2007-480 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. P20070480 Date Issued: Monday, January 10, 2011
This is to certify that work requested to be done as shown by Permit Number P20070480
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 Bowl
TOWN OF QUEENSBURY
Issuance of this Certificate of Compliance DOES NOT relieve the
property owner of the responsibility for compliance with Site Plan, s
Variance,or other issues and conditions as a result of approvals by theDWctor of Building bode Worcement
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: P20070480 Application Number. A20070480
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
2007-480
septic alteration for lots 95 &96
$35.00 PERMIT FEE PAID- THIS PERMIT EXPIRES: Wednesday,July 30,2008
(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 712;
b y,July 30, 2007
SIGNED BY for the Town of Queensbury.
Director of Building&Code Enforcement
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' r r OFFICE USE ONLY +
TAX MAP NO. PERMIT N0, PERMIT FEE, -C>G' rm_
+ + +
+
APPROVALS: ZONING TOWN CLERK ,
APPLICATION FOR SEPTIC DISPOSAL SYSTEM PERMIT:
A PERMIT MU T BE OBTAINED BEFORE WORK BEGINS.APPLICATION IS SUBJE TO REVIEW BEFORE ISSUANCE OF A VALID
PERMIT.
OWNER: INSTALLER l
ADDRESS J 2 �' '*/ ADDRESS: _ v ` Z 2 ' y
PHONE NOS., �� � PHONE NOS. 1796
LOCATION OF INSTALLATION: __` r 9s,,4 94,
...............................-.....................................................................;.....-......................................,...........................�............._................................................................... RESIDENCE INFORMATION.
.YEAR BUILT.... .,..O ..�..X .COMPUTATION. ........
1980 r ................................ GARBAGE GRIND
0 older X 150 gallon per bedroom = 1 INSTALLED?
,1981 -1991w;.. ....»........_.. X.. .....130 gallon per bedroom.....�....=...r..................................................................... SPA OR HOT TUB.. ........................ ..................................-..,................, INSTAL
+ 1992-present - X...t.. 110 gallon per bedroom j = i LED?
........»... ............................................................................ ...................................................................................i.......................,...................................................
PARCEL INFORMATION: /�
✓ TOPOGRAPHY: FLAT ROLLING •' STEEP SLOPE %SLOPE
✓ SOIL NATURE: SAND LOAM CLAY OTHER
✓ GRQUNDWATER: AT WHAT DEPTH? BEDROCKAMPERVIOUS MATERIAL: AT
WHAT DEPTH?
✓ DOMESTIC WATER SUPLY: MUNICIPAL WELL
—
(IF WELL:WATER SUPPLY FROM ANY SEPTIC-SYSTEM ABSORPTION IS FT. )
✓ PERCOLATION TEST: RATE IS PER MIINUTE 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). Add 250
gallons to the size of the septic tank and leach field for each garbage grinder, spa or whirlpool tub.
✓ SEPTIC TANK:/ � GALLON (MIN. SIZE IS 1,000 GAL.) TILE FIELD: EACH TRENCH FT.
✓ TOTAL SYSTEM LENGTH: FT. SEEPAGE PIT($): HOW MANY?
✓ SIZE OF EACH FT. X________FT.
✓ SIZE OF STONE TO BE USED: # -' /DEPTH OR THICKNESS fi/-2'FT.
✓ BED SYSTEM SIZE: X
✓ ALTERNATIVE SYSTEM: LENGTH AND/OR SIZE
✓ HOLDING TANK SYSTEM:(if required) NO. OF TANKS: /SIZE OF EACH
✓ GALLONS./TOTAL CAPACITY. GAL. ks � T&A%/. ... ...., ..,....,.,,,...1.................,, ....................
{ 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 nsbur-56 OR EMAIL
uee bury Sanitary ew a Disposal Ordinance.
codes�aueensburv.net
/ VISIT OUR WEBSITE FOR MORE INFORMATION
/2
� O*'1 wwwsweensbumnet
i ature of Perso esponslble Date
Town of Queensbury - Community Development Office - 742 Bay Road, Queensbury, NY 12804
Foundation Inspection Report
Office No.(518)761-8256 Date Inspectionyeuest received:
Queensbury Building&Code Enforcement Arrive: � ',-7,_am/pm Depart: am/pm
742 Bay Rd.,Queensbury,NY 12804 Inspector's Initials:
NAME: 15e-/)W r✓Z(: PERMIT#:
LOCATION: W--1- INSPECT ON: O
TYPE OF STRUCTURE:
Comments
Y N N/A
Footings
Piers
Monolithic Slab
Reinforcement in Place
The contractor is responsible for
providing protection from freezing
for 48 hours following the placement
of the concrete.
Materials for this purpose on site.
Foundation/Wallpour
Reinfo Place
Footin Dowel or Keyway in place
Foundation Dampproofing
Foundation Waterproofmg
Footing Drain Daylight or Sump
Footing Drain Stone:
12 inch width
6 inches above footing
6 mil poly for wet areas under slab
Backfill Approval
Plumbing Under Slab
PVC/Cast/Copper
Foundation Insulation Interior/Exterior
R-
Rough Grade 6 inch drop within 10 ft.
U folding&Codes Formsftilding&Codes\Inspection Forms\Foundation Inspection Report-doc
Last printed 12/20/2005 9:24:00 AM
Foundation Inspection Report
Office No.(518)761-8256 Date Ins cti request received:
Queensbury Building&Code Enforcement Arrive: am/p Depart: am/pm
742 Bay Rd.,Queensbury,NY 12804 Inspect s Initials:
NAME: PERMIT#:
LOCATION: INSPECT ON:
TYPE OF STRUCTURE:
CommentsY N N/A
Footings
Monolithic Slab
Reinforcement in Place
The contractor is responsible for
providing protection from freezing
for 48 hours following the placement
of the concrete.
Materials for this purpose on site.
Foundation/Wallpour
Reinforcement in Place
Footing Dowels or Keyway in place
Foundation Dampproofmg
Foundation Waterproofing
Footing Drain Daylight or Sump
Footing Drain Stone:
12 inch width
6 inches above footing
6 mil poly for wet areas under slab
Backfill Approval
Plumbing Under Slab
PVC/Cast/Copper
Foundation Insulation Interior/Exterior
R-
Rough Grade 6 inch drop within 10 ft.
L folding&Codes Formsftilding&Codes\Inspection Fonns\foundation Inspection Report.doc
Last printed 12/20/2005 9:24:00 AM
Septic Inspection Report
Office No. (518) 761-8256 Date Inspection req ved•
Queensbury Building&Code Enforcement Arrive: �inld
rt: am/pm
742 Bay Rd., Queensbury, NY 12804 Inspectnles
I -7 ) ,�L:'
NAME: �t" RMIT NO.:
LOCATION: S ` KL a INSPECT ON: -
RECHECK:
Comments andlor diacimm
Soil Type: Sand/ Loam Clay
T of Water: Municipal Well Water ti�f r
Waterline separation distance ft.
Well separation distance ft.
Other wells: ft.
Well Casing Length 50' + /-
150'to well required if NO
Absorption Field: Total lengthft•
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
O i Sealed: Y N
End qaL Y N
Inie 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-
SeDaration of Pits ft.
Conforms as per Plot Plan N
Engineer Report and As-Built�2y N
ETU Maintenance Contract ___ Y____N
rovided
Location of System on Property:
Front r Left Side Right Side Middle Front Middle Rear
stem t
Approved
Partial Approved and needs to be re-inspected, please call the Building&Codes Office
Disapproved
U\Pam Whiting\2010\13uiiding Codes Forms\Inspectlon Forrns\Septic Inspection Report..03 2910.d0c
ENVIRONMENTAL DESIGN
PARTNERSHIP,LLP
August 8,2007
New York State Department of Health
77 Mohican Street
Glens Falls,NY 12801
Attn: Mike Shaw
Re: Homestead Village Mobile Home Park
Lots 95196
Dear Mike:
On July 31, 2007 I visited the site of Lots 95 and 96 of the Homestead Village Mobile Home
Park on Alpine Ave. in the Town of Queensbury. The purpose of this visit was to observe the
installation of the new septic system designed by EDP and approved by your office on July 30,
2007. The approved plans are entitled:
SHEET 1 OF 2
SEPTIC DESIGN PREPARED FOR LOT 95&96 ALPINE AVENUE
HOMESTEAD VILLAGE TOWN OF QUEENSBURY
DULY 5, 2007
SHEET 2 OF 2
SANITARY DETAILS FOR LOTS 95&96 ALPINE A VENUE
HOMESTEAD VILLAGE TOWN OF QUEENSBURY
JULY5, 2007
Based on my review of the plans and observation of the installation it is my opinion that the
installation of the system is in compliance with the intent of the design plans. Copies of the as-
built plan will be submitted to the Town of Queensbury. Please contact me should you have any
questions regarding this system.
Sincerely,
690re�o
James Mitchell, PE
900 Route 146,Clifton Park,New York 12065 phone(518)371-7621 -fax(518)371-9540
Gill
Page 2 IIilllllll
Insert Recipient Name Here
Insert Date Here
Cc: Dave Hatin,Town of Queensbury
Larry Pasco,Homestead Village Mobile Home Park
900 Route 146,Clifton Park, New York 12065 phone(518)371-7621 - fax(518)371-9540
Pool Inspection
Queensbury Building&Code Enforcement
Office No.(518)761-8256
742 Bay Road,Queensbury,NY 12804
Date received: l
NAME:
LOCATION: 2
PERMIT#: h,v't--'n
o
INSPECTED ON: 0 am/pm
Arrive: am/pm 6epa am/pm
Inspector's Initials: -
Above Ground: In-Ground:
Y Ir N N/A
Pool enclosure around pool
or yard
4 feet above grade
2 inch maximum clearance
to grade from underside of
fence
4 inch maximum clearance
in fence pickets
Wall or Doors have self
closing device or alarms(30
second Alarm time)
Ladder secured in place and
latched
Deck gate < 56" to latch no
more than %2" spacing in
ate o enin s
ate open outward, self
closing
'Padlock provided on gates
and ladder
Indoor pool all doors self
closing or alarmed per
AG 105.2 Item 9
Timer on pool pump (no
plug in timer allowed
Final electrical
Vehicle access gate closed
&locked
Ok to issue C/C
COMMENTS:
i
7
Septic Ins _Z
p Inspection Report �
Office No. (51$)761-8256 Date Inspectionrequest received:
Queensbury Building&Code Enforcement Arrive: z 5 am4M> &pa!t: am/pm
742 Bay Rd., Queensbury, NY 12804 JI spector's Initials:
NAME: 1/ PERMIT NO.: �-7'VLJ
LOCATION: INSPECT ON:
RECHECK:
Comments and/or diagram
Soil TypevSan Clay
Type of : Munici Well Water
Waterline se istance ft.
Well separation distance ft.
Other wells: ft,
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 Si Type/-
Building to tank
Tank to Distributi Box 070W
Distribution Box tmPield Pit t
Opening Sealed: Y N Partial
End Ca
Inlet/Outlet Pipes&Baffles Y N
Location Se rations
Foundation to tank ft. �jE-� �•5- '�✓U(�
Foundation to absorption ft.
Separation of Pits ft
Conforms as r Plot Plan Y 0k,�"r AS — �U I i p L4
Engineer Report and As-Built Y N
Location of System on Property: G
Front Rear Left Side Right Side
Middle Front Middle Rear U ��System Use Status:
pproved
Partial Approved and needs to be re-inspected, please call the Building &Codes Office
Disapproved
Last revised 021006
Last revised 1/6/05
-
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