2012-521 v 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: P20120521 Date Issued: Tuesday, February 12, 2013
This is to certify that work requested to be done as shown by Permit Number P20120521
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
upo�`6z`r\A ROA-COBy 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& C ' n`:`cement
Planning Board or Zoning Board of Appeals.
TOWN OF 1QUEENSBI.. RY
7,17 lad Road,Queensbury,NY 12804-5902 y518i 761.8201
Community Development- Building& Codes (518) 761-825.6
BUILDING PERMIT
11'em•niuit Numb : P20120521 Application Number: A201.20521.
Tax ;1lal, 'els,,: 523400-308-014-0001-052-000-0000
Permission is hereby granted to: ARC COMMUNITIES 14 LLC
1�or property located a,t: 1 83 PL"�'����I�!"R Rd
in theTown of 1,a cunsbuti,,to construct or place
at the above localio n i.n accordance xvith ayrinlication together wvith plot plans and other information hereto filed
and approved and in connpIiance with the NYS Uniforann BuMinl,Gerdes sand the Queensbury Zoning
Ordinance, Type of Construction X 'Value
Owvner.\ddress: FOREST PARD MHC, LL
Se
31`200 NOR°i"I-1WESTEl RN Hwy
Septic Alteration Commercial
FARMINGTON 14ILLS Ml 413834-0I; htntativa�tte
"�
Contractor or Builder's Name / `address l�,lcctrical Inspection.1gcriq,
MYMOND JON1 S
518-424-0508
PO BOX 702
BALL.STON SPA NY 12020-0000
111ans &Specifications
2012-52'1
Septic Alteration - 6 & 8 Woodland Path
575.00 PERMIT FEE PAID -THIS PERMITEXPIRES: Tuesday, Novenibery 05, 2013
(If a longer period is required,an application for an extension nnust be made to the code Enforcernennt officer
of tlae"f"rnwvu of Queensbury before the expiration date.)
Dated at the Town of Queensbury; Monday, November 05, 201.2
SICTNFID BY fairs°theTown of Queensbury.
Director of Building& Cock 1,nforccaaaeant
Community Development Office
Town of Queensbury • 742 Bay Road • Queensbury, New York •12804
Office Use Only
TAX MAP NO.4 6 Q &I
).I '")_5 3 PERMIT NO. 1 c)----k..5-0,, PERMIT FEE '7c.-°--6'
APPROVALS: ONING 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 P•� INSTALLER: L`
J
`j� JL_( I'1.10 r�( k....1 G'LA �
ADDRESS: ADDRESS: Po P 7() _ Sek.C.e, l 1A. Ai
PHONE NOS. ( S ) 2 ) q.( 4- 0 c-'--- g PHONE NOS.
II -Ten �� o5o 8,{ /
LOCATION OF INSTALLATION: t(? e O 1/06'c) Le,_,-.�4 Pec,-(-&_ A-IO 6 CL' fiZ)1'VIeG
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\...:'541‘c SLOPE %SLOPE
✓ SOIL NATURE: SAN.QWH( LOAM CLAY OTHER
✓ GROUNDWATER: AT WHAT DEPTH?
✓ BEDROCK/IMPERVIOUS MATERIAL: AT WHAT DEPTH?
I DOMESTIC WATER SUPLY: MUNICIPA WELL (If well:water supply from any septic system absorption is: ft)
rr
✓ PERCOLATION TEST: RATE IS Lt L 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 a0 X y D
❑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„,,,,,,a
ulations with respect to this application and agree to
abide b h se arida I requirements of the Town of Queensbury QUESTIONS? CALL 761-8256 OR EMAIL
SanitarySe Dis J al Ordinance. codes(a.queensbury.net
a R~ ,......,r, j a..'.y 1-.i f
-11-s b sible Date VISIT OUR WEBSITE FOR MORE INFORMATION
Signature of Person
www.queensbury.net
Septic Inspection Report
Office No. (518) 761-8256 Date Inspection request received:
Queensbury Building &Code Enforcement Arrive: am/pm Depart: 7 j 'LK—am/pm
742 Bay Rd., Queensbury, NY 12804 Inspector's Initials: 6'.i-i.i,--)
_ r
NAME: Ti- 1,‘,C- -
1"r`-� '�v�C_ PERMIT NO.: -i r•2 — 1) 41
LOCATION: c,A—'"("5t,�e-7:7 n44,41. INSPECT ON: r1-•l 6k.
RECHECK:
a Comments and/or diagram
Soil Type: Sa . / Loam / Clay
Type of Water: Mur iicip:•.I / Well Water
Waterline/separation distanc ft.
Weld separa ion distan e ft.
other we s: ft.
Well Casing Length 50' + / - Y N N/A
[150'to well requi -d if 0]
Absor tion Field: Total :ngth ft.
Length of each •-nch ft.
Depth of tr:n es ft.
1 Size o Sto e
See.a•e Pits: umbe _
Size: x
St.ne Size: c2,_(-C
\ /� c pPiing Size TypeL/`�
Building to tank
Tan to Distributio Box
Distribution Box to Fie!. / Pit
FP6157---
Opening •-aled: Y N L
E d Cap Y Nl ""'
Inlet/Out t Pipes : Baffles Y-._._ N
Manholes 12"or less belo grade _Y— N
[provide exten ion coli r if Yes] Y N
Locatio / Se rations
Fou datiob to tank ft.
Foundation to absorption ft.
Sep rat' n of Pits ft.
Conf6r�s-as ei Plot Plan -7Y — N
Kngineer Re nd As-Built //a, Y/ N
ETUTMaintenance Contract Y N
provided
Location of System on Property:
Front Rear Left Side Right Side Middle Front Middle Rear
S stem Use Stat :.
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
NACE ENGINEERING, P.C.
169 Haviland Road, Queensbury, NY 12804
Phone-518-745-4400 Fax -518-792-8511
November 21, 2012
Job# 49335
Ms. Kristine Wheeler
New York State Dept. of Health
77 Mohican Street
Glens Falls, NY 12801
FED :i , 2013
RE: Forest Park Community—Queensbury, Warren County
6 & 8 Woodland Path—Replacement Septic System
Gentlemen:
This letter is to inform you that we inspected the completed replacement septic system for 6 & 8
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
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Septic Inspection Report
Office No. (518) 761-8256 Date Inspection request received:
Queensbury Building &Code Enforcement Arrive: am/pm Depart: /c/
j 0 am/pm
742 Bay Rd., Queensbury, NY 12804 Inspector's Initials:
NAME: `u F2. Z_- PERMIT NO.: 2-0 l
LOCATION: �b k.``-r-i ..Ak v INSPECT ON: (1 Z
0) \1--
RECHECK:
Comments and/or diagram
Soil Type: 0.�';�•4 Loam/ Clay
Type of Water: . i .. /Well Water
Waterlin- -..ration 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 (-7 J ft. tTh
57
Length of each trench 'j ft. � ��'A� �� �""
Depth of trenches r-. ft.
Size of Stone
Seepage Pits: Number
Size:
Stone Size: -7j
Piping Size Type
Building to tank 6 't. 4-40
Tank to Distribution Box '5/1
Distribution Box to Field/ Pit 0 N)r1-11-7
Opening Sealed: N
End Cap Y N
Inlet/Outlet Pipes&Baffles 1N-
Manholes 12"or less below grade _Y
[provide extension collar if Yes] Y N
Location/ Separations � v
qq � '
Foundation to tank ft. �� -raac.3�J,-:-0
Foundation to absorption ft. ��
Separation of Pits ft. � .�`� :�`�"
Conforms as per Plot Plan ?/ Y
Engineer Report and As-Built Y R Z5PL
ETU Maintenance Contract _Y_ N
provided
Location of System on Property:
Front Rear Left Side Right Side Middle Front Middle Rear
S stem Use S t :
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