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. Mitchell, P.E.
900 Route 146, Clifton Park, New York 12065 phone(518)371-7621 -fax(518)371-9540
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