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2008-629 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: P20080629 Date Issued: Monday, December 05, 2011 This is to certify that work requested to be done as shown by Permit Number P20080629 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, "'' r 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: P20080629 Application Number. A20080629 Tax Map No: 523400-3 09-009-0002-001-000-0000 Permission is herebygranted 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 Plans &Specifications 2008-629 37 & 38 Windsong Drive- septic alteration $35.00 PERMIT FEE PAID- THIS PERMIT EXPIRES: Wednesday, December 02, 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 the To o 7:rl/v rzi December 02, 2008 SIGNED BY for the Town of Queensbury. Director of Building&Code Enforcement -_-_`r -- ------------ OFFICE USE ONLY ____________; ------' Y ]PERMIT FEE TAX MAP NO.+ PERMIT NO. ', ' � `` a I ..� -4,• , 0 00 APPROVALS: ZONING TOWN CLERK ; APPLICATION FOR SEPTIC DISPOSAL SYSTEM PERMIT: A PERMIT ITT PERMIT. BE OBTAINED BEFORE WORK BEGINS.APPLICATION IS SUBJE 0 REVIEW BEFORE ISSUANCE OF A VALID OWNER:ji INSTALLER: �/" / �'J /��C� ADDRESS: ADDRESS: 40 ! o Z2- 4 to � y PHONE NOS. 79Z - 2-J of PHONE NOS. 796 —0 LOCATION OF INSTALLATION: NO.OF RESIDENCE INFORMATION: YEAR BUILT BEDROOMS X COMPUTATION= = TOTAL DAILY FLOW GARBAGE GRINDS 1980 or older X 150 gallon per bedroom = INSTALLED? 1981 -1991 X 130 gallon per bedroom = SPA OR HOT TUB A a 1992-present X 110 gallon per bedroom = INSTALLED?,, ,y �,v PARCEL INFORMATION: p6lln-' ✓ TOPOGRAPHY: Flat rolli Steep slope %Slope ✓ SOIL NATURE: Sand- 7—Loam ClaY Other ✓ GROUNDWATER: At what depth? ✓ BEDROCK/IMPERVIOUS MATERIAL: At at 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). TANK SIZE: 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. SYS M TYPE: ABSORPTION FIELD (WITH NO. 2 STONE) Total length � �ft. Each trench X. 62 ❑ 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 Quee sbury Sani ar ewage Di sal Ordinance. codes @aueensburv.net VISIT OUR WEBSITE FOR MORE INFORMATION �`/ www.pueensbury.net I nature of Person Responsible ate Town of Queensbury - Community Development Office • 742 Bay Road, Queensbury, NY 12804 Septic Inspection Report Office No. (518)761-8256 Date Ins Queensbury Building&Code Enforcement Arrive: it �742 Bay Rd., Queensbury, NY 12804 Inspector's INAME: Ct I�� 'LOCATION: _ 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 In 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 Separation of Pits ft. Conforms as per Plot Plan N Engineer Report and As-Built Y N ETU Maintenance Contract Y_N provided Location of System on Property: Front R r Left Side Right Side Middle Front Middle Rear tem Approved Partial Approved and needs to be re-inspected, please call the Building&Codes Office Disapproved L:\Pam Whiting\2010\Buiiding Codes Forms\Inspection Fomis\septic Inspection Report-03 2910.doc Septic Inspection Report C w S-e C) Office No. (518) 761-8256 Date Inspection req Queensbury Building&Code Enforcement Arrive: a rt: ar 742 Bay Rd.,Queensbury, NY 12804 Inspector's Initials NAME: �cry P S�` l� V it 1-1 _ 0 LOCATION: W ( S " ME NO.: SPELT ON: RECHECK: Comments and/or diagram Soil T m Cla Type of WateiCNknidpal ll Water Waterline separation distance ft.- Well separation distance ft. Other wells: ft, Absorption Field: Total length ft. Lencith of each trench ft. Depth of trenches Z.- ft. Size of Stone Z Seepage Pits: Number Size: x Stone Size: Piping Size Type Building to tank ill, Hn Tank to Distribution Box ki« Distribution Box to Id Pit t,41 PE�� Opening Sea P ' I End Ca Inlet/Outlet Pipes&Baffles Y N f Location Separations 40 tank ft. ,�1FED �tS�i��1Q �S SET -�-�A ti La €WRdat loa to absorption ft. .#-3S Separation of Pits ft. - t L� Co Ian Y En irteer Re rt and As-Built Y N Location of System on Property: Fron Rear eft Side Right Side Middle Front Middle Rear �-o �A�1�F►r-(_ System Use Status: p ;1 roved Partial Approved and s to be r Disapproved Last revised 021006 Last revised 1/6/05 STATE OF NEW YORKDQE ' 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 37/38 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 37 and 38 Windsong Drive Homestead Village and most recently dated September 4, 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 two sets 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. Res ectfully, t' Mike Shaw Senior Sanitary Engineer cc: Anita Gabalski Town of Queensbury IIIIIIIIIIII ENVIRONMENTAL DESIGN PARTNERSHIP,LLP August 26, 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 37/38 Windsong Dear John: On July 25, 2011 our office conducted a review of the septic system installed at the above noted location on December 12, 2008. Our inspection indicated that the system appears to have been installed as shown on the design plan dated September 4, 2008.. We have been unable to find our notes related to our field inspection which took place at the time of installation,however, we are certain that we did perform the inspection and the system was installed as indicated on the plan. Please contact me should you have any questions regarding this system. Sincerely, James E. Mitchell, P.E. 900 Route 146,Clifton Park, New York 12065 phone(518)371-7621 -fax(518)371-9540 - - - - - . D, iYdL>E'99=1® W04 '9? �MB'�NA�9NIM-8 -9Nt+ L " ®i NY7�a4 �81�17Y1-91� 1� W6a �NIN N A Isis � - {, !i1�h�aa.3�r`t7aYd Glas�r�(�� a o\s�ple� 9�l!!Q\�9 � l� t�1yYV \ \ i97u�\ a�6r��f�ka�N��i�s� ,.� tibr"J,l ,t��lU`�i3jfi3ii� (�t;���\;�fl�� 9��� �1�� �16'��J � 0oa. NZ ; � � � °� aNCD ZW) � oJco — � Oo Jti � ►') W = o o w m o w N LO T Q �� ,, m o f ? �O ? Q w mLLJ to J r' �r mU m Z o J Z mww YZ m ion N .,r W 02 U �,� (10 w LJm YUQ QO(n Z UI�I, wZ Q titi 6. ' V � W w LLJJQw w J ppU JwxQ Z Q -mwl� � M wZwo ��~�Jw m° °�mQ �QommJoQooN m��� wo�Q WSW I . ' N� m w w Qz� QF- J� 4 x� w w I ti 2 J Q� �l�(�lutiW� v1 J ?v)� w> U��O J w JOOQ t��w W I JOB W O O� T lu I' I�tiY� > O Y ti (n W �/� O W /� LL cn Q� •W2� Q> mWJw �v1wU'JW ~p wTww �� v' _c �// O 0 _� -1 xz w rn � r G (nwzw L"L"�Wo x� w~°'' �w ? 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