2009-112 TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518) 761-8201
4z:t Community Development- Building &Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number. P20090112 Date Issued: Friday, August 27, 2010
This is to certify that work requested to be done as shown by Permit Number P20090112
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 maybe occupied as a:
Septic Alteration Commercial
By Order of Town Board
TOWN OF QUEENSBURY
Issuance of this Certificate of Compliance DOES NOT relieve the
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& de E rcement
Planning Board or Zoning Board of Appeals.
TOWN OF QUEENSBURY
(2t 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development- Building&Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20090112 Application Number. A20090112
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
2009-112
180-181 ADIRONDACK STREET- SEPTIC ALTERATION COMMERCIAL
$35.00 PERMIT FEE PAID- THIS PERMIT EXPIRES: Tuesday,April 20,2010
(If a longer period is requited,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 Towpw1 ensb A
A"day,April 20,2009
SIGNED BY bm'" ` " "� for the Town of Queensbury.
V N-=,
Director of Building&Code Enforcement
-2 JA0� ---- ---------OFFICE
OFFICE USE ONLY- _- __-__ �-
TAX 0.�' PERMIT N X�
O• / PERMIT FEE 3S °` , r
APPROVALS: ZONING TOWN CLERK
------
APPLICATION FOR SEPTIC DISPOSAL SYSTEM PERMIT;
A PERMIT MUST BE OBTAINED BEFORE WORK BEGINS.APPLICATION IS SUBJEC 0 REVIEW BEFORE ISSUANCE OF A VALID
PERMIT.
OWNER: INSTALLER: l
ADDRESS: '
ADDRESS: .JX
PHONE NOS. '7 ( Z ,2/ v,> ;f Q4 P J
j n PHONE NOS. / / fT
LOCATION OF INSTALLATION:. / �"' t / t4dj .d S
YEAR BUILT NO.OF X COMPUTATION- RESIDENCE INFORMATION:
BEDROOMS = TOTAL DAILY FLOW
fl
80 or older AGE X 150 gallon per bedroom = GARBAGE GRIR
INSTALLED?
81 -1991 X 130 gallon per bedroom =
1992-present X 110 gallon per bedroom = SPA OR HOT TUB
INSTALLED?_ IJ-*�
PARCEL INFORMATION:
✓ TOPOGRAPHY: Flat rolling Steepslo e
P %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 minute 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).
w J
TANK SIZE: � GALLON (MIN. SIZE IS 1,000 GAL.) Add 250 gallons to the size of
each garbage grinder, spa or whirlpool tub. g the septic tank for
SYSTEM TYPE: �� s W •�I
ABSORPTION FIELD (WITH NO. 2 STONE) Total length 1 . 'Z ft. Each trench X
❑ 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
s
Septic Inspection Renqtt
Office No. (518) 761-8256 Date Inspection iv
Queensbury Building&Code Enforcement Arrive: /p rt: am/pm
742 Bay Rd., Queensbury, NY 12804 Inspector's Initial .
NAME: P M NO.: D� _ \`Z
LOCATION: l5T I S Cr ON: r�---7 ;-- 1I7
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 Ca 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
Foundation to absorption ft.
Separation of Pits ft.
rms r P N
Engineer R d As-Built Y N
Maintenance on ract Y_N
provided
Location of Syst7Rr
perty:
FrontLeft Side Right Side Middle Front Middle Rear
stem Use S
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 Repoi#_03 2910.doc
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ENVIRONMENTAL DESIGN
PARTNERSHIP,LLP
August 24, 2010
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
Dear John:
On May 20, 2010 I visited above referenced Homestead Village Mobile Home Park lots. The
purpose of this visit was to observe the installation of the new septic system designed by EDP
dated May 30, 2008.
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 50 feet each were installed in lieu of 4 lines at 63 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,
Dennis MacElroy
Dennis MacElroy, PE
900 Route 146,Clifton Park, New York 12065 phone(518)371-7621 -fax(518)371-9540
Septic Inspection Report
Office No. (518) 761-8256 Date Ins on e'
Queensbury Building &Code Enforcement Arrive: a part: �J m
742 Bay Rd., Queensbury, NY 12804 Inspector's Initials:
NAME: l N!`( E MIT NO.:
LOCATION: r' I SPECT ON:
RECHECK:
Comments and/or diogram
Soil Ty m/Clay
Ty of Water: Munta I II 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 Z.—Zz ft.
Size of Stone Af Z,
Seepage Pits: Number
Size: x
Stone Size:
Piping Size Type
Building to tank it
Tank to Distribution Box
Distribution Box to Field Pit `
Opening Sealed: N
End Cap N
Inlet/Outlet Pipes&Baffles N
Manholes 12"or less below grade _ _N
[provide extension collar if Yesl N
Location/ Separations
Foundation to tank - ft.
Foundation to absor lion ft.
Separation of Pits �6
Conforms as per Plot Plan Y
Engineer Report and As-Built Y ON—
ETU Maintenance Contract Y_ N
provided
Location of System on Property:
Front Rear Left Side Right Side Middle Front Middle Rear
t m Use Statu •/
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 2910.doc