2013-036 011111W
TOWN QUEENSBURY
- OF
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development - Building & Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: P20130036 Date Issued: Tuesday, February 12, 2013
This is to certify that work requested to be done as shown by Permit Number P20130036
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 Residential
By Order of Town Board
7 3 Ca r 6 Q(,3 cad ( t-A TOWN OF QUEENSBURY
Issuance of this Certificate of Compliance DOES NOT relieve the ` f
j 4
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: P20130036 Application Number: A20130036
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: ARC COMMUNITIES 14 LLC Septic Alteration Residential
PO BOX 61102 Total Value
CHICAGO IL 60606-0000
Contractor or Builder's Name/Address Electrical Inspection Agency
SANITARY SEWER
DAN DRELLOS
PO BOX 224
GLENS FALLS NY
Plans&Specifications
2013-036 73 Gregwwod Circle
Res. Septic Alteration
$40.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Saturday,February 01,2014
(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 of Qu sbu /J F ' y ary 01,2013
SIGNED BY for the Town of Queensbury.
Director of Building&Code Enforcement
11 Community Development Office
Town of Queensbury • 742 Bay Road • Queensbury, New York •12804 FEB 0 1 2013
Office Use Only 11
TAX MAP NO,.3f1 g.HA -5. PERMIT NO. I 3 'b3l� PERMIT FEE '1 rI
APPROVALS: ZONING TOWN CLERK
APPLICATION FOR SEPTIC DISPOSAL SYSTEM RMIT: A PER IT MUST BE OBTAINED
BEFORE WORK EEGINS. APPLICATION IS SUBJECT TO REVIEW /�FORE ISSUANCE i FF A VALID PERMIT.
OWNER:P1'�C • i r ' PAiL(L INSTALLER: � 14J � )---19. C (...A_-
ADDRESS:
. _-
ADDRESS: I c pi.) C ck 4, b ADDRESS: p J - -.1y... a y / b F
PHONE NOS. PHONE NOS.79 J'J' O
LOCATION OF INSTALLATION:?3 6-i-,2 `•GU:)`?) C / (c--(..e
RESIDENCE INFORMATION:
NO.OF COMPUTATION
YEAR BUILT X = TOTAL DAILY FLOW
BEDROOMS (Gallons per bedroom) GARBAGE GRINp7R.
1980 or older X 150 = INSTALLED? NV
1981 -1991 X 130 = SPA OR HOT TUB A
1992-present X 110 = INSTALLED? /"
PARCEL INFORMATION:
✓ TOPOGRAPHY: FLAT ROLL G ' STEEP SLOPE %SLOPE_
✓ SOIL NATURE: SAND LOAM CLAY OTHER
✓ GROUNDWATER: AT WHAT DEPTH?
✓ BEDROCK/IMPERVIOUS MATERIAL: AT WHAT DEPTH?
✓ DOMESTIC WATER SUPLY: MUNICIPAL✓ WELL (If well:water supply from any septic system absorption is: ft)
✓ PERCOLATION TEST: RATE IS 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: 100 u 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 X
❑SEEPAGE PIT(S)(WITH NO.3 STONE) How many?_ Size?______ _
ALTERNATIVE SYSTEM Bed 2
r other type? 0'x �4l !
❑ 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 read the re lata. with respect to this application and agree to
ide by these d all r . ement the Town o QueensburyQUESTIONS? CALL 761-8256 OR EMAIL
a 'ary Se a Disp..- • din codes(a�queensbury.net
VISIT OUR WEBSITE FOR MORE INFORMATION
Signature of Person Responsible ate www.queensburv.net
Septic Inspection Report
Office No. (518) 761-8256 Date Inspection r4.1..6=-:- -- - ed:
Queensbury Building &Code Enforcement Arrive: = _ Mas depart: I = armor m
742 Bay Rd., Queensbury, NY 12804 Inspector's Initials: 4
NAME: ARCe ) PE•J NO.: l3--0—*
LOCATION: 73 GP...E u C '0 ( CL_ IN'.• CT ON: 2_—I 1-13
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 lengthft.
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 ear 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
NACE ENGINEERING, P.C.
169 Haviland Road, Queensbury,NY 12804
Phone-518-745-4400 Fax -518-792-8511
February 11, 2013
Job#49335
Ms. Kristine Wheeler
New York State Dept. of Health
77 Mohican Street
Glens Falls,NY 12801
1 y
RE: Forest Park Community—Queensbury, Warren CountyFEB � 2013
73 Gregwood Circle—Replacement Septic System
Gentlemen:
This letter is to inform you that we inspected the completed replacement septic system for 73
Gregwood Circle in the Forest Park Community on 2/4/2013.
The septic system as installed was for a 3 bedroom trailer and consisted of a 1,000 gallon septic
tanks and 400 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. P. U r,�L
Marty Mancini, ARC
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Septic Inspection Report
Office No. (518) 761-8256 Date Inspectio - "led: 'Queensbury Building &Code Enforcement Arrive: '-L . •r�, 0 epart: \2-tt a /p
742 Bay Rd., Queensbury, NY 12804 Inspector's Ini . , /
NAME: A RC(-roR_- RY-N) P.' NO.: \�-C:40
LOCATION: (3 (2 REC.uCtO CAROL F •ECT ON: 2-Lk -`'j
RECHECK:
Comments and/or diagram
Soil Ty • San loam/ Clay
Type of Waterlunici al ell Water
Waterline separation distance 1 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 lengthCc)-LE-1-1
ft.Length of each trenchJ ft. / r y l_c�?CDepth of trenchesft. 6Size of StoneSeepa a Pits: Number
t.Ec \ c ED h SV -t-\ Size: x 7Stone Size: -�
Piping Size pe
Building to tank ''k " 6C.1\ -\n
Tank to Distribution Box k--\`k hnR 75
Distribution Box to Field/ Pit / \ '1 ,/ n R ?).?--i- TO 1/4-:t1t5 DR3 Peggy
Opening Sealed: ,/7__._ N
End Cap .,/Y_ N ----> GcNE9
Inlet/Outlet Pipes&Baffles / N
Manholes 12"or less below grade ,/fir
[provide extension collar if Yes] _Y ✓N
Location/ Separations
K Foundation to tank t Z. ft.
IA\A Foundation to absorptionft.
Separation of Pits -ft. i
Conforms as per Plot Plan Y DF!
Engineer Report and As-Built Y_./N 'Q E2.EV C c . 1
ETU Maintenance Contract _Y_ N ,oC� g-- ce._:‘,
provided
Location of System on Property: T
ront Rea eft Side Right Side Middle Front Middle Rear
System 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 Report 03 29 10.doc
Septic Inspection Report
Office No. (518) 761-8256 Date Inspection -••--, ei • •
Queensbury Building &Code Enforcement Arrive: tZ,=3o; 'pm /_. 'd-•• : l7,1hU a /pm
742 Bay Rd., Queensbury, NY 12804 Inspector' Initia : /!
NAME: C GC • _ t& R P 'MIT NO.: V-.)T n -JIo
LOCATION: !