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2008-630 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. P20080630 Date Issued: Monday, January 10, 2011 This is to certify that work requested to be done as shown by Permit Number P20080630 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 Omer 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, 4 4 Variance, or other issues and conditions as a result of approvals by the Director of Building& e E ement 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: P20080630 Application Number. A20080630 Tax Map No: 523400-309-009-0002-001-000-0000 Permission is hereby granted to: HOMESTEAD VILLAGE LP 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 Plans &Specifications 2008-630 3 &4 WINDSONG DR- 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�v1i` ::Pry, e a ecember 02, 2008 SIGNED BY ( for the Town of Queensbury. Director of Building&Code Enforcement OFFICE USE ONLY01 TAX MAP NO. / PER IT NO. ' PERMIT FEE APPROVALS: ZONING f TOWN CLERK ' A APPLICATION FOR SEPTIC DISPOSAL SYSTEM PERMIT: A PERMIT MUST BE OBTAINED BEFORE WORK BEGINS.APPLICATION IS SUBJECT REVIEW BEFORE ISSUANCE OF A VALID PERMIT. OWNER: �lA I� V1. INSTALLER:( 13 ADDRESS: W J�r�`t''- ��f� ADDRESS: P L PHONE NOS. / " ( V J PHONE NOS. J O ' LOCATION OF INSTALLATION: /�J [Q� �`�L� - RESIDENCE INFORMATION: YEAR BUILT NO.OF X COMPUTATION= TOTAL DAILY FLOW BEDROOMS GARBAGE GRINDER 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: ✓ TOPOGRAPHY: Flat rolling Steep slope %Slope ✓ SOIL NATURE: Sand Loam Clay Other ✓ GROUNDWATER: At what depth? ✓ BEDROCK/IMPERVIOUS MATERIAL: At what th? ✓ 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). (-A I ae, 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. SYST5M TYPE: ABSORPTION FIELD (WITH NO. 2 STONE) Total length ft. 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 (4i4g 1-8256 OR EMAIL abide by th an all requirements of the Town of burv.net Queens ury Sanitary Se g Disposa ance. MORE INFORMATION bury.net gnature of Perso esponsibie Date Town of Queensbury - Community Development Office • 742 Bay Road, Queensbury, NY 12804 �IIIIIIIIIIII� (Illlilllllll ENVIRONMENTAL DESIGN PARTNERSHIP,LLP January 7, 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 3 &4 Wiindsong Dear John: On December 9,2008 our office inspected the above referenced Homestead Village Mobile Home Park septic installation. The purpose of this visit was to observe the installation of the new septic system designed by EDP dated September 29, 2008. 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, James E. Mitchell, P.E. 900 Route 146,Clifton Park,New York 12065 phone(518)371-7621 -fax(518)371-9540 Septic Inspection Report Office No. (518) 761-8256 Date Inspection requ rece Queensbury Building &Code Enforcement Arrive: e m 742 Bay Rd., Queens ury, NY 1280 nspector's Initi NAME: _ ti1 `a - PERMIT NO.: i LOCATION: --s - INSPECT ON: RECHECK: �� � � Comments and/or diagram Soil T m/ Clay Type of Water- ici I W WL Water Wate ' ration distance k FT ft. -t- 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 1 ft. Size of Stone �kZ Seepage Pits: Number Size: x Stone Size: Piping Size Type Building to tank Tank to Distribution Box Distribution Box to Field/ Pit -_7-6 Y''FFAF Opening Sealed: VY N End Ca _ N Inlet/Outlet Pipes&Baffles N Location Separations Foundation to tank ft. Foundation to absorption ft. � ►J� Separation of Pits ft. l Conform an Y N L T� 1L En in and As-Built Y Location of System on Property: Front Rear a Side Right Sid Middle Front Middle Rear m Use s• Approved Partial App ved anoees to a ui Disapproved Last revised 06/18/07 U\Building&Codes Forms-OLD\Building&Codes\Inspection Forms\Septic Inspection Report.doc Septic Inspection Report Office No. (518)761-8256 Date Inspection reqPZrrNO.: ed: Queensbury Building&Code Enforcement Arrive: E apart: am/pm 742 Bay Rd., Queensbury, NY 12804 Inspector's Initials NAME: d1�' <� �.L' ' LOCATION: —� ei% l S ON: -- — RECHECK: Comments and/or diagram Soil Type: Sand/ Loam Clay TYW of Water: Municipal Well Water Waterline separation distance Well separation distance ft. — (f 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 ft. Separation of Pits ft. Conforms as per Plot Plan N Engineer Report and As-Built I VY—N ETU Maintenance Contract Y_ N provided Location of System on Property: Front Rear Left Side Right Side Middle Front Middle Rear m Approved Partial Approved and needs to be re-inspected, please call the Building&Codes Office Disapproved L:\Pam Whiting\2010\Bui1d1ng Codes Forms\Inspecdon Forms\Seplk Inspection Report_03 2910.doc ., - - u - ..fIUS.;aw1 v UN7 s 1J: �., �a �;�d�.,i_..+v r�., �.. _ ..,.,.�_..,:r�,,.a ,._.. ._ar,r i.. „ .J; � MaJr�2G '.. t.. 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