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2008-637 TOWN OF QUEENSBURY 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201 (zt Community Development- Building &Codes (518) 761-8256 CERTIFICATE OF COMPLIANCE Permit Number. P20080637 Date Issued: Monday, January 10, 2011 This is to certify that work requested to be done as shown by Permit Number P20080637 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 Oder 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, p r y° b,� ' tm Variance, or other issues and conditions as a result of approvals b the pp y 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: P20080637 Application Number. A20080637 Tax Map No: 523400-309-009-0002-001-000-0000 Permission is herebygranted to: HOMESTEAD VILLAGE L P For property located at: 200 LUZERNE Rd in the Town of Queensbury,to constnict 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 2008-637 100 Alpine - septic alteration commercial $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 Town of eensbury� Tu s a , December 02, 2008 SIGNED BY for the Town of Queensbury. Director of Building&GYde Enfbkement ______________r__-------__.__ ------------------ OFFICE USE ONLY , TAX MAP NO. PERMIT NO. ;mERMIT FEE JJ APPROVALS: ZONING DEC °ur � 200 ' TOWN CLERK ► ; APPLICATION FOR SEPTIC DISPOSAL SYSTEM PERMIT: A PERMIT MU T BE OBTAINED BEFORE WORK BEGINS.APPLICATION Is SUBJEC REVIEW BEFORE ISSUANCE OF A VALID PERMIT. OWNER: INSTALLER: l7 d/ '"►A- S�(,t J.t-t ADDRESS: v �L/U �(J ADDRESS: 0 Fx- Z'2-( t? PHONE NOS. l _ ! �� l g 6 ©j—ij PHONE NOS. LOCATION OF INSTALLATION:I� / �'C/� j Ak NO.OF RESIDENCE INFORMATION: YEAR BUILT BEDROOMS X COMPUTATION= = TOTAL DAILY FLOW 1980 or older X 150 gallon per bedroom = GARBAGE GRINDER INSTALLED?—� 1981 -1991 X 130 gallon per bedroom = SPA OR HOT TUB 1992-present X 110 gallon per bedroom INSTALLED? PARCEL INFORMATION: ✓ TOPOGRAPHY: Flat rolling / Steepslope- ° pe /°Slope ✓ SOIL NATURE: Sand Loam Clay Other ✓ GROUNDWATER: At what depth? BEDROCK/IMPERVIOUS MATERIAL: At vyhat 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: i 0l) 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 i ft. Each trench X Y� ❑ 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 sbury Sanitar Sewage Disposal Ordinance. codes*caueensburv.net ,,aue VISIT OUR WEBSITE FOR MORE INFORMATION www.clueensbury.net i ature of Person Responsible Date Town of Queensbury - Community Development Office - 742 Bay Road, Queensbury, NY 12804 Septic Inspection Report Office No. (518) 761-8256 Date In7f! Iv Queensbury Building&Code Enforcement Arrive: am/pm 742 Bay Rd., Queensbury, NY 12804 InspectNAME: 7�- ! .:A (�1 LOCATION; A SPECT ON: RECHECK: Comments and/or diagram Soil Type: Sand/ Loam Clay Type of Water: Municipal Well Water > f��C�l' 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 Inl 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. Conforms as r Plot Plan N Engineer Report and As-Built Y N ETU Maintenance Contract Y N provided Location of System on Property: Front Rear Left Side Right Side Middle Front Middle Rear 5ystem Use S s: Approved Partial Approved and needs to be re-inspected, please call the Building&Codes Office Disapproved L:\Pam Whiting\2010\Building Codes Fonns\Inspedon Fomm\se W Inspecbm Report_03 2910.doc r IIIIIIIIIIIIII �IIIIIIIIIIII� 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 100 Alpine Dear John: On December 5, 2008 our office 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 November 25, 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. 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 io r t re i Queensbury Building &Code Enforcement Arrive: rt: -�`7 am 742 Bay Rd., Queensbury, NY 12804 Inspector's Initia s: ` .:NAME: -c P IT NO 0J 77- ;! t _ LOCATION: I PECT ON: RECHECK: Comments and/or diagram Soil Ty am/ Clay Type of Water: I ell Water Wate ' se6ration distance ft. Well separation distance ft. Other wells: ft. Well Casing Length 50' + - Y N N/A Absorption Field: Total length ft. Length of each trench 162 ft. Depth of trenches ft. Size of Stone Seepage Pits: Number Size: x Stone Size: Piping Size Type Buildin to tank Tank to Distribution Box i► > Distribution Box to Field Pit Iy` Opening Sealed: N End Ca _ �'"� N Inle Outlet Pi s&Baffles Y N Location / Se arations Foundation to tank ft. \ undation to absorption Se ration of Pits ft. con o a Y - Ineer Re rt and As-Built Y N Location o System on Property: t Front Rear F Left Side Rig Side Middle Front Middle Rear `-- System Use 7Partiz pproved l Approved an to -1 e g Ice Disapproved Last revised 06/18/07 U\Building&Codes Foriris-OLD\Building&Codes\Inspection Forms\Septic Inspection Report.doc DCASTATE OF NEW YORK DEPARTMENT OF HEALTH ( � Glens Fails District Office 77 Mohican Street Glens Falls,New York 12801 (518)793-3893 Fax(518)793-0427 Richard F.Daines,M.D. Wendy E.Saunders Commissioner Chief of Staff December 2,2008 Mr. James Mitchell, P.E. EDP, LLP 900 Route 146 Clifton Park,NY 12065 Re: Letter of Approval Homestead Village MHP Septic Replacement Lot 100 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 100 Alpine Avenue Homestead Village and most recently dated November 25, 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. Respeettylly, av ,kA'� j i Mike Shaw Senior Sanitary Engineer cc: Anita Gabalski Town of Queensbury