2011-165 TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development- Building & Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: P20110165 Date Issued: Wednesday, May 18, 2011
This is to certify that work requested to be done as shown by Permit Number P20110165
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
Issuance of this Certificate of Compliance DOES NOT relieve the
property owner of the responsibility for compliance with Site Plan, '14
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.
TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development-Building&Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20110165 Application Number: A20110165
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
Septic Alteration Commercial
4294 ROUTE 5
CALEDONIA,NY 14423 Total Value
Contractor or Builder's Name/Address Electrical Inspection Agency
Plans&Specifications
2011-165
75 & 76 Alpine Ave- septic alteration
$75.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Friday,May 04,2012
(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 T of /
cy eens rys/' ay,May 04,2011
SIGNED BY ` for the Town of Queensbury.
Director of Building&Code Enforcement
IRE
�M Community Development Office t�`sli° 2 11
Town of Queensbury • 742 Bay Road - Queensbury, New Yor 2.804;-..;z,- . , URY
=„
R,Jll D!kG & CODES
Office Use O I 2 -1
A 7
TAXQ,A' PERMIT NO. L PERMIT FEE
APPROVALS: ZONING TOWN CLER
APPLICATION FOR SEPTIC DISPOSAL SYSTEM PERMIT: A PERMIT MUST BE OBTAINED
BEFOR WORK BEGINS. APPLICATION IS SUBJECT TO REVIEW FrORE ISSUANCE OF A VALII PERMIT.
OWNER:�W I L _ INSTALLER: _/" /9"F� fir_(/ � t_G'�
ADDRESS: V e �— l 6 n 2— _ /
ADDRESS: �st Y _
PHONE NOS. �i ' 2y PHONE NOS.-17
LOCATION OF INSTALLATION: 1 —7 i m o
V RESIDENCE INFORMATION:
YEAR BUILT NO.OF X COMPUTATION = TOTAL DAILY FLOW
BEDROOMS Gallons per bedroom GARBAGE GRINDER
1980 or older X 150 = INSTALLED?
1981 -1991 X 130 = SPA OR HOT TUB
1992-present X 110 = INSTALLED?
PARCEL INFORMATION:
✓ 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[mpi] (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�dJ`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_ ft. Each trench X
❑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.
Lbav,e read the regulations with respect to this application and agree to
a id by thesA, ' equire °Is of the Town o Queen bury QUESTIONS? CALL 761-8256 OR EMAIL
ni ry Sewsal Or_-nce.— --- /n codes(aDaugensburv.net
gnature of Person Responsible Date VISIT OUR WEBSITE FOR MORE INFORMATION
www.gueensbury.net
Septic Inspection Report
Office No. (518)761-8256 Date InsMu
qQueensbury Building&Code Enforcement Arrive: p rt: am/pm
742 Bay Rd., Queensbury, NY 12804 Inspector's Initials:
NAME: '� Of(�F PE V41 NO.:
LOCATION: LtjE �F_ INS E 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.
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
Inlet/Outlet Pi s&Baffles Y N
Manholes 12"or less below grade _Y_N AS BUILI
[provide extension collar if Yes Y N
Location Separations
Foundation to tank ft.
Foundation to absorption z ft.
Separation of Pits ft.
r Plot Plan N
Engineer Re and As-Built Y N
ance Contract Y_N
provided
Location of System on Property:
Front r Left Side Right Side Middle Front Middle Rear
stem Use S us.
Approved
Partial Approved and needs to be re-inspected, please call the Building &Codes Office
Disapproved
L:\Pam Whiting\2010\13uilding Codes Forms\Inspection Forms\Septic Inspection ReporIL03 2910.doc
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ENVIRONMENTAL DESIGN
PARTNERSHIP,LLP
May 12, 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
Lots 75-76 Alpine Ave.
Dear John:
On May 12, 20111 visited 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
dated April 27,2011.
Based on my review of the plans and observation of the installation it is my opinion that the
installation of the system was in substantial compliance with the intent of the design plans. The
location and configuration of the installation is in substantial compliance with the design plan
thus no as-built plan is provided. Please contact me should you have any questions regarding
this system.
Sincerely,
Dennis MQcElroy
Dennis MacElroy,PE
900 Route 146,Clifton Park,New York 12065 phone(518)371-7621 -fax(518)371-9540
r
_ # /0,
Septic Inspection Report
Office No. (518) 761-8256 Date Ins tonrPECT
Queensbury Building&Code Enforcement Arrive: art: 'Z=r742 Bay Rd., Queensb ry, NY 12804 Inspector's InitiaNAME:LOCATION:
RECHECK:
Comments and/or diagram
Soil Ty am/Clay
Type of Water: u i ' ell Water
"Waterline separation distance 7 ft.
Well separation distance ft.
Other wells: ft.
Well Casing Length 50' +/- Y N N/A
150'to well required if NO3 i
Absorption Field: Total length ft.
Length of each trench ft.
Depth of trenches ft.
Size of Stone q�
See a e Pits: Number
Size: x
Stone Size:
Piping Size Type
Building to tank "
Tank to Distribution Box L�
Distribution Box to Field/ Pit
Opening Sealed. _ N
End Ca _ z N
Inlet/Outlet Pipes&Baffles N
Manholes 12"or less below grade _Y
[provide extension collar if Yesl Y v N
Location Separations
Foundation to tank ft.
Foundation to absorption ft.
Separation of Pits ft.
Conforms r r Plot Plan —Y o
Engineer Report and As-Built Y
ETU Maintenance Contract Y_N `
provided
Location of System on Property:
Front Rear Middle Front Middle Rear
S stem Use Statu .
Approved
Partial Approved and needs to be re-inspected, please call the Building &Codes Office
Disapproved
L:\Pam Whiting\2010\13uilding Codes Forms\Inspection Forms\Septic Inspection Report-03 2910.doc
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