2002-546 TOWN OF QUEENSBURY
742 Bay Road,Queensbuty,NY 12804-5902 (518)761-8201
Community Development-Building&Codes (518)761.8256
CEIRT IFIrATE OF COMPLIANCE
Permit Number: P20020546 Date issued: Wednesday,August 03,2005
This is to certify that work requested to be done as shown by Permit Number P20020546
has been completed.
Tax Map Number: 523400-309.009-0002-001-000-0000
Location: 200 LUZERNE Rd
Owner: HOMESTEAD VILLAGE L P
Applicant: HOMESTEAD VILLAGE L P
This structure may be occupied as a:
Septic Alteration Residential
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 Zoting Board of Appeals.
TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
tit Community Development-Building&Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20020546 Application Number: A20020546
Tax Map No: 523400-309-009-0002-001-000-0000
Permission is hereby granted to: HOMESTEAD VILLAGE T. P
For property located at: 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 Septic Alteration Residential
4294 ROUTE 5 Total Value
CALEDONIA,NY 14423
Contractor or Builder's Name/Address Electrical Inspection Agency
GLEN BATTEASE
NY 12904-0000
Plans&Specifications
2002-546
Septic Alteration Lots 1414&Vt
$25.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Saturday,June 28,2003
(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 Quee *f0,
SIGNED BY r e Town of Queensbury.
Director of Building&Code Enforcement
Application for Permit—Septic t pis osat System
Town of Queensbury 742 Bay Road QueensGsu�y IYT 2? -8256
1. OWNER INFORMATION:
J11N ....................................
_.............................
...................
_......................
_..-----_....._
,,^,, 2 ��02 Office Use
Location of installation:� �ll .a .��`/4�/ �Py' a
C t c tbEili it No. 6.�--s�f 6 {
Tax Map No. 3v9 t G 9 —yP—/ t 1" -- i L,CXg z
E
F ee Paid
Owner's Name:
Address: �IQON,�i�Gh .�?'" _ 4}Aq. /
2. INSTALLER'S NAME 9#4 XiFW S,e tl'r'+ --'WCPHONE NO.
3. RE ENCE INFORMATION: (circle year of dwelling,indicate 9 bedroom(s) and multiply# of
L bedrooms with applicable gallons per bedroom to equal total daily flow)
Year of House: No. of Bedrooms x Computation — Total Daily Flow
1980 or older '?� x 150 gal/bdrm =
" � 1980—1991 �— x 130 gal/bdrm =
1991 —present x 110 gal/bdrm =
Garbage Grinder Installed yes— / no c-�`�~
Spa or Whirlpool Installed yes_ / no
4. PARCEL INFORMATION: (circle applicable information&indicate measurements)
rah So' ture Ground Water Bedrock or Impervious Material Domestic Water SURpl
Flat sand at what depth at what depth municipal
o ing m feet feet well
Steep slope clay if well; water supply
�%slope other from any septic-system
depth: absorption is ft.
other
Percolation Test: (To be completed by licensed professional engineer or architect)
Rate: minute per inch
5. 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). Add 250 gallons to the size
of the septic tank and leach field for each Garbage Grinder,Spa or Whirlpool Tub.
Septic Tank: O(9 J6 gallon(min. size 1,000 gal.)
Tile Field: each trench 5 d ft. Total System Length: ft
Seepage Pit(s): number of size ofeach: ft. by_ft-
Size of Stone to be used: # / depth or thickness feet
Bed System Size: x
Alternative System: length and/or size
6. HOLDING TANK SYSTEM: (if required)
Number of tanks: 1 Size of each: gallons /TOTAL Capacity: gallons
Note: Alarm System and associated electrical work must be inspected by a Town approved
electrical inspection agency.
7. SIGNATURE &INFORMATION FOR RESPONSIBLE PERSON(please read)
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 Queensbury Sanitary Sewage Disposal Ordin ce.
Signature of responsible person Date
-" •1'��wet Of tZltectiSIMT-v
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7. SIGNATURE &INFORMATION FOR RESPUNbioi r-
Septic Inspection Report
Office No.(518)761-8256 Date Inspection request received:
Queensbury Building&Code Enforcement Arrive: am/Dm j Depart: am/pm
742 Bay Rd.,Queensbury,NY 12804 hweCVW itials:
0
NAME: Ir
MIP RMIT NO.:
LOCATION: INSPECT ON:
RECHECK:
Comments and/or diagram
Soil Type: Sand 1 Loam Clay
Type of Water: Municipal/Well Water
Waterline separation distance ft.
Well separation distance
Other wells:
Absorption Field: Total length
Length of each trench
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/Partial
End Ca
Location/Separations
Foundation to tank
Foundation to absorption
Separation of Pits
Conforms as per Plot Plan
I Engineer Report and As-Built VY N_
Location of System on Property:
Front Rear Left Side Right Side
Middle Front Middle Rear
System Use Status:
Approved
Partial Approved and needs to be re-inspected,please call the Building&Codes Office
Disapproved
Last revised 1/6/05
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TOM p=
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lG,i�ND CODE ..
BUILDIN T
REVIEWED 3Y
DATE17-1
"I have seen or observed, or believe I saw evidence of,
all objects such as houses, wells, trees, fences,letc.;
show, on this docume'Pt:. I also represent that l have
personally mea red ih -distance of form on the diagra,+."
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r"LLOCATION PLAN
SCALE: N.T.S.
r
PM
EXISTING / BY OTHERS:
(existing features denoted by lower case lettering)
NEW / PROPOSED IN THIS DESIGN:
MUNICIPAL WATER LINE:
v
SILT FENCE / EROSION CONTROL:
TEST HOLE:
PERCOLATION TEST:
O
DRAWING t
DETAIL REFERENCE TAG:
NOTE: s-t
of
SEE DRAWING /FUR DETAIL
DEVIL I
2
DETAIL REFERENCE TAG:
D1
SEE DRAWNJG /FOR DETAIL
SECTION REFERENCE TAG:
SECTION CUT DIRECTION
SECTKm LETTER
01
SEE DRAWING / FOR SECTION
a
z
0
r PIIo
t�
zg
0 P.T. #27-1 PORCH
I
I
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I
FmLarj14
WATER VALVE
I r' —• —• 1 ( ST.P. #2
I I I
I i I
i r mac aaa Paaroo
I I I
30" DRY WELL
OF PAVEMENT
ADIRONDACK
APPROXIMATE
mL Pubw
vm
SHED
PORCH
CONCRETE
PARKING AREA
n acre NASTFIFA>a oew.LTER PLAN GRAPHIC SCALE
u eo■c
10 0 5 10 20 40
( DI FM)
RECORD DOCUMENT
THESE DRAWINGS HAVE BEEN PREPARED FROM LIMITED FIELD MEASUREMENTS BY
JARRETT—MARTIN ENGINEERS, PLLC, SYSTEM DESIGN AND INSTALLATION BY OTHERS.
INFORMATION PROVIDED BY OTHERS HAS NOT BEEN VERIFIED BY
JARRETT—MARTIN ENGINEERS, PLLC FOR ACCURACY AND/OR COMPLETENESS.
WATER VALVE
GENERAL NOTES:
G-1) BASE MAP BASED ON LIMITED FIELD MEASUREMENTS AND INFORMATION PROVIDED BY OWNER
SUBSURFACE INVESTIGATION(LOT 1411:
0 — 10' BROWN SANDY TOPSOIL
10 — 20- RED/BROWN LOAM
20 — 74" GRAY MED SAND
74' BOTTOM OF PIT
ROOT TRACES TO 54"
NO MOTTLING OR EVIDENCE OF HIGH GROUND WATER
TEST PR !2
0 — 12" DARK SANDY TOPSOIL
12— 26" RED BROWN LOAM
26— 42' GREY MED SAND
42— 74' GREY FINE SAND
NO MOTTLING OR EVIDENCE OF HIGH GROUND WATER
PERCOLATION TEST #I
TEST DEPTH: 30'
SOIL: GREY MED SAND
STABILIZED PERCOLATION RATE OF 0 MINUTES 11 SECONDS.
SYSTEM DOCUMENTATION (LOT #141):
DESIGN BASIS
NEW YORK STATE DEPARTMENT OF HEALTH
TOWN OF OUEENSBURY
POTABLE WATER SUPPLY
NO DOCUMENTED POTABLE WATER SUPPLY SOURCES
LOCATED WITHIN 100 FT. OF PROPOSED WASTEWATER DISPOSAL
SYSTEM. LOT #141 AND THE NEIGHBORING TRAILERS ARE SERVED BY A
MUNICIPAL WATER SYSTEM.
DESIGN FLOW
RESIDENCE
2 BEDROOMS x 150 GPD/BEDROOM - 300 GPD
(WATER SAVER FIXTURES RECOMMENDED, HOWEVER 150 GPD/BEDROOM
USED PER TOWN OF QUEENSBURY REQUIREMENTS)
SEPTIC TANK
1000 GALLONS (MIN.) CAPACITY FOR 2 BEDROOM RESIDENCE
LEACHING SYSTEM (FIELD)
300 GPD + 1.2 GPD/SO. FT. - 250 SO. FT. REQ'D
250 SO. FT. + 2' WIDE TRENCH - 125' MINIMUM OF TRENCH REQUIRED.
(4) LATERALS EACH 50' FT. LONG PROVIDED
EFFLUENT DISTRIBUTION
GRAVITY DOSING/ DISTRIBUTION VIA "D—BOX" FROM SEPTIC TANK.
SUBSURFACE INVESTIGATION(LOT 142):
PERCOLATION TEST Y1
TEST DEPTH: 30'
SOIL: GREY FINE SAND
STABILIZED PERCOLATION RATE OF 0 MINUTES 16 SECONDS.
SYSTEM DOCUMENTATION (LOT #142) :
DESIGN BASIS
NEW YORK STATE DEPARTMENT OF HEALTH
TOWN OF QUEENSBURY
POTABLE WATER SUPPLY
NO DOCUMENTED POTABLE WATER SUPPLY SOURCES
LOCATED WITHIN 100 FT. OF PROPOSED WASTEWATER DISPOSAL
SYSTEM. LOT #142 AND THE NEIGHBORING TRAILERS ARE SERVED BY A
MUNICIPAL WATER SYSTEM.
DESIGN FLOW
RESIDENCE
3 BEDROOMS x 150 GPD/BEDROOM - 450 GPD
(WATER SAVER FIXTURES RECOMMENDED, HOWEVER 150 GPD/BEDROOM
USED PER TOWN OF QUEENSBURY REQUIREMENTS)
SEPTIC TANK
1000 GALLONS (MIN.) CAPACITY FOR 2 BEDROOM RESIDENCE
REUSE EXISTING 1D00 GALLON SEPTIC TANK.
LEACHING SYSTEM (FIELD)
450 GPD + 1.2 GPD/SQ. FT. - 375 SO. FT. REQ'D
250 SO. FT. + 2' WIDE TRENCH - 187.5' MINIMUM OF TRENCH REQUIRED.
(4) LATERALS EACH 50' FT. LONG PROVIDED
EFFLUENT DISTRIBUTION
GRAVITY DOSING/ DISTRIBUTION VIA 'D—BOX' FROM SEPTIC TANK.
8/01/05 [1, I RECORD DOCUMENT RUH
DATE REV # I ISSUED / REVISIONS By
SITE PLAN C1
HOMESTEAD VILLAGE - LOTS #141 & #142
REPLACEMENT WASTEWATER SYSTEM
LUZERNE ROAD
QUEENSBURY, NEW YORK
JARRETT - MARTIN ENGINEERS, PLLC
PROFESSIONAL ENGINEERING
12 EAST WASHINGTON STREET PHONE: (518) 792-2W7
COPYRIGHT G 2005 1 GLENS FALLS, N.Y. FAX: (518) 798-1864
JULY2DO5 PRO# 02-098 SHEET: 1 OF 1
.ravuc
BASESHEET SIZE: 24x36 PLOTTED / REVISED:001/0512:00 PM