2008-339 TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development- Building &Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number. P20080339 Date Issued: Monday, January 10, 2011
This is to certify that work requested to be done as shown by Permit Number P20080339
has been completed.
Tax Map Number. 523400-309-009-0002-00 1-000-0000
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 ;
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.
TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development- Building&Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20080339 Application Number. A20080339
Tax Map No: 523400-3 09-009-0002-001-000-0000
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. Tyne 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
Plans &Specifications
2008-339
SEPTIC ALTERATION COMMERCIAL
125 &126 ADIRONDACK ST
$35.00 PERMIT FEE PAID- THIS PERMIT EXPIRES: Friday,June 26, 2009
(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 tl e`To f ns ry; day,June 26, 2008
SIGNED BY for the Town of Queensbury.
Director of Building&Code Enforcement
__.A_..--_.- OFFICE USE ONLY
/----____% %---- -.---
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TAX MAP NO. PERMIT NO. €' 1 4PERMIT FEE—:3r ' ' r r
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o APPROVALS: ZONING , TOWN CLERK '
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______ _
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APPLICATION FOR SEPTIC DISPOSAL SYSTEM PERMIT:
A PERMIT MU T BE OBTAINED BEFORE WORK BEGINS.APPLICATION IS SUBJECT T EV1EW BEFORE IS UANCE OF A VALID
PERMIT.
OWNER: L t9fi GA7 / INSTALLER:
ADDRESS!_(/),q,(=f:NQ_, ADDRESS: P 9 LPDX
PHONE NOS. —2 _I- / J PHONE NOS.
LOCATION OF INSTALLATION: f 2�f �� �a��d LJ' f-e e
NO.OF RESIDENCE INFORMATION:
YEAR BUILT BEDROOMS X COMPUTATION= = TOTAL DAILY FLOW
GARBAGE GRI
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: �P p
✓ TOPOGRAPHY: Flat rolling Steep slope %Slope
✓ SOIL NATURE: Sand Loam Clay Other
✓ GROUNDWATER: At what depth?
✓ BEDROCK/IMPERVIOUS MATERIAL: At what pth?
✓ 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).
TANK SIZE: , 'Qc7'� 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 -r 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
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
Queensbury Sanitary Se I
e Disposal Ordinance. codes@aueensbury.net
VISIT OUR WEBSITE FOR MORE INFORMATION
/0 � www.aueensbury.net
i ature of Person R ponsible ate
p ;. Town of Queensbury - Community Development Office • 742 Bay Road, Queensbury, NY 12804
Septic Inspection Report
Office No. (518) 761-8256 Date InspectlonrrNO,.:
Queensbury Building&Code Enforcement Arrive: ht: am/pm
742 Bay Rd., Queen sbury, NY 12804 Inspector's IMtia
,p -,
NAME: 6 '1�l . .-LOCATION: - , �c >
RECHECK:
Comments and/or diagram
Soil Type: Sand Loam Clay '
Type of Water: Municipal Well Water r-ed
Waterline separation distance
Well separation distance
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 i
In Outlet Pipes&Baffles Y N
Manholes 12"or less below grade _Y—N
[provide ext rislon collar if Yes Y N
Location Separations
Foundation to tank ft.
Foundation to absor tion 7 ft.
Separation of Pits ft.
Conforms as per Plot Plan Y N
Engineer Report and As-Built Y N
ETU Maintenance Contract Y N
provided f — —
Location of System on Property:
f
Front Rear Left Side Right Side Middle Front Middle Rear
Use S
ls:
Approved
Partial Approved and needs to be re-inspected, please call the Building&Codes Office
Disapproved
L:\Pam Whiting\2010\Buiiding Codes Farms\Iwedion Forms\Septic Inspection Report_03 2910.doc -
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ENVIRONMENTAL DESIGN
PARTNERSHIP,LLP
January 7, 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 125 & 126 Adirondack
Dear John:
On June 30,2008 I inspected the above referenced Homestead Village Mobile Home Park septic
installation. 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
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,
James E. Mitchell,P.E.
pho�e�51a�3-(1 z62�-�axl5�a13��9�ao
90o Route 146,Clifton Park,New York 12065
DQNSTATE OF NEW YORK -33 7
DEPARTMENT OF HEALTH
Glens Falls District Office
77 Mohican Street Glens Fails,New York 12801 (518)793-3893 Fax(518)793-0427
Richard F.Daines,M.D. Wendy E.Saunders
Commissioner Chief of Staff
November 13, 2008
Mr. James Mitchell, P.E.
EDP, LLP
900 Route 146
Clifton Park,NY 12065
Re: Letter of Approval
Homestead Village MHP Septic Replacement
Lot 125/126
Town of Queensbury, Warren County
DOH Facility Code: 56-9611
Dear Mr. Mitchell,
We have approved the septic system replacements for the Homestead Village MHP in the Town
of Queensbury, Warren County. The approved design is described on plans designed by your
office and titled Septic Design Prepared for .Lot 125 and 126 Adirondack Street Homestead
Village and most recently dated May 30, 2008. This approval is conditioned on the following:
• Construction is completed in accordance with the approved plans.
• Construction is inspected by a design professional and certified to this office and the
applicable code enforcement office.
• Construction is completed within two years of the date of this approval. After that time,
plans must be resubmitted to the Department of Health for review and approval prior to any
construction.
The responsibility for the design of the sanitary system lies solely with the design professional
and the proper operation of the sanitary system lies solely with the owner. The purpose of the
Department of Health review is for compliance with the New York State Sanitary Code and in no
way guarantees proper system operation.
Enclosed you will find one set of the approved plans, one copy should be made for your records.
Please forward a copy to the owner/applicant and a copy to the code enforcement office. An
additional set of the plans will remain on file in the Glens Falls District Office. Please contact me
if you have any questions.
Respectfully,
AIv L t
Mike Shaw
Senior Sanitary Engineer
cc: Anita Gabalski
Town of Queensbury
Septic Inspection Report
Office No. (518) 761-8256 Date Inspectio gq ed� 0
Queensbury Building &Code Enforcement Arrive: = rt: a742BayRd., Queensbury NY 12804 Inspector's Initia
NAME: U IT LOCATION: IELT ON:
RECHECK:
41"1 el cfl /
Comments and/or diagram
Soil T and am Clay
Type of Water: a Well Water
Waterline separation distance ft.
Well separation distance I ft.
Other wells: ft.
Well Casing Length 50' + - Y N_N/A
Absorption Field: Total length ft.
Length of each trench ft.
Depth of trenches
Size of Stone
Seepage Pits: Number
Size: x
Stone Size:
Piping Size Type
Building to tank i4o
Tank to Distribution Box s'
Distribution Box to Field/ Pit
Opening Sealed: N
End Ca N
Inlet/Outlet Pi s&Baffles]
W
tion/ Se rationsoundation to tank �m ft.tion to absor tion ! ftSe ration of Pits ft
s as r"Pro Y Report and As-Built Y N
Location of System on Property:
Front Rear Left Side Right Side Middle Front Middle Rear t �17 : kr-4�j
c.,ctn.r, i�cP cr tus:' r-
_ :Approved
Approved nd`n to reinspected, lease call tl�e Building&-ems 01
Partial q�
Disapproved—
Last revised 06/18/07 U\Building&Codes Forms-01_1)\Building&Codes\Inspection Forms\Septic Inspection Report.doc
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