi
December 02, 2008
SIGNED BY for the Town of Queensbury.
Director of Building&Code Enforcement
-_-_`r -- ------------ OFFICE USE ONLY
____________; ------'
Y
]PERMIT FEE
TAX MAP NO.+ PERMIT NO. ', ' � `` a I
..� -4,• ,
0
00 APPROVALS: ZONING TOWN CLERK ;
APPLICATION FOR SEPTIC DISPOSAL SYSTEM PERMIT:
A PERMIT ITT
PERMIT. BE OBTAINED BEFORE WORK BEGINS.APPLICATION IS SUBJE 0 REVIEW BEFORE ISSUANCE OF A VALID
OWNER:ji INSTALLER: �/" / �'J /��C�
ADDRESS: ADDRESS: 40 ! o Z2- 4
to � y
PHONE NOS. 79Z - 2-J of PHONE NOS. 796 —0
LOCATION OF INSTALLATION:
NO.OF RESIDENCE INFORMATION:
YEAR BUILT BEDROOMS X COMPUTATION= = TOTAL DAILY FLOW
GARBAGE GRINDS
1980 or older X 150 gallon per bedroom = INSTALLED?
1981 -1991 X 130 gallon per bedroom = SPA OR HOT TUB A a
1992-present X 110 gallon per bedroom = INSTALLED?,, ,y �,v
PARCEL INFORMATION: p6lln-'
✓ TOPOGRAPHY: Flat rolli Steep slope %Slope
✓ SOIL NATURE: Sand- 7—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: 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.
SYS M TYPE:
ABSORPTION FIELD (WITH NO. 2 STONE) Total length � �ft. Each trench X. 62
❑ 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 761-8256 OR EMAIL
Quee sbury Sani ar ewage Di sal Ordinance. codes @aueensburv.net
VISIT OUR WEBSITE FOR MORE INFORMATION
�`/ www.pueensbury.net
I nature of Person Responsible ate
Town of Queensbury - Community Development Office • 742 Bay Road, Queensbury, NY 12804
Septic Inspection Report
Office No. (518)761-8256 Date Ins
Queensbury Building&Code Enforcement Arrive: it
�742 Bay Rd., Queensbury, NY 12804 Inspector's INAME: Ct I�� 'LOCATION: _
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 Ca Y 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 Y N
ETU Maintenance Contract Y_N
provided
Location of System on Property:
Front R r Left Side Right Side Middle Front Middle Rear
tem
Approved
Partial Approved and needs to be re-inspected, please call the Building&Codes Office
Disapproved
L:\Pam Whiting\2010\Buiiding Codes Forms\Inspection Fomis\septic Inspection Report-03 2910.doc
Septic Inspection Report C w S-e C)
Office No. (518) 761-8256 Date Inspection req
Queensbury Building&Code Enforcement Arrive: a rt: ar
742 Bay Rd.,Queensbury, NY 12804 Inspector's Initials
NAME: �cry P S�` l� V it 1-1 _ 0
LOCATION: W ( S " ME NO.:
SPELT ON:
RECHECK:
Comments and/or diagram
Soil T m Cla
Type of WateiCNknidpal ll Water
Waterline separation distance ft.-
Well separation distance ft.
Other wells: ft,
Absorption Field: Total length ft.
Lencith of each trench ft.
Depth of trenches Z.- ft.
Size of Stone Z
Seepage Pits: Number
Size: x
Stone Size:
Piping Size Type
Building to tank ill, Hn
Tank to Distribution Box ki«
Distribution Box to Id Pit t,41 PE��
Opening Sea P ' I
End Ca
Inlet/Outlet Pipes&Baffles Y N
f Location Separations
40 tank ft. ,�1FED �tS�i��1Q �S SET
-�-�A ti La €WRdat loa to absorption ft.
.#-3S Separation of Pits ft. - t L�
Co Ian Y
En irteer Re rt and As-Built Y N
Location of System on Property:
Fron Rear eft Side Right Side
Middle Front Middle Rear
�-o �A�1�F►r-(_
System Use Status:
p ;1
roved
Partial Approved and s to be r
Disapproved
Last revised 021006
Last revised 1/6/05
STATE OF NEW YORKDQE '
DEPARTMENT OF HEALTH
Glens Falls District Office
77 Mohican Street Glens Fails,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 37/38
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 37 and 38 Windsong Drive Homestead Village
and most recently dated September 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 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.
Res ectfully,
t'
Mike Shaw
Senior Sanitary Engineer
cc: Anita Gabalski
Town of Queensbury
IIIIIIIIIIII
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 37/38 Windsong
Dear John:
On July 25, 2011 our office conducted a review of the septic system installed at the above noted
location on December 12, 2008. Our inspection indicated that the system appears to have been
installed as shown on the design plan dated September 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 Park, New York 12065 phone(518)371-7621 -fax(518)371-9540
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