SEP-0319-2022 SEE 11 ICIDISD 0 5AL h3Et[CMf,,,. APP IC :6 ONYi office Use onill
r0_11:0011 42 Bag Read,QUeensl'unji,MY 12904
-�6 -��a =,l�tj'.i•��.�ti�'s?$'}'1"�%i7c ''r..csi7ii#:
Talc Flap OD Permit Fee: e • Invoice,#:/6 eD
Project Location: _ � y 9 �— �\Y1F�p Y Septic Variance? Yes V tqo
Prim2rij Ouvner(s)
Mailing Address
Phone &Email
InsfallerjOuildee I
Mailing Address 6'71 wf / �� 12ea/
Phone,Or-,, Email
(engineer
Mailing Address /�G:
Phone &Email
Coniact Person for Building ix Mode Compliance: Phone-.
RESIDENCE INFORMATION:
fear Built• #of bedrooms X gallons per bedroom =total daily flown Garbage Grinder Yes No
1980 or older installed? (circle one)
t981 799g Spa or Hot Tub Yes No
Installed? (circle one)
?992-Present ��� ZOO
PARCEL INFORMATION-.
Topography Fiat Rolling Steep Slope %Slope
Soil Nature Sand Loam Clay Other
Groundwater At what depth? Az It
Bedrock/Impervious material At what depth? 9
Domestic Water Supply XMuniapal _Well(if well,water supply from any septic system absorption is_fi )
Percolation Test Rate:Z, !/o per minute per inch(test to be completed by licensed eogioeerl2rchtiect)
PROPOSED SYSTEM FOR NEW CONSTRUCTRON:
Tank size 1,4W 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 /&,,7 ft.; Each Trench
Seepage Pit With#3 stone How many:
Alternative System Bed or other type:
Holding T ank System Total required capacity? ;tank size :#of Tanks
NOTES-.1.Alarm system«associated electrical work must be inspected by a Town approved ele�Ical 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 match 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_1
have read the regulations and agree to abide by these and all requirements of the Town of Queensbury Sanitary Seuvage
Disposal Ordinance. I b
PRINT NAME: J C �'i�i"-f DAT E:.� el-Z G'
SIGNATURE: DATE:
Town of Queensbury Building&Code Enforcement Revised February 2017
1 .,
TOWN OF QL'IEENSBURY
742 Bay Road, Queensbury, NY. 12804-5902
Septic System Checklist
.Plan to scale
1611eceived Deep hole pert 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 shown
16mater 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 � '"�
_ eptic tank and pump stations 10'from foundation 50'from any well/lake/wetland 10'from any waterline
��KSeptic 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)
XSeptic tank sized for number of bedrooms and add 250 gals for Jacuzzi tubs/garbage grinder each
9Leech Field 20'from foundation 100'from any well 10'from water line
�IlASeepage pit 150'from well 50'from septic tank
}
eepage Pits 3-times diameter apart
Septic tank and pump stations over 30 gallons 50'from watercourse or wetland
6distance from bottom of trench or.system 24"to bedrock or mottling 36"within 1000'of Lake George
L)KLeech field 100'from watercourse or wetland
VfAToe of mound or bottom of retaining wall 10'from property line 100'from well 20'from
Foundation
I Provide Engineer/Architect stamp for bed or design systems
%Department of Health Approval for all mobile home park new systems Flood Plain requirements
NU 2'above established flood elevation to bottom of system
&All tanks anchored or 2' above flood elevation
900 New York 146 Clifton Park, NY 12065
(P)518.371.7621 (F) 518.371.9540 edpllp.com
July 22, 2022
Mr. John O’Brien
Queensbury Building & Code Enforcement
742 Bay Road
Queensbury, NY 12804
Via email: johno@queensbury.net
Regarding: Homestead Village Mobile Home Park
Lots 49 & 50 Windsong Drive
Dear Mr. O’Brien:
On July 20, 2022, our office inspected the above referenced Homestead Village Mobile
Home Park lots. The purpose of this visit was to observe the installation of the new septic
systems designed by EDP (February 2022) and approved by NYSDOH (April 29, 2022).
Based on review of the plans and our observation of the installation, it is our opinion that
the system was installed substantially in compliance with the intent of the design plans.
There were slight modifications to the septic tank and distribution box locations, and pipe
arrangement ,and they are shown on the attached “As-Built”.
Please feel free to call if you have any questions.
Regards,
Charles Baker, P.E., 70,149
Cc: Kevin Kenyon
Charles Dwyer