2011-446 TOWN OF QUEENSBURY
^to 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development - Building & Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: P20110446 Date Issued: Tuesday, October 11, 2011
This is to certify that work requested to be done as shown by Permit Number P20110446
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 QUEENSBURR
ftIr
ssuance of this Certificate of Com liance 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.
TOWN OF QUEENSBURY
411111%
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development-Building&Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20110446 Application Number: A20110446
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
Plans&Specifications
2011-446
septic alteration residential
$75.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Saturday, September 08,2012
(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 To ueensb ; Thursday,September 08,2011
SIGNED BY �{ for the Town of Queensbury.
/v
Director of Building .t. 'ode"y•forcement
-f i Community Development Office �D, f
— Town of Queensbury • 742 Bay Road • Queensbury, New York •12 : I�
Office Use Only j� � II
QUffEWSBIJRYL
TAX MAP NO. PERMI� O. PER FEE RIJ!WING & CODES
APPROVALS: ZONING TOWN CLERK
APPLICATION FOR SEPTIC DISPOSAL SYSTEM PERMIT: A PERMIT MUST BE OBTAINED
BEFOREIORK BEGINS.APPLICATION IS
SUBJECT TO REVIEW : ,FORE ISSUANCE • A VALID • RMIT.
OWNER: , INSTALLER: I rj� Lr �� C:�L�eCIL V /�
ADDRESS:�V 1—Q�.,– & r ( ADDRESS: P J N X �/ V
`� ('G� /
PHONE NOS. //j Q 1!e- - 2- ` -7 1 o PHONE NOS. Q 4 ra
- 0 V
LOCATION OF INSTALLATION: 1071-- /v F Pc-di/^a lrCte._ J v►
RESIDENCE INFORMATION:
NO.OF COMPUTATION
YEAR BUILT BEDROOMS X = TOTAL DAILY FLOW
(Gallons per bedroom) GARBAGE GRIND
1980 or older X 150 = INSTALLED? �J
1981 -1991 X 130 = SPA OR HOT TUB m
1992-present X 110 = INSTALLED? /"
PARCEL INFORMATION: 1I p e_ p ,J
✓ TOPOGRAPHY: FLAT ROLLIN STEEP SLOPE �J %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[mpg (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 installed11in a Planning Board approved subdivision).
TANK SIZE:1_V c)'o`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: (
?i
A043SORPTION FIELD(WITH NO.2 STONE) Total lengthal'.
+�ft. Each trench ` X 6 ,-
0
,-
❑ SEEPAGE PIT(S)(WITH NO.3 STONE) How many? _ Size? _
o 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.
Ia - read the regulations with respect to this application and agree to
ra,ide •y these -•• -II requirements of the Town of� Qu ensbu QUESTIONS? CALL 761-8256 OR EMAIL
ni .rySew., e '� pose • :finance. �7� L1 codes(a�aueensburv.net
r• - 4 i — — VISIT OUR WEBSITE FOR MORE INFORMATION
• •ture of r - on Res. •nsible Date www.queensburv.net
.
Septic Inspection Report
Office No. (518)761-8256 Date Inspection request received:
Queensbury Building&Code Enforcement Arrive: am/• P-part:7.4\ ,p am/pm
742 Bay Rd., Queensbury, NY 12804 Inspector's Initials:
t�� jj JJ fi 1
NAME: � �,l�"1�- PERMIT NO.: ON lr
LOCATION: IoL$ KI-N").‘G 01A6t2` INSPECT ON: 'I" IMElf
RECHECK: gr
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:
Stone Size:
Piping Size Type
Building to tank 425-Th
Tank to Distribution Boxc'2 ,-(90%
Distribution Box to Field/ Pit
Opening
Opening Sealed: Y 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 ft.
Separation of Pits ft.
Conforms as per Plot Plan N
Engineer Report and As-Built —N
ETU Maintenance Contract Y N
provided
Location of System on Property:
Front Rear Left Side Right Side Middle Front Middle Rear
tern U - S _ .
Approv-
•- • pproved and needs to be re-inspected, please call the Building&Codes Office
Disapproved
L:\Pam Whiting\2010\Building Codes Forms\Inspection Forms\Septic Inspection Report_03 29 10.doc
r . . . 11111411111111111111
III
ENVIRONMENTAL DESIGN
PARTNERSHIP,LLP
September 30,2011
Queensbury Building& Code Enforcement
742 Bay Road
Queensbury,NY 12804
Via email john@queensbury.net
Attn: John O'Brien
Re: Homestead Village Mobile Home Park
Lot 107 & 108 Adirondack
Dear John:
On September 22, 2011 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 system
designed by EDP dated August 24, 2011.
Based on my review of the plans and observation of the installation it is my opinion that the
system was installed substantially in compliance with the intent of the design plans. The only
deviation from the plan was that the tanks were installed at 45 degree angles due to dimensional
constraints.
Please contact me should you have any questions regarding this system.
Sincerely,
("4/1110025
James E. Mitchell, P.E.
900 Route 146,Clifton Park, New York 12065 phone(518)371-7621 -fax(518)371-9540
�c /c r- ii:) fes:, ) J. I� �r 5
Septic Inspection Report
Office No. (518)761-8256 Date Inspection request received:
Queensbury Building&Code Enforcement Arrive: am/pm part: 'yam/pm
742 Bay Rd., QueensOury, NY 12804 Inspector's Initials:
NAME: /h t__,4 PERMIT NO.. /Ki'i
LOCATION: INEMMINITIMPAC INSPECT ON: 22-j`
RECHECK:
Comments and/or diagram
Soil Type: ' ,.m/Clay
Type of Water: j Well Water
Waterline separation distance ft.
Well separation distance ft.
Other wells: ft.
Well Casing Length 50' +/ - Y N N/AVrA,V\A>fe
NC
[150'to well required if NO]
/t _
Absorption Field: Total length ZA, ft.
-
Length of each trench &2 ft.
Depth of trenches ft.
Size of Stone '7
Seepage Pits: Number �,
Size: /^'
Stone Size:
Piping Size T�
Building to tank ikt‘ 5- , O
Tank to Distribution Box eik«
Distribution Box to Field/ Pit R 3 P! L-
Opening Sealed: N
End Cap N
Inlet/Outlet Pipes&Baffles Y SIV
Manholes 12"or less below grade Y r
[provide extension collar if Yes] Y_114/4
Location/ Separations
Foundation to tank ft. `Z,
Foundation to absorption ft. � Pt.-44-4J
Separation of Pits aft.
Conforms as per Plot Plan Y
Engineer Report and As-Built Y N
ETU Maintenance Contract Y_ N
provided
Location of System on Pro
Front Rear Left Side Right Side Middle Front Middle Rear
stem - S .t •:
Approved
Partial Approved and needs to be re-inspected, please call the Building&Codes Office
•
Disapproved
L:\Pam Whiting\2010\Bullding Codes Forms\Inspection Forms\Septic Inspection Report_03 29 10.doc
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