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2006-855 TOWN OFQ UEENSBURY Iwo742 Bay Road,Queensbury,NY 12804-5902 (518) 761-8201 Community Development - Building & Codes (518) 761-8256 CERTIFICATE OF COMPLIANCE Permit Number: P20060855 Date Issued: Monday, December 05, 2011 This is to certify that work requested to be done as shown by Permit Number P20060855 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 Commercial By Order of Town Board TOWN OF QUEENSBURY 4 Issuance of this Certificate of Compliance DOES NOT relieve the ( V 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 Zoning Board of Appeals. 1 IOWN OF QULL1NSIUKY 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201 Community Development- Building&Codes (518) 761-8256 BUILDING PERMIT Permit Number: P20060855 Application Number: A20060855 Tax Map No: 523400-309-009-0002-001-000-0000 Permission is hereby granted 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 SANITARY SEWER DAN DRELLOS PO BOX 224 GLENS FALLS NY Plans&Specifications 2006-855 SEPTIC ALTERATION COMMERCIAL $35.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Saturday,December 01,2007 (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 of ensb F i,a December 01,2006 SIGNED BYfor the Town of Queensbury. , r Director of Building& •de Eorcement OFFICE USE ONLY ; _z - f - , - \ ..� TAX 110 PERMIT NO. PERMIT FEE �� • APPROVALS: ZONING TOWN CLERK , ! ,• • 0 _HSBURY • l APPLICATION FOR SEPTIC DISPOSAL SYSTEM PERMIT: A PERMIT MUST BE OBTAINED BEFORE WORK BEGINS.APPLICATION IS SUBJECT 0 REVIEW BEFORE ISSUANCE OF A VALID PERMIT. /74 /,, �' ` —�/� OWNER: / eel brei+ '///�e INSTALLER: Alti% /!`/Z" / Jj ADDRESS: ) Zv ,,-NQ ,/) ADDRESS: o 0 N 0 22 V P PHONE NOS. 7 92._- 2.- e dU PHONE NOS. 7 9 6 - 0P,5"o LOCATION OF INSTALLATION: 0 �-f V/ y� NO.OF RESIDENCE INFORMATION: YEAR BUILT gEDR0 X COMPUTATION= = TOTAL DAILY FLOW GARBAGE GRINDER 1980 or older X 150 gallon per bedroom = INSTALLED? 1981 -1991 X 130 gallon per bedroom = SPA OR HOT TUB 1992-present X 110 gallon per bedroom = INSTALLED? , PARCEL INFORMATION: 0-s P-' _ i3O-/uf.. ✓ TOPOGRAPHY: FLAT ROLLING STEEP SLOPE %SLOPE / SOIL NATURE: SAND LOAM CLAY OTHER / GROUNDWATER: AT WHAT DEPTH? BEDROCK/IMPERVIOUS MATERIAL: AT WHAT DEPTH? ✓ DOMESTIC WATER SUPLY: MUNICIPAL WELL (IF WELL:WATER SUPPLY FROM ANY SEPTIC-SYSTEM ABSORPTION IS FT. ) / PERCOLATION TEST: RATE IS PER MIINUTE 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). Add 250 gallons to the size of the septictank /tank and leach field for each garbage grinder, spa or whirlpool tub. ✓ SEPTIC TANK:/253 GALLON (MIN. SIZE IS 1,000 GAL.) TILE FIELD: EACH TRENCH I`'3 FT. ✓ TOTAL SYSTEM LENGTH: 2,(2— FT. SEEPAGE PIT(S): HOW MANY? ✓ SIZE OF EACH FT. X FT. ✓ SIZE OF STONE TO BE USED: # Z- /DEPTH OR THICKNESS /2 FT. ✓ BED SYSTEM SIZE: X ✓ ALTERNATIVE SYSTEM: LENGTH AND/OR SIZE ✓ HOLDING TANK SYSTEM:(If required) NO. OF TANKS: /SIZE OF EACH ✓ GALLONS./TOTAL CAPACITY: GAL. 11 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 e e Disposal Ordinance. codes@queensburv.net VISIT OUR WEBSITE FOR MORE INFORMATION c)J �� ��� www.queensbury.net S'gnature of Per n esponsible Date ; Town of Queensbury . Community Development Office . 742 Bay Road, Queensbury, NY 12804 STATE OF NEW YORK DEPARTMENT OF HEALTH Glens Falls District Office 77 Mohican Street, Glens Falls NY 12801 (518)793-3893 Fax(518)793-0427 Antonia C. Novelle, M.D., M.P.H., Dr.P.H. Dennis P.Whalen Commissioner Executive Deputy Commissioner November 24, 2006 J James Mitchell,P.E. t- w NED Environmental Design Partnership, LLP 900 Route 146 106 Clifton Park, NY 12065 TOVti:. •,o3URY BUILDwaL,r,r4D CODE Re: Letter of Approval Homestead Village Mobile Home Park,Lots 41 and 42 Town of Queensbury, Warren County Dear Mr. Mitchell, We have, this day, approved the plans for the construction of the on-site wastewater treatment systems for the Homestead Village Mobile Home Park on Lots 41 and 42. The approved plans were designed by James Mitchell, P.E. of Environmental Design Partnership, LLP, titled Septic Design prepared for Lot 41 and 42. These plans are most recently dated November 9,2006. This approval is conditional upon the following items. • That the proposed facilities shall be installed according to the approved plans. • The design engineer must inspect construction. • When complete, the design engineer must certify in writing to the Town of Queensbury, Building and Code Office, and this office that construction was completed according to the approved plan. • This approval will expire two years from today. After that time if construction is not complete, plans must be resubmitted to this office for approval. Enclosed you will find one set of the approved plan. Your office is responsible for distribution of the approved plan to the Town of Queensbury, the applicant, and the contractor. This office will retain one copy in our file here in Glens Falls. If you have any questions, please call me. S.nce ly, Mike Shaw Senior Sanitary Engineer cc: Homestead Village MHP, Applicant Town of Queensbury Building Office Anita Gabaiski Kristen Sayers S'If-rAtCS Septic Inspection Report Office No. (518) 761-8256 Date Inspection qeived•/' Queensbury Building &Code EnforcementArrive: -"- 7 a' p D-•.rt: i=qt.; aip 742 Bay Rd., Queensbury, NY 12804 Inspector's Initials- , NAME: /ti�� S /( t1 P-RMIT NO.: ( _. LOCATION: �f J/2 /�j� 5c,.-� INSPECT ON: \ RECHECK: Comments and/or diagram Soil Type: Sand / Loam / Clay Type of Water: Municipal / Well Water Waterline separation distance ft. -� Well separation distance ft. L -/ - f - 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 T N End Cap Y_ N Inlet/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 Rear Left Side Right Side Middle Front Middle Rear system Use Sta : Approved Partial Approved and needs to be re-inspected, please call the Building &Codes Office Disapproved L:\Pam Whiting\2010\Building Codes Forms\Inspection Forms\Septic Inspection ReporL03 29 10.doc o01111111111 Wm"tl 11, 1►►►1►II►►►11 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 41/42 Windsong Dear John: On July 25, 2011 our office conducted a review of the septic system installed at the above noted location on December 6, 2006. Our inspection indicated that the system appears to have been installed as shown on the design plan dated November 9, 2006. 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, 074"/"042% James E. Mitchell, P.E. 900 Route 146, Clifton Park, New York 12065 phone(518)371-7621 -fax(518)371-9540 , ' DO —// . JE7 )E5 )4 Y( ____, /z/6 O Septic Inspection Report Office No. (518)761-8256 Date Ins•- s• •-. .;:-/r9- -.• �� Queensbury Building&Code Enforcement Arrive: 1• 4 . i ••rt: ii.' am • 742 Bay Rd.,Queensbury, NY 12804 Inspector`s In • . NAME: /-,61-Ssko,a Vfta-c*//11 ea, D� IrrNO.: ECT ON: ep6 -ps— LOCATION: —l0 RECHECK: Comments and/or diagram Soil Type. �' --- •• Clay 0 - Type of Water: Municipallll Water Waterline separation distance tft• Well separation distance ft. Other wells: ft. Absorption Field: Total length .-"1, ft. 1 Length of each trench ft. ---- -10-, Depth of trenches - 1 ft. ".-- Size of Stone 2 -• Seepage Pits: Number Size: x ----- ildji-e Stone Size: Piping Size Type Building to tank Tank to Distribution Box Distribution Box to Field/ Pit Opening Sealed: Y/N/Partial End Cap I Inlet/Outlet Pipes&Baffles ._,._Y..,_._.,N Location/Separations 4.1\t,e-- .r ri• •n too tank .. _A._5.„,ft. r( „: (1•,1- i,, to absorption 1\ ,ft. Separation of Pits ft Engineer Re y,rr -Bui ' _Y N ......\ Location of System on Prope : Front Rear Left Side 'ght Side Middle Front addle Rear System Use Status: Approved Partial Approved and needs do be re-inspected, please call the Building&Codes Office Disapproved Last revised 021006 Last revised 1/6/05 I@diagram."• , ---77.....„„„„,....zima 1 • LOT 81 LOT 82 PROPOSED 1.250 GALLON SEPTIC TANK (SEE DETAIL — SHEET 2) PROPOSED 4' PVC SDR —35 (GASKE1ED BELL) AT 1% MIN. 7REE PROPOSED DISTRIBUTION BOX #2 ? , (SEE DETAIL - ET 2) , EXIST)NG , BLDG. 11 e'O0. 47— SCH 400AAT 42* MIN.MI , PROPOSED 4" PVC SCH 40 AT 2X MIN. . K ■-- Z , ' -. -.Cii,;5-49.2-01a4A-4*-45,44,,4- !.4.4":-.7-At----'--- ----: ---',..A.: 1::-...-..--..-''''' - . , --, --,,:-_-:,,,_,-,1 ,"-.--,,,...-,-.. o 1 ir' n 1 iq 7R6ff (; TREE m 0 ) I �. I I 4-• TREd 0 2 i.i ' kLOTI41 LOT 142 1. I 1 1 1 PROPOSED ABS PTION FIELD 4 UNE FT. EACH TO S VICE BOTH LOTS 35 ' I (SEE DETAIL — 'HEET 2) • I •ow rn_, 1� . I 2 ,, ,W1 :;), 'EE yI o I TREE i PARKING 11 PARKING ' f` PARRKPINNG AREA 1 I ) I TREE J 1 I WINDSONG DRIVE 0 .._gs--3--- '1*