SEP-0700-2020 r- -,
up ~-.42 'PTOC DISPOSAL P NHiIITPP""FG7 9 Office Use Only
742 Rafe Read,a eerisbuni,NY 12804 Permit*: ��~��'� '��
finenaog nhnri- ?:518-?61_6 56 i° _.� -a- _,.-
sb
%0 , 1 ^ 2 1 .,: Permit Fee:$ 1 '?— ; invoice#: Z
Tax Map 1�3#: `i
Z,L V•i� �� Y Septic Variance? Yes No
Project Location: - --
'Y
Primary Owner(s) 0-0N Jae `'i//,'ier F~ tU E r,
Mailing Address 'al- 2Z 11//ia>/S'oc /).' . i
Phone &Email NOV 09 2020 I d,/
/ 6
lnst:aller�l uddee j J v-ems ✓e v/eY TOWN-Cr CLI"i s\rddress o Zi BUILDING& CODES
Mailing A 4-iv
� �j Z `�, 1 G __,_.�
Phone &Email C-de v..1 /4-d U l2tU 7 S/i 7Gg"�76
Engineer E. d p f,
Mailing Address GOO ,r✓ea) Vr /z rL c a/ /` 6"-' "7-re `22o
• Phone &Email _ p/ /�,
Contact P for Building&code ompiaancea geersonO( Die45-- Phone: ,�4-79 —3749
_ RESIDENCE INF"RMATION:
Year Built' ( #of bedrooms X gallons per bedroom =total daily flow Garbage Grinder Yes XInstalled? (circle one)
_►980 or older Spa or Hot Tub Yes No
1981-1991 Installed? (circle one)
1992-Present I L.9 I /p 5,70
PARCEL INFORMATION:
Topography Flat Rolling Steep Slope %Slope
Soil Nature Sand Loam Clay Other
- Groundwater At what depth? AM
Bedrock/Impervious material Atwhat depth? /114
,
Domestic Water Supply Municipal —Well(if well,water supply from any septic system absorption is ft.)
Percolation Test Rate: L'PO per minute per inch(test to be completed by licensed engineer/architect)
PROPOSED SYSTEM FOR NEW CONSTRUCTION:
Tank size 1/ 'V gallons(min.size 1,000 gallons,add 250 gallons for each garbage cylinder or spa/hot tub
System I Absorption field wit 0•"one Total length/ ft.; Each Trench LS"0" ft.
f Seepage Pit with#3 one How many: :Size:
Alternative System I
Holding Tank System Bed or other type:
Total required capacity? ;tank size ;#of tanks
NOTES:1.Alarm system&associated electrical work must be inspected by a Town approved electrical inspection
agency;2.We will no longer allow systems to be covered until such time as an as-built plan is received and approved.
The installed system must match the septic layout on file—no exceptions.
Declaration:Any permit or approval granted which is based upon or is granted in reliance upon any material
representation 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 and agree to abide by these and all requirements of the Town of Queensbury Sanitary Sewage
Disposal Ordinance.PRIM T NAME: l bi.,0 _ DATE: /7 C
<:n7----/ DATE: /1 / — v
SIGNATURE: - �� -
Revised February 203.7
Town of Queensbury Building&Cade Enforcement
900 New York 146 Clifton Park, NY 12065
(P)518.371.7621 (F) 518.371.9540 edpllp.com
December 3, 2020
Mr. John O’Brien
Queensbury Building & Code Enforcement
742 Bay Road
Queensbury, NY 12804
Via email: johno@queensbury.net
Regarding: Homestead Village Mobile Home Park
Lot 22 Windsong Drive
Dear John:
On December 1, 2020, our office inspected the 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.
Based on my review of the plans and our observation of the installation it is my opinion
that the system was installed substantially in compliance with the intent of the design
plans. The location of the system as shown on the attached as built sketch was based on
observation. No modifications were made to the design.
Please feel free to call if you have any questions.
Very truly yours,
Charles Baker, P.E.
Cc: Kevin Kenyon, P.E. NYSDOH
HOMESTEAD VILLAGE
LOT 22 WINDSONG DRIVE
CHARLES D. BAKER PE 70,149 cbaker@edpllp.com
WARREN COUNTY, NEW YORK
AS-BUILT SEPTIC PREPARED FOR
DECEMBER 3, 2020
TOWN OF QUEENSBURY
SCALE: 1" = 20'