DOH approvalSER OZA-TOLD
Notice of Intent to Construct,
[NEW YORK STATE DEPARTMENT OF HEALTH
Bureau of Community Environmental Health and Food Protection
‘Please read instructions on back before completing form.
Enlarge or Convert a Facility
Proposed facility name:
‘evsing current faity name,Homestead Village Mobile Home Park 27
‘The property willbe used as:|__|Food service establishment ricultura fairground
-fa sean WN OF QUEENSBURYTemporaryresidenceMigrantfarmworkerhousing)3)Disa ODES
Children's camp ‘Mobile home park.~~
Campground Swimming poot
Mass gathering Bathing beach
coun Tow,Village GyWarrenCounty ‘Queensbury
New vation conversion Are plans tached?No
Detailed ination ret,bulding number distance from well-known point:(9.road,street buling ei Lot #119 Adirondack Street
Name of ome:Adress:Phone
Homestead Vago,LP PO Bon 180,Avon,NY 14418
Name of operator:Address:Phone:(5%782-7257
George Drellos 144 Luzerne Road Queensbury NY 12804
IRs proposed io describe in deta se adtiona sets if necessary
See Attached sheet
The following permits or approvals for the proposed construction,enlargement or conversion have been applied for or received:
Name of local code enforcement officer for facility location:Address:Phone:("761-8256
John O'Brien 742 Bay Road,Queensbury,NY 12804
Signature:Date:5/19/2020
Title:Owner Operator other specity Design Engineer
Maing Adress:Phones S721 15
Environmental Design Partnership,00 Route 146,Citon Park,NY 12065
DOH-154 (4/04)Page 1 of 2 (GEN-140)
ECEIWVEHi|
JUN 04 2000 |{U)
Homestead Village Mobile Home Park TOWN OF QUEENSBURY
Septic System Replacement for Lot #119 Adirondack Street BUILDING &CODES
Supplemental Information to NYS DOH Form 154
“Notice of Intent to Construct,Enlarge or Convert a Facility”
May 19,2020
This application proposes to replace the septic system for Lot 119 Adirondack Street in the
Homestead Village Mobile Home Park.Approximately 61 systems have been replaced in the
park since roughly 2007.The park is served by a central potable water system.
The soils on the park property are very well drained sandy soils with a typical percolation rate of
approximately one minute per inch.Soil and percolation tests were done park wide several years
ago prior to the first replacements.Tests from that era have been accepted by the Town and
DOH and are not repeated when new replacements are proposed.
The septic replacements are done when the prior sanitary facilities show signs of failure.Ina
prior agreement with NYS DOH,the design engineer reviewed each site when a new system was
needed.Plans were rapidly developed and submitted to the Queensbury building inspector for a
building permit.Copies of the plans were also submitted to NYS DOH for their records but a
blanket approval for the park had been issued allowing construction to proceed upon issuance of
the building permit.Inspections of the new system were conducted by the design engineer's
representative prior to backfilling and a letter summarizing the inspection is submitted to the
Queensbury building inspector.This arrangement allowed for the quick replacement of the
failed systems with a new tank and field.
This application is the fifth under new DOH policy to review plans before a building permit can
be issued by the Town.Lot #119 Adirondack Street requires quick attention as the prior system
has failed.The applicant respectfully appreciates every effort to streamline the approval of the
replacement system.