2012-517 !fel& TOWN OF QUEENSBURY
742 BayRoad,Queensbury,NY 12804-5902 (518) 761-8201
Q rY,
Community Development - Building & Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: P20120517 Date Issued: Tuesday, February 12, 2013
This is to certify that work requested to be done as shown by Permit Number P20120517
has been completed.
Tax Map Number: 523400-308-014-0001-052-000-0000
Location: 183 PITCHER Rd
Owner: ARC COMMUNITIES 14 LLC
Applicant: ARC COMMUNITIES 14 LLC
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 4
property owner of the responsibility for compliance with Site Plan, V�
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
7-12 BaY Road,Quccnsbur.v,NY 12804-5902 (518)761-8201
Cornniiinity Developinient- Building& Codes (518) 761-8256
BUILDING PERMIT
Perinit Number: P20120517 Application Number: A20120517
Tax 1,lap No: 523400-308-014-0001-052-000-0000
Pertnission is hereby granted to : ARC COMMUNiTIES 14 L,LC
f�'(�)r property locatedat: 183 PITCHER Rd
in the Town of Quvensbury,to construct or phice
at the al location in accordance with application together%%rith plot:playas and other infortnation hereto filed
and approved and ill conipliance with the NYS Uniforni Building(:o des and the QueensburN Zoning
OrdinAnce. Tylie.of Construction Value
Owner.\ddress: FORESTPARK MFIC, LLC Septic: Alteration Coiiii-nercial
31200 NORTHWESTERN I lwy Total Value
FARMINGTON HILLS MI 48834-0(
('ontractor or Builder's Nance / Address Flectrical Inspection Agency
RAYMOND JONE'S
518-424-0508
PO BOX 702
BALLSTON SPA NY 12020-0000
Plans& Specifications
2012-517
Septic Alteration - 6 & 8 Briwood Circle
$75.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Tuesday, Noveniber 05, 2013
(1fa longer period is required,an application for an extension inust he made to tile code Enfofccluent Officer
of tlwl'o-wn of Queen shury before the expiration date.)
Dated at the Town of Queensbury; Monday, Novenill)er 05, 2012
1;1('N 1 1) BY for the:`[own of Quicensbury.
Director of Building& Code 1riiforcenicnt
Community Development Office
Town of Queensbury • 742 Bay Road • Queensbury, New York -12804 IJC i .' 7 012
Office Use Only �
TAX MAP NO. 2o 8 )11-1-.5 a I PERMIT NO. _ i� 4.73 .-'
PERMIT FEE
APPROVALS: ZONING TOWN CLERK
APPLICATION FOR SEPTIC DISPOSAL SYSTEM PERMIT: A PERMIT MUST BE OBTAINED
BEFORE WORK BEGINS.APPLICATION IS SUBJECT TO REVIEW BEFORE ISSUANCE OF A VALID PERMIT.
OWNER: A-"t\ I PO +C't'-cST p aK I� INSTALLER: i�f t c i Li O t'�t.5 / /
ADDRESS: ADDRESS: ( 06)y 70 - B:'J is{ !'i 4L-`'/
PHONE NOS. (S 1 S\ 4.. ^J S.—C7? PHONE NOS. (,fib 1 `{"' U 50 8
LOCATION OF INSTALLATION: 6 4'4 8 i---t L'06 d d C�c'rcl L Z6.v , `(c)4,.(e__ttI'litA
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 '`3 X 110 = INSTALLED?
PARCEL INFORMATION:
✓ TOPOGRAPHY: FLAT ROLLING".y STEEP SLOPE %SLOPE
V SOIL NATURE: SAND`J LOAM CLAY OTHER
✓ GROUNDWATER: AT WHAT DEPTH?
✓ BEDROCK/IMPERVIOUS MATIE)�AL: AT WHAT DEPTH?
✓ DOMESTIC WATER SUPLY: MUNICIPAI:..."--f WELL (If well:water supply from any septic system absorption is: ft)
✓ PERCOLATION TEST: RATE IS t.6 0 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: 1, 0 0 Q 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:r `
ABSORPTION FIELD(WITH NO.2 STONE) Total length ft. Each trench :•'R X LI b
❑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.
I have read tie regulations with respect to this application and agree to
abide by hes Qd all requirements of the Town of Queensbury QUESTIONS? CALL 761-8256 OR EMAIL
Sanitary S age osal Ordinance. codes ac queensburv,net
,,5---e--4.. la, ;, t2_,
Signature of Person Reesp psible Date VISIT OUR WEBSITE FOR MORE INFORMATION
www.queensbury.net
Septic Inspection Report
Office No. (518) 761-8256 Date Inspection r-•u- - - -.:
Queensbury Building &Code Enforcement Arrive: \\14b t ! / ^part: 1A1.___*_,-G:(arn
742 Bay Rd., Queensbury, NY 12804nn Inspector's Initials ,,
NAME: aF kr— aRC( g.i Pr 'MIT NO.: 12--St-7
LOCATION: (o (32.i Li)en CIRCLE NSPECT ON: Z— 11— 13
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 eFoundation to tank ft. AS BUILT
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 '-ar Left Side Right Side Middle Front Middle Rear
S stem Use S . us:
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
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NACE ENGINEERING, P.C.
169 Haviland Road, Queensbury, NY 12804
Phone-518-745-4400 Fax -518-792-8511
November 21, 2011
Job#49335
Ms. Kristine Wheeler
New York State Dept. of Health
77 Mohican Street
Glens Falls,NY 12801 FEB 1 ' 2013
RE: Forest Park Community—Queensbury, Warren County
6 & 8 Briwood Circle—Replacement Septic System
Gentlemen:
This letter is to inform you that we inspected the completed replacement septic system for 6 & 8
Briwood Circle in the Forest Park Community on 11/15/2012.
The septic system as installed was for a two (2) - 3 bedroom trailers and consisted of two (2)
1,000 gallon septic tanks and 800 sf of absorption bed constructed with stone and 4 — 35 ft long
perforated pipe laterals. The system conforms to the requirements of the approved replacement
design drawings.
Please call me if you have any questions or concerns.
Sincerely,
Thomas R. Center Jr., PE . -
cc: Dave Hatin, TOQ Building Dept. r'-,c
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Marty Mancini, ARC '��
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Septic Inspection Report
Office No. (518) 761-8256 Date Inspection req -. - : ed: /`i /2
Queensbury Building &Code Enforcement Arrive: 12 r-6D • .f� •%epart: . :7 a pm
742 Bay Rd., Queensbury, NY 12804 . Inspector's Initial• �i��
NAME: rt C-C CCow tYv OA i 1 I eSI' <
PES IT NO.: (a' •-irt
LOCATION: =0,�*; _ v ,(.-' ( (C I /PECTON:
RECHECK: 411 f
Comments and/or diagram
Soil Type: oam/ Clay
Type of Water: unici / Well Water
Waterline separatoldistance ‘0 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 1 '-kb ft.
Length of each trench I-I( _- 2a ft.
Depth of trenches 2, _ _ft.
Size of Stone xt--
Se §eP-it mber L -1 A
Size: z..t 1 x t--1 UV
Stone Size:
Piping Size Type
Building to tank /-J " 4 j4 41
Tank to Distribution Box y '( Dry
Distribution Box to Field/ Pit '( 1 b P-��--
Opening Sealed: _ N \J[__----
End Cap %A//T N L_-ot5 _P
Inlet/Outlet Pipes&Baffles ✓Y N
Manholes 12"or less below grade N
[provide extension collar if Yes] _Y -4(
Location/ Separations
(`i1\A Foundation to tank 5 ft.
V1(-` Foundation to absorption IThft.
Separation of Pits ft. w. E-' %' _,61 v ,,7 � 2�h
Conforms as per Plot Plan Y_ _N/
Engineer Report and As-Built ^Y ._Av
ETU Maintenance Contract _Y_ N
provided
Location of System on Property:
Front Rear Left Side Right Sid- Middle Front Middle Rear
System Use Status.
Approved
Partial Approved a d 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