SEP-0320-2022 aSEPTIC[01SPOI SAL PERMIT XPP ICA�_� Office s,-i � d"� �U Oniy
742 Say Road,Queensbunj,KY 1200-4 ��20 Z2
rearn��fe�mrndu�n � t=L F�Ltltllta:�:_�� =-i-�l��
fax i1Aap I<d#: Permit Fee:T ` °�83 Invoice
Project Location: 41- � S� ���� � Septic Variance? Yes V No
Primary Owner(s) Q"S ka
Mailing Address
Phone &Email
Insl:alierIguildee
Mailing Address 100 , vx 7"zxl 4 le r /ill
Phone &Email - A6 ?76V
Engineer - /0
Mailing Address /k6- f-
Phone &Email
Contact Person for Building&Code Compliance: Phone:
RESIDENCE INFORMATION:
Year Built• #of bedrooms 'gallons per bedroom =total daily flow Garbage Grinder Yes No
1980 or older Installed? (circle one) AL
1 981 T 991 Spa or Hot Tub Yes No
Installed? (circle one) je
1992-Present Jed �2 J
PARCEL INFORMATION.-
Topography Flat Rolling Steep Slope %Slope
Soil Nature Sand Loam Clay Other
Groundwater At what depth? AZA
Bedrock/Impervious material At what depth? fi
Domestic Water Supply Municipal _Well(if well,water supply from any septic system absorption is_ft.)
Percolation Test Rate:/, �/y per minute per inch(test to be completed by licensed engineerf archleecc)
PROPOSED SYSTEM FOR NEW CONSTRUCTION:
Tank size I IZV .gallons(min-size 1,000 gallons,add 250 gallons for each garbage cylinder or spa/hot tub
System Absorption field with#2 stone Total length /&V ft.; Each Trench 5`0 ft.
Seepage Pit with#3 stone How many: :Size:
Alternative System Bed or other type:
Holding Tank System Total required capacity? /Y 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 orfailure 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.
PRINT NAME: C ' 4 t"1 DATE:S 'z�f'Zz
SIGNATURE: DATE: .5�''z`�- Z
-town of Queensbury Building&Code Enforcement Revised February 2017
TOWN OF QUEENSBURY
74-2 Bay Road, Queensbury, NY. 12804-5902
Septic System Checklist
Plan to scale
Received Deep hole pert test results from engineer/Architect if applicable(Town Approved Engineers and
Architects;June 30 to April 15 Town Engineer for unapproved Engineers and Architects)
WAll wells on property and adjacent properties shown
16Nater line shown Municipal or well 10'separation to any part of system
Setback to property lines show 10'or more for any part of system Mali 4 C t46Mk_F$Z1f-
—1eptic tank and pump stations 10'from foundation 50'from any well/lake/wetland 10'from any waterline
�qkSeptic tank to foundation crawl space/slab on grade,grade in crawl space must be above top of septic tank
for 0',Separation required(field verification required)
J_(�Septic tank sized for number of bedrooms and add 250 gals for Jacuzzi tubs/garbage grinder each
ALeech Field 20'from foundation 100'from any well 10'from water line
LIJAseepage pit 150'from well 50'from septic tank
Y_hseepage Pits 3-times diameter apart
MI Septic tank and pump stations over 30 gallons 50'from watercourse or wetland
L6distance from bottom of trench or.system 24"to bedrock or mottling 36"within 1000' of Lake George
ILeech field 100'from watercourse or wetland
X44Toe of mound or bottom of retaining wall 10'from property line 100'from well 20'from
Foundation
AProvide Engineer/Architect stamp for bed or design systems
ADepartment of Health Approval for all mobile home park new systems Flood Plain requirements
2'above established flood elevation to bottom of system
&All tanks anchored or 2' above flood elevation
900 New York 146 Clifton Park, NY 12065
(P)518.371.7621 (F) 518.371.9540 edpllp.com
July 22, 2022
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
Lots 49 & 50 Windsong Drive
Dear Mr. O’Brien:
On July 20, 2022, our office inspected the above referenced Homestead Village Mobile
Home Park lots. The purpose of this visit was to observe the installation of the new septic
systems designed by EDP (February 2022) and approved by NYSDOH (April 29, 2022).
Based on review of the plans and our observation of the installation, it is our opinion that
the system was installed substantially in compliance with the intent of the design plans.
There were slight modifications to the septic tank and distribution box locations, and pipe
arrangement ,and they are shown on the attached “As-Built”.
Please feel free to call if you have any questions.
Regards,
Charles Baker, P.E., 70,149
Cc: Kevin Kenyon
Charles Dwyer