2010-411 TOWN OF QUEENSBURY
*Gm 742 Bay Road,Queensbury,NY 12804-5902 (518) 761-8201
Community Development- Building &Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number. P20100411 Date Issued: Friday, August 27, 2010
This is to certify that work requested to be done as shown by Permit Number P20100411
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, �-, ,�/
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
`ION 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development- Building&Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20100411 Application Number. A20100411
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 Queens bury 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
2010-411
SEPTIC ALTERATION - 2 WINDSONG DR
$35.00 PERMIT FEE PAID- THIS PERMIT EXPIRES: Friday,August 19, 2011
(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 queens ury;, Thursday,August 19, 2010
SIGNED BY 'y
�° % `f for the Town of Queensbury.
Director of Building&CodeVnforcement
011* Community Development Office
—, Town of Queensbury • 742 Bay Road • Queensbury, New York •12804
•
Office Use Only
TAX MAP NO.____—
'_ 7-2 PERMIT NO._7JL_ __ / PERMIT FEE #3s---.c,
APPROVALS: ZONING TOWN CLERK
APPLICATION FOR SEPTIC DISPOSAL SYSTEM PERMIT: A PERMIT MUST BE OBTAINEC
BEFORE WORK BEGINS. APPLICAT N IS SUBJECT TO REVIEW
LFORE ISSUANCE OF A VALID PERMIT.
OWNER: _ 1S/ _Q_1 l� INSTALLER: _/ i
__O-2)___y_ ci.ew GL 14,2.--A4 c.c...
ADDRESS:_LV Ze,lN R-- l�,
�7 ADDRESS:_Pv .. C-144-- 2 2 of
PHONE NOS. -2 9) gat) PHONE NOS. 1 2 — 0 (F(
LOCATION OF INSTALLATION: (I4-1 1t"DX' --S-)5 7)gi_e
NO.OF X COMPUTATION RESIDENCE INFORMATION:
YEAR BUILT = TOTAL DAILY FLOW
BEDROOMS (Gallons per bedroom)
GARBAGE GRI
1980 or older X 150 = INSTALLED?
1981 -1991 X 130 = SPA OR HOT TUB . `
1992-present X 110 = INSTALLED? _NX)
PARCEL INFORMATION: S Q '- e tivis`
✓ TOPOGRAPHY: FLAT ROLLIN __7—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�pproved subdivision).
TANK SIZE:10 AD 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:
BSORPTION FIELDSTONE) g
(WITH NO. 2 Total length_/SO ft. Each trench � X .
❑ SEEPAGE PIT(S) (WITH NO. 3 STONE) How many? Size?
❑ALTERNATIVE SYSTEM Bed or other type?
0 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.
I have read the regulations with respect to this application and agree to
i .e by t - - and all requi ments of the Town of Queensbury QUESTIONS? CALL 761-8256 OR EMAIL
S•ni ;ry Sew.:- m ispo a rdinance. ¢//� ` codes(a.queensburv.net
gn• ure of Per on Responsible Date VISIT OUR WEBSITE FOR MORE INFORMATION
www.oueensburv.net
•
Septic Inspection Report
Office No. (518) 761-8256 Date Inspection req :
Queensbury Building &Code Enforcement Arrive: 31 3D a 1 pm = • . !
742 Bay Rd., Queensbury, NY 12804 Inspector's Initials:
NAME: t--1pmAFhTEv ) P.RM' NO.:
LOCATION: Z d`�-� , I SP'CT 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 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.
s.as r Plot Plan
Engineer Report a d As-Built Y_N
am enance Contract _Y N
provided
Location of System on Property:
Front ear Left Side Right Side Middle Front Middle Rear
stem Use S tus:
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 Report_03 29 10.doc
4
eN VIIIIIIIIIII
41
'AIVSTV IIIIIIIIIIIII
ENVIRONMENTAL DESIGN
PARTNERSHIP,LLP
August 24, 2010
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 2 Windsong
Dear John:
On August 24, 2010 I 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 May 25, 2010.
Based on my review of the plans and observation of the installation it is my opinion that the
installation of the system is in compliance with the intent of the design plans. Please contact me
should you have any questions regarding this system.
Sincerely,
Dennis MacEiroy
Dennis J. MacElroy, PE
900 Route 146, Clifton Park, New York 12065 phone(518)371-7621 -fax(518)371-9540
CCSB [ o 3 �` et,„
,,, • Septic Inspection Report
v
Office No. (518) 761-8256 Date Inst t '•n r-• j ed:
Queensbury Building &Code Enforcement Arrive: • ' , -�► • � -•epart: : 1r a . •
742 Bay Rd., Queensbury, NY 12804p .Inspector's Initials: ,_/• JJ
NAME: `L ( )#� NA t I ray P • NO.: / L
LOCATION: , ,.d , CA D( , I 'ECT ON: 977M111,1 0
RECHECK:
Soil Typ74
Comments and/or diagram
10oam/ Clay
Type of Water: • , Well Water
Water - -:.ration distance t ft.
separation distance ft.
Other wells: ft.
Well Casing Length 50' + / - Y N N/A
Absorption Field: Total length 4.0 ft.
Length of each trench , ,Alb ft.
Depth of trenches Zi ft.
Size of Stone
Seepage Pits: Number
Size: x
Stone Size:
Piping - - ---Size Type
Building to tank 1.0 brAA%-lb
Tank to Distribution Box " hcl e-16-
Distribution Box to Field/ Pit " ,A, Tc, '
Opening Sealed: 1f N
End Cap _N
Inlet/Outlet Pipes&Baffles _.Y—N
Location/ Separations
tkom,EttotiE Foundation to tank ft. 6W• 0
it Foundation to absorption ft. r ‘t ---.c?---‘17
Separation of Pits ft. 9
Conforms as per Plot Plan __AL Y N tJ
Engineer Report and As-Built Y_ N
Location of System on Property:
Front Rear Left Sid- Right Side Middle Front Middle Rear
System Use Status:
pproved
Partial Approved and needs to be re-inspected, please call the Building &Codes Office
Disapproved
Last revised 06/18/07 L:\Building&Codes Forms-OLD\Building&Codes\Inspection Forms\Septic Inspection Report.doc
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