SEP-0655-2021 anti .r�.<
- ������i✓.L�,B��C����.E���M��.�1��,L� _�dtiy Gi::ce use aniv
9h?2 aay road,mueembur'y,MY Katia.
tarn=*ft`rt-ruiw>z o per tilt#:
Tax Map ID#a �rt► Permit Fee:$A 5 :invoice
Septic Variance? Yes rvo
Project Location: 0', &SSE IJ _
Pdmanj Owners) z e.-,
Mailing Address
Phone&Ernai! Rio ~
Installer/Builder
Mailing Address
Phone 11-U-mail
Engineer
Mailing Address Q /zt
Phone iv Email
Contact Person for Building Code Compl"eance:
RESIDENCE INFORMATION:
Year Built' #of bedrooms X gallons per bedroom =total daily flow Garbage Grinder Yes 1Vq
1980 or older Installed? (circle one)
Spa o ,X
?9S?-?991 r Not Tub Yes NPR
//0 installed? (circle one) K
1992-Present
PARCEL INFORMATION:
Topography Flat Rolling Steep Slope %Slope
Soil Nature Sand Loam Clay Other
Groundwater At what depth? Al
Bedrockjlmperv►ous material At what depth? /9
Domestic Water Supply _ unicipal _Well(if well,water supply from any septic system absorption is ft)
Percolation Test: Rate:/'GS' per minute per inch(test to be.conapleted by licensed en ineerlarchited)
PROPOSED SYSTEM FOR NEW EONSTRUCFlom.*
Tank size gallons(min.size 1,000 gallons,add 250 gallons for each garbage cylinder or spa/hot tub
System Absorption field with#2 stone Total length ' ft; Each Trench JSa ' ft.
Seepage Pit with#3 stone Now many: :Size:
('Alternative System Bed or other type: D
Holding:Tank System Total required capacity? :tank size :#ofianks
NOTES:1.Alarm sy#em-&associated electrical work musk be inspected by a T own approved electrical inspection
agency;2.We will no longer allow systems to be covered until such time as an as-built plan is received and approved_
The installed system must march the septic layout on file--no exceptions.
Declaration:Any-permit or approval granted which is based upon or is granted in reliance upon any material
representation or failure to make a material fact or circumstance known by or on behalf of an applicant,shall be void.l
have read the regulations and agree to abide by these and all requirements of the Town of Queensbury Sanitary Sewage
Disposal Ordinance. C�
PRINT NAME: DATE:
SIGNATURE: �-- DATE:
--� l
Town of Qaeembury Bu►Uding code Enforcement Revised February z017
�Q C65E --207_k
TOWN OF OUEENSBURY
742 Bay Road, Queensbury, NY. 12804-5902
Septic System Checklist
Plan to scale
Received Deep hole perc test results from engineer/Architect if applicable(Town Approved Engineers and
Architects;June 30 to April 15 Town Engineer for unapproved Engineers and Architects)
All wells on property and adjacent properties shownvo.��GOPt��
Water line shown Municipal or well 10'separation to any part of system
Setback to property lines show 10' or more for any part of system
Septic tank and pump stations 10'from foundation 50'from any well/lake/wetland 10'from any waterline
N-4t )FOCNU V-V�;' \-kW--lIF—
Septic tank to foundation crawl space/slab on grade,grade in crawl space must be above top of septic tank
for 0',Separation required (field verification required)
Septic tank sized for number of bedrooms and add 250 gals for Jacuzzi tubs/garbage grinder.each
4+_
Leech Field; from fGn�i 100'from any well 10'from water line
1�Seepage pit 150'from well 50'from septic tank
Seepage Pits 3-times diameter apart
Septic-tank and pump stations over 30 gallons 50'from watercourse or wetland
distance from bottom of trench or syste 4" edrock or mottling 36" within 1000'of Lake George
Leech field 100'from watercourse or wetland
\\)Toe of mound or bottom of retaining wall 10'from property line 100'from well 20'from
Foundation
Provide Engineer/Architect stamp for bed or design systems
Department of Health Approval for all mobile home park new systems Flood Plain requirements
_10_2' above established flood elevation to bottom of system
O'_ 1
All tanks anchored or 2' above flood elevation
Revised 4/15/2021
x�WYo�a�c Department
STATE OF
OFPORTUN.ITY_ of Health
ANDREW M. CUOMO t9OWARD A.ZUCKER;.M.D.,I.D. LISA 3. PINQ,M;A,ID.
Governor Commissioner Executive Deputy Commissioner
August 13,2021 -•• �-
Charles Baker,P.E. D Ei [
Environmental Design Partnership,LLP
900 Route 146 SEP 0 2 IMI
Clifton Park,NY 12065
TOWN OF QUEENSBURY
Re: Homestead Village Mobile Home Park BUILDING&COLpE
Facility ID#56-6911
Lots#62, 97&98;43,44,and Replacement Onsite Wastewater Treatment Systems
Queensbury(T),Warren County.
Dear Mr.Baker,
We have this day,approved the plans and specifications for the above referenced project. Application for.
this project was duly made by you on plans titled, "Septic Design prepared for Lot 62 Alpine Avenue
Homestead Village;Lot 97& 98 Alpine Avenue;Lot 43 Windsong Drive;Lot 44 Windsong Drive;Lot
79 Alpine Avenue," and were most recently dated June 30,202L. This project includes modification of
the Onsite Wastewater Treatment Systemerving Lots#62,97 &98, 43, 44,and 79. The replacement
systems consists of a 1,000-gallon septic,tanks and 150-feet of absorption trenches to serve 3-bedroom
homes. Approval of these'plans is conditioned on the following:
1. That the proposed,works be constructed in complete conformity with the approved plans or
amendments thereto;
2. That all components of the proposed works be installed, operated, and maintained as per the
manufacturer's.specifications;
3. That approval be granted by other agencies or municipalities having jurisdiction;
4. That the design professional provides inspects the construction and provides certification to this
office that construction was completed in accordance with the approved plans. Certification shall
also be provided to the Town Office Building and Code Enforcement.
The responsibility for the design of the sanitary system:lies solely with the design'professiondl and the
proper operation of"tfie sanifary 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
operation..A set of the approved plans is being retained in our files.
Sincerely,
Kevin J.Ke on
Profession Engineer I -
Glens Falls District Office
Empire State Plaza,Corning Tower,Albany,NY 122371 heaith,ny.gav
Cc: Jeffrey Cohen,Affordable.Great Locations,Inc.
Dave Hatin,Town of Queensbury
John Schroeder,Glens Falls District Office
Rebecca Bussert, Glens Falls District Office
Maria O'Connell, Glens Falls District Office