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2012-519 4 ` 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: P20120519 Date Issued: Tuesday, February 12, 2013 This is to certify that work requested to be done as shown by Permit Number P20120519 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 t o 'er + By Order Board `1 ,�d- P C� TOWN OFF QUEENSBURY Issuance of this Certificate of Compliance DOES NOT relieve the (Dz, property owner of the responsibility for compliance with Site Plan, r ' y Variance, or other issues and conditions as a result of approvals by the Director of Building& Co e Enfo ement 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: P20120519 Application Number: A20120519 Tax Map No: 523400-308-014-0001-052-000-0000 Permission is hereby granted to: ARC COMMUNITIES 14 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 Septic Alteration Commercial 31200 NORTHWESTERN Hwy FARMINGTON HILLS MI 48834-0( Total Value Contractor or Builders Name/Address Electrical Inspection Agency RAYMOND JONES 518-424-0508 PO BOX 702 BALLSTON SPA NY 12020-0000 Plans&Specifications 2012-519 Septic Alteration-2 &4 Woodland Path $75.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Tuesday,November 05,2013 (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; Monday,November 05,2012 SIGNED BY for the Town of Queensbury. Director of Building&Code Enforcement Community Development Office Town of Queensbury • 742 Bay Road • Queensbury, New York •12804 Office Use Only K f = 1 201•,- TAX MAP NO\ .() ,, 141--l--.5.) PERMIT NO. I cA-5I9 PERMIT FEE/Sof 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: r / fL` INSTALLER: �� r1.'-10 cmc-( .....fcIA e� ADDRESS: ADDRESS: Po (36, <, < 7o-� � (�(S C, lbt^4?,_ ti PHONE NOS. ( S 1 ) Le R zi r 0 S O tS ' 1 PHONE NOS. 4�)� JJAf.)-4 -0�.�70 I> LOCATION OF INSTALLATION: �{ °I/ t/�,1L�C�Ci L y�CL'T"k_ . 4'63 A-106 6( z)oket 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 OLLING 3t‘c STEEP SLOPE %SLOPE ✓ SOIL NATURE: SAN LOAM CLAY OTHER ✓ GROUNDWATER: AT WHAT DEPTH? ✓ BEDROCK/IMPERVIOUS MATERIAL: AT WHAT DEPTH? ✓ DOMESTIC WATER SUPLY: MUNICrr IPA WELL (If well:water supply from any septic system absorption is: ft) L ✓ PERCOLATION TEST: RATE IS , (0-13 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: 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: ❑ABSORPTION FIELD(WITH NO.2 STONE) Total length ft. Each trench O X y 0 ❑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 the R) ulations with respect to this application and agree to abide b b se arid\ I requirements of the Town of Queensbury QUESTIONS? CALL 761-8256 OR EMAIL Sanitary Se a Disp al Ordinance. codesnaslueensburv.net (��1�. V�� 1©-.1.?l-...l p�,f Signature of Person It s sable Date VISIT OUR WEBSITE FOR MORE INFORMATION www.queensbury.net Septic Inspection Report Office No. (518) 761-8256 Date Inspection request received: Queensbury Building &Code Enforcement Arrive: am/ m Depart:-2.'p L am/pm 742 Bay Rd., Queensbury, NY 12804 Inspector's Initials: �N� - --��J"" �� '' NAME: �` 'zr � fin\ PERMIT NO.: G,o i 2- CI i LOCATION: i -r'A- Gl i)' Via--TU Via--TINSPECT ON: ez-'\-\\ 3 RECHECK: Comments and/or diagram Soil Type: Sand/ Loam/ CIa Type of Water: Municipal/Well Wat.r Waterline s=,be.ration dista - ft. Well s-p,.ration dist: ce ft. Other -Hs: ft. Well Casing en,th 50' + /- Y N N/A [150'toell -•uired f NO] Absorption field: Tio - length ft. Le gth o' ea• trench ft. Depth o trenches ft. S -- of Stone Seepage Pi''• Number Size: x St,ne Size: j Pipin• Size Type Buildi � to tan' Tank to Distri• tion Bo q/Cc—LV c Distribution Box t. Field/ Pit Open ng Sealed: Y N � End Cap Y N . u t Ki '1 Inlet/Outlet Pi! -s&Baffles Y N Manholes 12"or les below grade Y_N [provide extenslo' collar if Yes] Y N Locati• / Separations Foundation to tank ft. Foundation to absorption ft. Separation of Pits _ft. ffen as •-r Piot Plan /( N ngineer Report . • As-Built / N ■- - . ce Contract _Y_ N provided Location of System on Property: FrontR r Left Side Right Side Middle Front Middle Rear S stem Us 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 Report_03 29 10.doc t r NACE ENGINEERING, P.C. 169 Haviland Road, Queensbury, N Y 12804 Phone-518-745-4400 Fax -518-792-8511 November 21,201/ Job#49335 Ms. Kristine Wheeler New York State Dept. of Health 77 Mohican Street Glens Falls, NY 12801 RE: Forest Park Community—Queensbury, Warren County FEi3 I ? 2013 2 & 4 Woodland Path—Replacement Septic System Gentlemen: This letter is to inform you that we inspected the completed replacement septic system for 2 & 4 Woodland Path in the Forest Park Community on 11/12/2012. 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. Marty Mancini, ARC � n J z a m 0,LL- — Ld w d K N r N W 1•., Wgga U. 'sE< A x H Gpm a a a TA rc mFFnn a sI a z;gp ea U qa i 10ffiq, a Q € Qmr- � ppRfy <7d'a I�� a �a € _ I Z m 3 OW e�� � ' 2zFA e p l ili� gr y O aP%o 096 � pwrc< z 3g95 ozp = zaFp opg iL EGO ww o Z FIIE JLL Q wlgmgw 8�0� w yr`g m x _ 3��iYi��1ili1 �FFOiE -p{p Vi z V�- o z6 zFzdi•� aTd'� � o ao o Z r vi a ui Id m a Av � O � W a m � N io o �o c3 N Z As N U N NN2 yK`� m Q'l W Z D g m 2 I '4 ALL:=� U)� wog � � at N t}n$a O 6 fib: w=w �� m U w rnzC = ~ U �i/l5{ z !2jF Z g ir3W` Lu 3 0 � m24 1 eLnl a W N X� 3 3 o�m �• 0 2 M _-_--- EL < f N O b8 g O Q<W 3 3 a ® 3 mim xm P .00 w i 'NIN AC a Z S M .- ri F yt 3 p� N Septic Inspection Report Office No. (518) 761-8256 Date Inspection request received: Queensbury Building &Code Enforcement Arrive: am/pm Depart: (j !:-.;Z:-/ am/pm 742 Bay Rd., Queensbury, NY 12804 Inspector's Initials: 1_ NAME: � M . LOCATION: INSPECT ON: t(k t?� CI-- RECHECK: Comments and/or diagram Soil Type: l Loam / Clay Type of Water: Municipal / Well Water Waterline separation distance ft. Well separation distance f ft. Other wells: ft. Well Casing Length 50' + / - Y N N/A [150'to well required if NO] Absorption Field: Total length 7_ft. Z—�' .,fir' A.`-> Length of each trench ft. Depth of trenches "'Z.. - ft. Size of Stone Seepage Pits: Number \ Size: Stone Size: Piping Size Type Building to tank 4-, Tank to Distribution Box Distribution Box to Field / Pit Opening Sealed: Y/ N End Cap Y/ N Inlet/Outlet Pipes& Baffles VY Manholes 12"or less below grade Y^' N [provide extension collar if Yes] ,Y T` N Location / Separations Foundation to tank jj ft. -- Foundation to absorption 1/ ,ft. Separation of Pits ' ` ft. 51'- C `/vlv�v� Conforms as per Plot Plan Engineer Report and As-Built Y '{/ N n - ETU Maintenance Contract Y N provided Location of System on Property: Front Rear Left Side Right Side Middle Front Middle Rear S stem Use Stats: 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 Report03 29 10.doc