2010-392 Ala TOWN OFQ UEENSBURY
WOO 742 Bay Road, NY 12804-5902 (518)761-8201
Community Development- Building &Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: P20100392 Date Issued: Friday, August 27, 2010
This is to certify that work requested to be done as shown by Permit Number P20100392
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 r� � `
property owner of the responsibility for compliance with Site Plan, a, /45-4c-
Variance,
or other issues and conditions as a result of approvals by the Director of Building&Code Er4fort
Planning Board or Zoning Board of Appeals.
TOWN OF QUEENSBURY
`oto 742 Bay Road,Queensbury,NY 12804-5902 {518)761-8201
Community Development- Building&Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20100392 Application Number. A20100392
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
2010-392
11 Windsong Drive
$35.00 PERMIT FEE PAID- THIS PERMIT EXPIRES: Saturday,August 13,2011
(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 Tornuyeensl� ry;/ qday,August 13, 2010
SIGNED BY t .f�s, t !7 /�[}'Y 1_, for the Town of Queensbury.
Director of Building&Code nforcement
Community Development Office
Town of Queensbury • 742 Bay Road • Queensbury, New York •12804
Office Use
Only
-2 / 33TAX MO. PERMIT NO. ill y PERMIT FEE____
APPROVALS: ZONING_ __ __ __ TOWN CLERK_
APPLICATION FOR SEPTIC DISPOSAL SYSTEM PERMIT: A PERMIT MUST BE OBTAINED
BEFORE WORK BEGINS. APPLICATION IS SUBJECT TO REVIEW FORE ISSUANCE OF A VLID PERMIT.
OWNER: a_1-'tl'Q i� — t(1611-4-' INSTALLER: 1-@i41'"4
ADDRESS:I U 2e- IZ) ADDRESS: P_C7 O ?Z�-f 1
PHONE NOS./9Z ' O J PHONE NOS. 79 to O cFJ
LOCATION OF INSTALLATION:�l fri_ 9
RESIDENCE INFORMATION:
NO.OF COMPUTATION
YEAR BUILT X = TOTAL DAILY FLOW
BEDROOMS (Gallons per bedroom) GARBAGE GRINDfq
1980 or older X 150 = INSTALLED?
1981 -1991 X 130 = SPA OR HOT TUB LI)
1992-present X 110 = INSTALLED?
PARCEL INFORMATION: SQ-Q._, L,A "`)
✓ 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[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: I_Ot)C' 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 b.5-3 ft. Each trench_7i X S J
❑ SEEPAGE PIT(S) (WITH NO. 3 STONE) How many? Size?
❑ALTERNATIVE SYSTEM Bed or other type?
❑ 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 have read the regulations with respect to this application and agree to
abide by these an• .11 requirements of the Town of Queensbury QUESTIONS? CALL 761-8256 OR EMAIL
n�.Yry Sewag/m' .I Or :nce. /0.-- �� codes(a�queensburv.net
-- _' — — -- VISIT OUR WEBSITE FOR MORE INFORMATION
•nature of Perso 'esponsible Date www.queensburv.net
r �
f t
Septic Inspection Repo
Office No. (518) 761-8256 Date Inspection -• ed:
Queensbury Building &Code Enforcement Arrive: alaC• 1 • 10tDe••rt: 3.71-0 a m
742 Bay Rd., Queensbury, NY 12804 Inspector's Initial- :
NAME: FAV EP\1) 'J tU JE PE' � IT NO.: i�
LOCATION: , \ 16 t ��bt�f:�� n I 'ECT ON: , —7..R=1C)
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.
Foundation to absorption ft.
Separation of Pits ft.
• ms •-rPlo • - • N
n•ineer Re•• t' As-Bui T Y N
Maintenance Contract _Y_ N
provided
Location of System on Property:
Front ear Left Side Right Side Middle Front Middle Rear
em Use S us:
Approved
Partial Approved and needs to be re-inspected, please call the Building &Codes Office
Disapproved
L:\Pam Whiting\2010\Building Codes Forrns\Inspection Forms\Septic Inspection Report03 29 10.doc
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ENVIRONMENTAL DESIGN
PARTNERSHIP,LLP
August 24, 2010
Queensbury Building & Code Enforcement
742 Bay Road
Queensbury,NY 12804
Via email john@queensbury.net
Attn: John O'Brien
Re: Homestead Village Mobile Home Park
La; 1 t t 'LYD-6
Dear John:
On August 17, 2010 I visited 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 May 26, 2010.
Based on my review of the plans and observation of the installation it is my opinion that the
installation of the system is in compliance with the intent of the design plans. I would like to
note that 5 lines at 30 feet each were installed in lieu of 3 lines at 50 feet as indicated on the
original plan. I am mailing a revised plan.
Please contact me should you have any questions regarding this system.
Sincerely,
(.394,P042%
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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Septic Inspection Rep. / /
Office No. (518) 761-8256 Date In pection r=.��- fed: S 1 1 It/
Queensbury Building &Code Enforcement Arrive: = �_�� art: erg••
742 Bay Rd., Queensbury, NY 12804 Inspector's I
NAME:
I-It S rs( ) i/• t ✓ — P • r NO.: (, 3 2-
LOCATION: v�c1 S� _ ih - I 'ECT ON: : /`7 U
RECHECK:
Comments and/or diagram
Soil T • Clay
Type ofWate • • - ater
• : - separation distance ft.'r
Well separation distance ft.
Other wells: ft.
Well Casing Length 50' + / - Y N N/A
Absorption Field: Total length
Length of each trench
Depth of trenches 7__,ft.
Size of Stone
Seepage Pits: Number
Size: x
Stone Size:
Piping Size Type
Building to tank Ll,‘ b4-rt 41>
Tank to Distribution Box 4" 1-740-'77c
Distribution Box to Field/ Pit 1-1" V 7 Tb VEQf-
Opening Sealed: ' N
End Cap N
Inlet/Outlet Pipes&Baffles N
Location/ Separations 'v ±V IV)— CT
e1%-\ • Foundation to tank c% ft.
Mrk Foundation to absorption ft.
Separation of Pits ft
Conforms as per Plot Plan _YX
Engineer Report and As-Built _•Y
Location of System on Property:
Front Rear Left Si.• Right Side Liddle Front Middle Rear
Y -1 s- _ •
Approved
Partial Approved and needs to be re-inspected, please call the Building &Codes Office
Disapproved
Last revised 06/18/07 L:\Building&Codes Forms-OLD\Building&Codes\Inspection Forms\Septic Inspection Report.doc