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2011-561 TOWN OFQ UEENSBURY 742 BayRoad,Queensbury,NY 12804-5902 (518)761-8201 Community Development - Building & Codes (518) 761-8256 CERTIFICATE OF COMPLIANCE Permit Number: P20110561 Date Issued: Wednesday, December 07, 2011 This is to certify that work requested to be done as shown by Permit Number P20110561 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 Issuance of this Certificate of Compliance DOES NOT relieve the / / . Ai property owner of the responsibility for compliance with Site Plan, /4 -` 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. TOWN OF QUEENSBURY 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201 Community Development-Building&Codes (518)761-8256 BUILDING PERMIT Permit Number: P20110561 Application Number: A20110561 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 Septic Alteration Commercial 4294 ROUTE 5 Total Value CALEDONIA,NY 14423 Contractor or Builder's Name/Address Electrical Inspection Agency SANITARY SEWER DAN DRELLOS PO BOX 224 GLENS FALLS NY Plans&Specifications 2011-561 septic permit residential $75.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Saturday,November 10,2012 (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 • • Queens ry; u y.day,November 10,2011 SIGNED BY . i+ ��I. for the Town of Queensbury. Director of Building&Code Enforcement Community Development Office - Town of Queensbury • 742 Bay Road • Queensbury, New York •12804 Office Use Only TAX MAP NO. 3o7.7-2- / PERMIT NO. (L�'l PERMIT FEE S APPROVALS: ZONING_ TOWN CLERjf_S APPLICATION FOR SEPTIC DISPOSAL SYSTEM PERMIT: A PERMIT MUST BE OBTAINED BEFORE WORK BEGINS. APPLICATION IS SUBJECT TO REVIEW14-it-r-,7,13/ FORE ISSUANCE OF A V4LID PERMIT. OWNER: PL2-c1 €�) V L(( # 5e— INSTALLER: 14-iu'% (//QGrt y/¢"�t G Z ADDRESS: L�UZ CR-Pik_ () ADDRESS:_ 1 o '�"'x 22'7' 6 PHONE NOS.7(?2. ' 2(16 3 3 PHONE NOS. 790, d P. LOCATION OF INSTALLATION:Lo T 1(0 Pd Cf`e.�`Jla_te crJ RESIDENCE INFORMATION: NO.OF COMPUTATION YEAR BUILT BEDROOMS X (Gallons per bedroom) = TOTAL DAILY FLOW GARBAGE GRIN 1980 or older X 150 = INSTALLED? 1981 -1991 X 130 = SPA OR HOT TUB 1992-present X 110 = INSTALLED? 1" PARCEL INFORMATION: d e 6 ✓ TOPOGRAPHY: FLAT ROLLING STEEP SLOPE %SLOPE ✓ SOIL NATURE: SAND LOAM CLAY OTHER ✓ GROUNDWATER: AT WHAT DEPTH? ✓ BEDROCK/IMPERVIOUS MATERIAL: AT WHAT DEPTH? I DOMESTIC WATER SUPLY: MUNICIPAL_ " /ELL (If well:water supply from any septic system absorption is: ft) ✓ PERCOLATION TEST: RATE IS PER MIINUTE PER INCH[mpi] (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). TANK SIZE: MD GALLON(MIN.SIZE IS 1,000 GAL.)Add 250 gallons to the size of the septic tank for each garbage grinder, spa or whirlpool tub. SYSTEM TYPE: ❑ABSORPTION FIELD(WITH NO.2 STONE) Total length / ft. Each trench X ❑SEEPAGE PIT(S)(WITH NO.3 STONE) How many? Size? O ALTERNATIVE SYSTEM Bed or other type? 0 HOLDING TANK SYSTEM Total required capacity? Tank size? Number of tanks? __ 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 ha - --• •- -•ula ions with resp: to this application and agree to .•'.e by eSe,.i d - quirem:A of the Town of Queen ury QUESTIONS? CALL 761-8256 OR EMAIL f ita ew.• I sp..al Or Ce. /. codesa..queensburv.net � L-'`4E- `( VISIT OUR WEBSITE FOR MORE INFORMATION S • / ure of Pe •n Responsible Date www.queensburv.net OC A Septic Inspection Report ✓ Office No. (518) 761-8256Date Ins n . • -' 111 . Queensbury Building&Code Enforcement Arrive: 1 - . 17 %�- : 11:mtprill 742 Bay Rd., Queensbury, NY 12 04 /Inspector`s Initials: NAME: �i 71eC % fil '` PE' 'ITNO.: j LOCATION: '/j6 /44 /( S '7- I► CT ON: -- RECHECK: Comments and/or diagram Soil Ty•. oam/Clay Type of Water: icipal ell Water - Waterline separation distance 1 t` ) ft.'s` Well separation distance ft. Other wells: ft. Well Casing Length 50'+/- Y N N/A [150'to well required if NO] Absorption Field: Total length 1 6-"C) ft. Length of each trench ® ft. Depth of trenches 7 Size of Stone Seepage Pits: Number Size: x Stone Size: Piping Size T Building to tank L-/ I/ L Tank to Distribution Box 35— Distribution Box to Field/ Pit rf,Diz. 34 m U 14ie _4— t Opening Sealed: _N End Cap _N Inlet/Outlet Pipes&Baffles �_N Manholes 12"or less below grade ✓Y_. [provide extension collar if Yes] Y Location/Separations Foundation to tank Mk3C22lL 1-\DiA t= t•c i ��i f\kA €2 Foundation to absorption ft. Separation of Pits Conforms as per Plot Plan Y N Engineer Report and As-Built _Y_N ETU Maintenance Contract Y_N provided Location of System on Property: Front Rear Left Side :'. • Side Middle Front Middle Rear st-m S .t s• Approved Partial Approved and needs to be re-inspected, please call the Building&Codes Office Disapproved L:\Pam Whiting\2010\Building Codes Forms\Inspectlon Fonns\Septic Inspection Report`03 29 10.doc Septic Inspection Report Office No. (518)761-8256 Date Inspection req w i -. Queensbury Building&Code Enforcement Arrive: 3 t.1a a I MVV '- '•rt: 3 . tc—arurriDn 742 Bay Rd., Queensbury, NY 12804 Inspector's Initials"11111"-- NAME: g01-AF.f ii E= \D \I 1 LLAC illfrr NO.: \ 5(oI LOCATION: I t IR SPECf ON: —t RECHECK: Comments and/or diagram Soil Type: Sand/ Loam/ Clay Type of Water: Municipal/Well Water Waterline separation distance ft. Well separation distance ft. 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 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. Foundati., to absorption ft. Separation • Pits Conforms as per Plot Ian7-ft. N Engineer Report and :uiltN at -. «- •ntract _Y N provided Location of System on Property: Front r Left Side Right Side Middle Front Middle Rear stem S Approved Partial Approved and needs to be re-inspected, please call the Building &Codes Office Disapproved L:\Pam Whiting\2010\Building Codes Forms\Inspecdon Forms\Septic Inspection Report_03 29 10.doc ' Ilul�lllll� I I • IIIIIIIIIII ENVIRONMENTAL DESIGN PARTNERSHIP,LLP December 6, 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 110 Adirondack Dear John: On December 6, 2011 our office inspected the above referenced Homestead Village Mobile Home Park lot. The purpose of this visit was to observe the installation of the new septic system designed by EDP dated November 2, 2011. Based on my review of the plans and observation of the installation it is my opinion that the system was installed substantially in compliance with the intent of the design plans. Please contact me should you have any questions regarding this system. Sincerely, (.39417"0025 .... James E. 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