2015-180 TOWN OF QUEENSBURY
oN742 Bay Road,Queensbury,NY 12804-5902 (518) 761-8201
Community Development - Building & Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: P20150180 Date Issued: Tuesday, August 11, 2015
This is to certify that work requested to be done as shown by Permit Number P20150180
has been completed.
Tax Map Number: 523400-308-014-0001-052-000-0000
Location: 183 PITCHER Rd
Owner: FOREST PARK MHC, LLC
Applicant: FOREST PARK - 59 & 61 GREGWOOD CIRCLE
This structure may be occupied as a:
Septic Alteration Residential
By Order of Town Board
TOWN OF QUEENSBURY
Issuance of this Certificate of Compliance DOES NOT relieve the (.— J
‘1&-
property owner of the responsibility for compliance with Site Plan, /d
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
hiA
t4riv 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development- Building& Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20150180 Application Number: A20150180
Tax Map No: 523400-308-014-0001-052-000-0000
Permission is hereby granted to: FOREST PARK MHC. LLC
For property located at: 183 PITCHER 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: FOREST PARK MHC, LLC
31200 NORTHWESTERN Hwy Septic Alteration Residential
FARMINGTON HILLS MI 48834-00 Total value
Contractor or Builder's Name /Address Electrical Inspection Agency
Plans&Specifications
2015-180 septic alteration
59 & 61 Gregwood Circle
$40.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Saturday, May 21,2016
(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 n o eens ,V d u s May 21,2015
4
SIGNED BY for the Town of Queensbury.
Director of Building&Code Enforcement
SEPTIC DISPOSAL PERMIT _
n ..-. Office Use Only
s1i9I/s .v�;
'`� Rece''
DATE -
Tax M:0)
TAX MAP ID 1 ki;it 2 0 Zijtirmit • 15 —1'tb
Permit Fee tktir pct
LOCATION OF INSTALLATION ! TOWN OF QUEM ,` 4 l .Is:
BUILDING&CODES
15IA -:crena-park l
APPLICANT Fo res4- Park m C LLC- PHONE/E-MAIL-715-1 111-0 p-Tam f' (,tat/
ADDRESS 5q4 L 6 re6K,and Circle_ QueashvA t\Iy I a Ve LI to
INSTALLER/BUILDER: LY C. I ' ta'c 1 O'' is PHONE/E-MAIL 6?'-/-L I b3
ADDRESS: _l 305 r - 0 aI pr Ad I t y l OLaId Ii)
OWNER 12re st Park m vit LL PHONE/E-MAIL /1 U '1 t•-
Address I g3 7tkLf L( i A OSb..I N1 I aAV1-1
/4
CONTACT PERSON FOR BUILDING&CODES COMPLIANCE: Ma 331 e.61011401/1 PHONE 141,5-1 TAP
RESIDENCE INFORMATION
• Yea+ Buil' ! *of bedr>'ms X Gallon'pe hedroo 1 •Tr*aI r-,ily Flow ,
1980 or older Garbage grinder installed • Y N
1981-1991 '3 64 ( o 5allan.S. Spa or Hot Tub installed _Y _N
1992-Present
PARCEL INFORMATION
Topography ✓ Flat rolling Steep slope %slope
Soil Nature t/ Sand Loam Clay Other
Groundwater At what depth?
Bedrock/Impervious Material At what depth?
Domestic Water Supply ✓ Municipal Well(if well,water supply from any septic system absorption is ft.)
Percolation Test Rate: 5 7 mi Vl.per minute per inch(test to be completed by licensed engineering/architect)
PROPOSED SYSTEM FOR NEW CONSTRUCTION1
�A�� c��u�nb zrs IA 1:e�o f .2 Sine, pi pc,
Tank Size I,r7) gallons(minimum size 1,000 gallons,add 250 gallons to size for each garbage grinder or spa or hot tub)
System Type Absorption field with#2 stone Total length ,3(90 ft.;Each trench to x LoO
Seepage Pit with#3 stone How many: ;size
Alternative System Bed or other type? _
Holding Tank System Total required capacity? Tank size #of tanks
Notes: 1)Alarm system&associated electrical work must be inspected by a Town approved electrical inspection agency;2)We will no longer
allow systems to be covered until such time as an As-Built plan is received & approved. The installed system must match the septic system
layout on file—no exceptions.
DECLARATION: Any permit or approval granted which is based upon or is granted in reliance upon any material representation or
failure to make a material fact or circumstance know by or on behalf of an applicant,shall be void. I have read the regulations and
agree to abide byese and 411 requirements of the Town of Queensbury Sanitary Sewage Disposal Ordinance.
Print Name: 9 C101- Lit_ot _ Date: ill-15'
Signature: Date: ,5-jet-1,5-
Town of Queensbury Building&Codes Septic Disposal Permit July 2014
Town of Queensbury Building & Code Enforcement
Office No. (518) 761-8256
Septic Inspection Report
Inspection request re ived:
-
Name: L Inspected on: e*,aCt
Location: lrrive: . . p.m.
Permit No.: ' I f )T,e0.1)2. --6,,c4i0e) �f�Inspector's Initials: _' .Wlli
Comments and/or diagram
Soil Type: Sand/Loam C :y
Type of Water: Municip.,l/ -II Water
Waterline separation di•tance ft.
Well separation distanc• ft.
Other wells: ft.'
Well Casing Length '0'+/- Y N/A
[150'to well required if 0]
Absorption Field: Total I-ngth 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
End Cap Y
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 Pitsft.
Conforms as per Plot N
Engineer Report a As-Built Y N
ETU Maintenance provided Y N
Location of System on Property:
Front Rear Left Side Right Side Middle Front Middle Rear
System Use Stat :
pprov1
a ial Approved and needs to be re-inspected, please call the Building&Codes Office
Disapproved \�
Septic Inspection Report
G. Peter Jensen
li `II
17 West Road
LUL JSouth Glens Falls S 2015 ��New York 12803
(518) 798—3859 OF QUEENSBURY
ILDING &CODES
May 25, 2015
To Whom It May Concern:
I have designed(plan 14-1109)and observed the installation of the septic system
at lot 59& 61 Gregwood Circle, Forest Park MHC, Town of Queensbury, Warren
County,New York. It would appear that the installation is within the intent of the design
documents. To the best of my knowledge and belief, no field conditions were
encountered that would require a re-design of the septic system. Hancor ARC 24
chambers, with a 25%reduction,have been substituted for the stone and pipe system.
To the best of my knowledge and belief all of the distance separation requirements
have been met.
Sincerely
G. Peter enseng��AE D 4.;;;�C9� to ER.Jt4,
• 2
� ° e•ozo P. r�,# •
OP KIN
— !LO
FQueensbury Building & Code Enforcement
11111
Office No. (518) 761-8256
Septic Inspection Report
Inspection request receive�d:(�
Name: rx , HCl✓k., _ Inspected on: - .�
Location: , Q,1, cv+2 Wp cC\ Arrive: IilY' m. p.
Permit No.: I�J J ) 0 U Inspector's Initials: * l�
Co IV s and/or dia.ram
Soil Types _ Cl
er: ay
Type of W Municipal! ll Water
Waterline separation distance I'D _ft. r
Well separation distance ft.
Other wells: ft.
Well Casing Length 50'+/- Y N N/A
[150'to well required if NO] 1
Absorption Field: Total length 1 11.—V) �
b ft. j
�7 1-61-1SL—
Length of each trench ft.
Depth of trenches Z—1 ft.
Size of Stone A Q-C_ -7_k-( C. R-AvFL� C—arm e-,F z5
Seepage Pits: Number l
Size: x
Stone Size: 1
Piping f ) !boo GAL. Til&S j Size Type
0( d���"ttttanBuilding tlk w" 12L1-k tin
Tank to Distribution Box %-C b O L -275--
Distribution Box to Field/Pit y 1` 4 0 123 6—
Opening Sealed: ►_,,,r- N
End Cap ,/'`f N I
Inlet/Outlet Pipes&Baffles ::..,)IN w1 i LTez—
Manholes 12"or less below grade N/
[provide extension collar if Yes] Y ✓N
Location/Separations
ri
FF
tiQr to tank I IO ft. 'Ian_--0 � E�lj RE----Pc ,
F.e+ on absorpt 1c f'e ft. R}j—a)%L� QO
Po
Separation of Pits ft/
Conforms as per Plot Plan Y VN _ ° R RC__ Z 4 2 csrVEL�j!
Engineer Report and As-Built Y C\--\pt- QE2b
ETU Maintenance Contract provided Y N '
Location of System on Property:
Front Rear Left Side 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
Septic Inspection Report
.Z
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AB,,:,Ov-�.P-nON AREA SECTION
NTS
N O T" E a
PERGOI-ATIDN DATE WAS LESS THAN ONE MINUTE PER INCH, PEMOYE SOIL TO A
Di=PTH OF4'rnl ,gg;'CJFiFrtE>N! ARr--A A1140 -'J3EYOND,4Mt:1Y0 S01L TU A j-'7
Mlt'4iTE PERCOLA-'10IV RATE' OR REPLACE W11-- NSW SOIL i0 NAVE A6^'7 MINUTE
P1!RC0L-AT'l0N RATE AT BOMAOK' Ptr, COMPACT REPLACEMENT 90rLCAM&NDEIJ OR NEW)
IIyG"! lF75114CVV PCRGOLATION TEST MUST 150- PCRFZ�RMPI�IN AMENDOO OR r;iapLAcrmC-NT
SOIL 70 VGRtFY PERCOLATION .RATE AND ODES IGN, Re SIOE'Na0d W1TH CRMBIN,=D
7ZOGPO R'LOW RATE IN SOIL yYITH.A S-7MiNUTe PERGOLA?'lotr RATE'' REQuIRe-f� 360
1„lN,FY, A4SS:JRPTION"iT{fNQH-3bOLtAi•FT.PROVIpED((eRUN9�60`F-AGN�.
t. COW TAG -K piG SAFE
AT -1-800-9/62-791&2 r-oR UTIL4rrItL-S I_OCATIOIv PRIOR TO LzXCAV
AT1pJ,
31 REMOVE` C -X ISTINCO ORYWLLI. AND TREES AS rzkI-=QUIR-OD.
A, REMOVG AMY CONTAMI"AT00 SOIL BhkGOUN"r•EKtED.
5-PROVIO BPFLUI'-NY FILTER ON OUTLET OF SEPTIC TANKS,
6, SET SEPTIC TANKS ANID UISTrt1BHT/ON 80X LEVEL,
7, PROVtDE ePEED LEVHLERS IN 0ISTR18UTIC>N BOX,
5,U -'E ONLY SOLa.? SDR 35 PIPE WI'rH ria-HTeJOINTS P-.,ETWE;/J SEPTtC TANK AND 0t%-rRIgVTION
rjox ANI] PjE rwEEN p1STRt$U?,DN SOX ANv J rI NI11N r OFAeN5ORfi`TI0N 77?49 r#A
9, ALL PIPE ,JOINT'S MUST gE WATrRr/&H7,,
FO,NO POIRTfON OF S%PTie, SYSTEM SHALL ,Rif WITHIN /O'CJF ANY PROPERTY L1N4
//, NO OPEN PORTION-D15TRIBUTION DOX OR AISSORPTION ARTA- SHA -'I- 175L5 W171-i1:a
lDD'GW ANY WALL, LAKE) STREAM/'OND�S IVER DR W'CTLAND,
J2, INSTALLATION Mu5'r >3E INS pECTiwD-r'R1OR TD COVERUVC,- t3Y THc ML);Lt71NICs
IN5Pr-CTOR c7F THu TOWN OF* OOCENSSUR'f,
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r t:715'Tt 1p}U ,ION e K .
I IODOCAt (MIN) I -� �^ , 4'0 SOLID SDR 35 PIPE
i SEPtrG TANK -_ t II 1 #' I ` \ I PITCH 8 PER f�k3T
= r=1LL ! A15ANVt5fv , I lfi �bW 4 1' I t I- x000 GAL (MIN) SEPTIC '-ANN)
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-- } i14 -I_f L��CR�MOv£ 0XISTtF.iG ,SES'' -IG TANK]
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A CORP T, ON TRE'Ne,4 I 1Vl
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TEST PIT REVEALED:
O-Ip"'YOP SOIL,
Io'L 27" ORANGE COARSE SAND
27-72" GRAY BROWN COARSE SA No
--SEED AREA AFLTbR INSTALLATION
IMANHOL-e GDvF-R --
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CAULKED JOINT --
s^NITAR'( TE6 --
N (,k?4TREA7rF0BUILD0NG PAPER
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Or-
Z! TR ENCNES MUNI MUNI 2.' ABOvE 9UEASONAL-
HIGH GROOND WATeft OR IMP!5Rv101JS
LAYER,T)4E'NGHES GAO O,C, NJ,T'H 4'
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X CC USEApI-E SOIL r?EQUIRES7 J!,L-rWE�IY
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PART PLOT 'PLAhd
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Forest Park MHC BP 2015-180
59 & 61 Gregwood Circle
R,,sidential septic alteration
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SEPTIC TANK
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LTRENCH 13077L)M
TREMCH I-OW;ITuOINAL- s57CTION
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M,�y 0 1015 D 1
TO
Cnlnl
TOWN OF Ot
BUILDING & i
Reviewed By:
Date:
WARREN COUNTY
ESPY Tprrr41 OF t7uceN�BURY
tPtD arc
It it a Violation of the Law for any Parson, 1
Unless Acting Under the Direcocin of a
1 ' Licensed Architect, to Alter any Portion of ThiS
7t Document in any way. It any Portion N this
T. Document is So Altered, the Aitering Architect
= Shat Alfa tothe Portion so Altered his Seal and
s�4 oze02° y�� the Notation "Altered By" Followed by his
Signature and the Date of Such Atteratlon, and
/ a Specific Description nr the Alteration.
MAIGHT'S SEPTIC SERVICE
FOR
FoREs`r PARK MHC
G. PETER JENSEN
17 WEST ROAD IPLA1•{ 13Y DA rT, I SCALE^
SOUTH GLENS FALLS -
NEW YORK 12803 1 14 I l09 Nov r4A „ N 1
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