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2010-568 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: P20100568 Date Issued: Monday, April 02, 2012 This is to certify that work requested to be done as shown by Permit Number P20100568 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 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201 Community Development-Building&Codes (518)761-8256 BUILDING PERMIT Permit Number: P20100568 Application Number: A20100568 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 Constructio Value Owner Address: HOMESTEAD VILLAGE L P Septic Alteration Commercial 4294 ROUTE 5 Total value CALEDONIA,NY 14423 Contractor or Builder's Name/Address Electrical Inspection Agency SANITARY SEWER GEORGE DRELLOS 792-7257 PO BOX 224 GLENS FALLS NY Plans&Specifications 2010-568 55 & 56 Windsong Dr $35.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Thursday,December 08,2011 (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 of Queensbury; Wednesday,December 08,2010 SIGNED BY for the Town of Queensbury. Director of Building&Code Enforcement Septic Inspection Report_ Office No. (518)761-8256 Date Ins•-.1• , oast '- - ed: Queensbury Building&Code Enforcement Arrive: $ 4." am •�"'� •- : -� e a, •m 742 Bay Rd., Queensbury, NY 12804 Inspector's In - 4/ NAME: b u in I* ' • • REMIT NO.: —5(0 LOCATION: "� .1♦ F V.INSPECT ON: Z.—1 "7, 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. Conforms as per Plot Plan Y N Engineer Report and As-Built Y—N ETU Maintenance Contract _Y_N provided Location of System on Property: Front • -.r Left Side Right Side Middle Front Middle Rear tem _ - S. s: 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 Repork_03 29 10.doc III.I.I...I...7:T) _ � i it(57C7-7Dij \\, Septic Inspection Rep• • • Date Inspection r-• est r•,- -s Office No. (518) 761-8256 Arrive: or"----s Initial Ip Depart: am/pm Queensbury Building&Code Enforcement ctor's Initial • v 742 Bay Rd., Queensbury, NY 12804 / Pe i I, PELT ON: C � LOCATION: ,'�- �l , r-.: "^ RECHECK: • j ph{t' 'i fL.. I C Comments and/or diagram Soil Type: Sand/ Loam / Clay Type of Water: Municipal/ Well Water e '0 j red Waterline separation distance ft. Well separation distance ft. Other wells: ft. 1 a f l Well Casing Length 50' + / - Y N N/A 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 67. Distribution Box to Field / Pit Opening Sealed: _Y N End Cap Y N Inlet/Outlet Pipes&Baffles _Y N Location/ Separations • Foundation to tank ft. Foundatio tion ft. Separation of Pr ft. Conforms as per Plot Plan _Y_ / Engineer Report and As-Built _Y Location of System on Property: Front Rear Left Side Right Side Middle Front Middle Rear Approved 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 Reportdoc cirscr Septic Inspection Report Office No. (518) 761-8256 Date I •- ion r-•uest •=2% ed: Queensbury Building &Code Enforcement Arrive: le = -� '--,rt: '` 6417 a •r. 742 Bay Rd., Quee bury, NY 12804 Inspector's Initials: — NAME: f ime,) -(':„-ofP• ' G/) MIT NO.: S LOCATION: SSS - SPECT ON: — - RECHECK: a Comments and/or diagram SoilTy•-• n•- ••m/Clay Type of Wate r •.. t. ell Water Waterline separation distance n4— 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 Z ft. Size of Stone Seepage Pits: Number Size: x Stone Size: Piping Size Type Building to tank 9 " 6c4k 4r Tank to Distribution Box y" hi)PN: 5F Distribution Box to Field/ Pit L-;'' 1, TO VEef Opening Sealed: c N End Cap t4 N Inlet/Outlet Pipes&Baffles IX—N Manholes 12"or less below grade ✓:N [provide extension collar if Yes] Y N Location/ Separations Foundation to tank I ft. Foundation to absorption ft. Separation of Pits 1�Yft. 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