2006-855 TOWN OFQ UEENSBURY
Iwo742 Bay Road,Queensbury,NY 12804-5902 (518) 761-8201
Community Development - Building & Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: P20060855 Date Issued: Monday, December 05, 2011
This is to certify that work requested to be done as shown by Permit Number P20060855
has been completed.
Tax Map Number: 523400-309-009-0002-001-000-0000
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 Board
TOWN OF QUEENSBURY
4
Issuance of this Certificate of Compliance DOES NOT relieve the ( V
property owner of the responsibility for compliance with Site Plan,
Variance, or other issues and conditions as a result of approvals by the Director of Building&Code Enforcement
Planning Board or Zoning Board of Appeals.
1
IOWN OF QULL1NSIUKY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development- Building&Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20060855 Application Number: A20060855
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
2006-855
SEPTIC ALTERATION COMMERCIAL
$35.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Saturday,December 01,2007
(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 of ensb F i,a December 01,2006
SIGNED BYfor the Town of Queensbury.
, r
Director of Building& •de Eorcement
OFFICE USE ONLY ;
_z -
f - , - \ ..�
TAX 110 PERMIT NO. PERMIT FEE ��
•
APPROVALS: ZONING TOWN CLERK , ! ,•
•
0 _HSBURY •
l
APPLICATION FOR SEPTIC DISPOSAL SYSTEM PERMIT:
A PERMIT MUST BE OBTAINED BEFORE WORK BEGINS.APPLICATION IS SUBJECT 0 REVIEW BEFORE ISSUANCE OF A VALID
PERMIT. /74 /,, �' ` —�/�
OWNER: / eel brei+ '///�e INSTALLER: Alti% /!`/Z" / Jj
ADDRESS: ) Zv ,,-NQ ,/) ADDRESS: o 0 N 0 22 V P
PHONE NOS. 7 92._- 2.- e dU PHONE NOS. 7 9 6 - 0P,5"o
LOCATION OF INSTALLATION: 0 �-f V/ y�
NO.OF RESIDENCE INFORMATION:
YEAR BUILT gEDR0 X COMPUTATION= = TOTAL DAILY FLOW
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: 0-s P-' _ i3O-/uf..
✓ TOPOGRAPHY: FLAT ROLLING STEEP SLOPE %SLOPE
/ SOIL NATURE: SAND LOAM CLAY OTHER
/ GROUNDWATER: AT WHAT DEPTH? BEDROCK/IMPERVIOUS 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 septictank
/tank and leach field for each garbage grinder, spa or whirlpool tub.
✓ SEPTIC TANK:/253 GALLON (MIN. SIZE IS 1,000 GAL.) TILE FIELD: EACH TRENCH I`'3 FT.
✓ TOTAL SYSTEM LENGTH: 2,(2— FT. SEEPAGE PIT(S): HOW MANY?
✓ SIZE OF EACH FT. X FT.
✓ SIZE OF STONE TO BE USED: # Z- /DEPTH OR THICKNESS /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.
11 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 761-8256 OR EMAIL
sbury Sanitar e e Disposal Ordinance. codes@queensburv.net
VISIT OUR WEBSITE FOR MORE INFORMATION
c)J
�� ��� www.queensbury.net
S'gnature of Per n esponsible Date
; Town of Queensbury . Community Development Office . 742 Bay Road, Queensbury, NY 12804
STATE OF NEW YORK
DEPARTMENT OF HEALTH
Glens Falls District Office
77 Mohican Street, Glens Falls NY 12801 (518)793-3893 Fax(518)793-0427
Antonia C. Novelle, M.D., M.P.H., Dr.P.H. Dennis P.Whalen
Commissioner Executive Deputy Commissioner
November 24, 2006
J
James Mitchell,P.E. t- w NED
Environmental Design Partnership, LLP
900 Route 146 106
Clifton Park, NY 12065
TOVti:. •,o3URY
BUILDwaL,r,r4D CODE
Re: Letter of Approval
Homestead Village Mobile Home Park,Lots 41 and 42
Town of Queensbury, Warren County
Dear Mr. Mitchell,
We have, this day, approved the plans for the construction of the on-site wastewater treatment
systems for the Homestead Village Mobile Home Park on Lots 41 and 42. The approved plans
were designed by James Mitchell, P.E. of Environmental Design Partnership, LLP, titled Septic
Design prepared for Lot 41 and 42. These plans are most recently dated November 9,2006. This
approval is conditional upon the following items.
• That the proposed facilities shall be installed according to the approved plans.
• The design engineer must inspect construction.
• When complete, the design engineer must certify in writing to the Town of Queensbury,
Building and Code Office, and this office that construction was completed according to the
approved plan.
• This approval will expire two years from today. After that time if construction is not
complete, plans must be resubmitted to this office for approval.
Enclosed you will find one set of the approved plan. Your office is responsible for distribution of
the approved plan to the Town of Queensbury, the applicant, and the contractor. This office will
retain one copy in our file here in Glens Falls. If you have any questions, please call me.
S.nce ly,
Mike Shaw
Senior Sanitary Engineer
cc: Homestead Village MHP, Applicant
Town of Queensbury Building Office
Anita Gabaiski
Kristen Sayers
S'If-rAtCS
Septic Inspection Report
Office No. (518) 761-8256 Date Inspection qeived•/'
Queensbury Building &Code EnforcementArrive: -"- 7 a' p D-•.rt: i=qt.; aip
742 Bay Rd., Queensbury, NY 12804 Inspector's Initials- ,
NAME: /ti�� S /( t1 P-RMIT NO.: (
_.
LOCATION: �f J/2 /�j� 5c,.-� INSPECT ON: \
RECHECK:
Comments and/or diagram
Soil Type: Sand / Loam / Clay
Type of Water: Municipal / Well Water
Waterline separation distance ft. -�
Well separation distance ft. L -/ - 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 T N
End Cap Y_ N
Inlet/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
Separation of Pits ft.
Conforms as per Plot Plan _ N
Engineer Report and As-Built Y N
ETU Maintenance Contract _Y N
provided
Location of System on Property:
Front Rear Left Side Right Side Middle Front Middle Rear
system Use Sta :
Approved
Partial Approved and needs to be re-inspected, please call the Building &Codes Office
Disapproved
L:\Pam Whiting\2010\Building Codes Forms\Inspection Forms\Septic Inspection ReporL03 29 10.doc
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ENVIRONMENTAL DESIGN
PARTNERSHIP,LLP
August 26, 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 41/42 Windsong
Dear John:
On July 25, 2011 our office conducted a review of the septic system installed at the above noted
location on December 6, 2006. Our inspection indicated that the system appears to have been
installed as shown on the design plan dated November 9, 2006.
We have been unable to find our notes related to our field inspection which took place at the time
of installation, however, we are certain that we did perform the inspection and the system was
installed as indicated on the plan.
Please contact me should you have any questions regarding this system.
Sincerely,
074"/"042%
James E. Mitchell, P.E.
900 Route 146, Clifton Park, New York 12065 phone(518)371-7621 -fax(518)371-9540
, ' DO —// . JE7 )E5 )4 Y( ____,
/z/6 O
Septic Inspection Report
Office No. (518)761-8256 Date Ins•- s• •-. .;:-/r9- -.• ��
Queensbury Building&Code Enforcement Arrive: 1• 4 . i ••rt: ii.' am •
742 Bay Rd.,Queensbury, NY 12804 Inspector`s In • .
NAME: /-,61-Ssko,a Vfta-c*//11 ea, D� IrrNO.:
ECT ON: ep6 -ps—
LOCATION: —l0
RECHECK:
Comments and/or diagram
Soil Type. �' --- •• Clay
0 -
Type of Water: Municipallll Water
Waterline separation distance tft•
Well separation distance ft.
Other wells: ft.
Absorption Field: Total length .-"1, ft. 1
Length of each trench ft.
---- -10-,
Depth of trenches - 1 ft. ".--
Size of Stone
2 -•
Seepage Pits: Number
Size: x ----- ildji-e
Stone Size:
Piping Size Type
Building to tank
Tank to Distribution Box
Distribution Box to Field/ Pit
Opening Sealed: Y/N/Partial
End Cap
I Inlet/Outlet Pipes&Baffles ._,._Y..,_._.,N
Location/Separations
4.1\t,e-- .r ri• •n too tank .. _A._5.„,ft.
r( „: (1•,1- i,, to absorption 1\ ,ft.
Separation of Pits ft
Engineer Re y,rr -Bui ' _Y N
......\
Location of System on Prope :
Front Rear Left Side 'ght Side
Middle Front addle Rear
System Use Status:
Approved
Partial Approved and needs do be re-inspected, please call the Building&Codes Office
Disapproved
Last revised 021006
Last revised 1/6/05
I@diagram."• , ---77.....„„„„,....zima
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LOT 81 LOT 82
PROPOSED 1.250 GALLON
SEPTIC TANK
(SEE DETAIL — SHEET 2)
PROPOSED 4' PVC SDR —35
(GASKE1ED BELL) AT 1% MIN.
7REE PROPOSED DISTRIBUTION BOX #2
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(SEE DETAIL - ET 2) ,
EXIST)NG ,
BLDG. 11
e'O0. 47— SCH 400AAT 42* MIN.MI ,
PROPOSED 4" PVC
SCH 40 AT 2X MIN.
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