2013-037 9.1141k TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development - Building & Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: P20130037 Date Issued: Tuesday, February 12, 2013
This is to certify that work requested to be done as shown by Permit Number P20130037
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
GA 0-DA\c�a�1c� P Cwt TOWN OF QUEENSBURY
----cDatriP 34/1---
Issuance of this Certificate of Compliance DOES NOT relieve the t
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: P20130037 Application Number: A20130037
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
2012-037 22 Woodland Path
res. septic alteration
$40.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Tuesday,February 04,2014
(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 Town • : nsbu . , ,February 04,2013
SIGNED BY ' eta. for the Town of Queensbury.
Director of Building&Code Enforcement
rt,T. Community Development Office
: . ,: Town of Queensbury • 742 Bay Road • Queensbury, New York •12804' .; rj 1 nil
Office Use Only
TAX MAP NO. _3_0 Q -f,
1 ? PERMIT NO._13".6 3 PERMIT FEE _ G�
APPROVALS: ZONING_ TOWN CLERK __
APPLICATION FOR SEPTIC DISPOSAL SYSTEM PERMIT: A PERMIT MUST BE OBTAINED
BEFORE WORK EGINS. APPLICATION IS SUBJECT TO REVIEW FORE ISSUANCE O A VALID PERMIT.
tt_
OWNER:��"�t Lii/ '.",l.L I�lc- INSTALLER: r�A_ �1 7712 _ r 41 L.1/2�-
ADDRESS:_�"" ' 1 1.41�L- l� p ADDRESS: t f0--3 (3)( d p (iT__cF
PHONE NOS._______ A /___� PHONE NOSS, _.79: --0(F,..5--,:i
LOCATION OF INSTALLATION:2 I/J a O 7(--4,1/4-)1.)_ p14-171-
RESIDENCE INFORMATION:
YEAR BUILT NO.OF X COMPUTATION = TOTAL DAILY FLOW
BEDROOMS (Gallons per bedroom) GARBAGE GRINQEI[2
1980 or older X 150 = INSTALLED? IJ L)
I 1981 -1991 X 130 = SPA OR HOT TUB 1 j
1992-present X 110 = INSTALLED? 1`�
PARCEL INFORMATION: /
✓ TOPOGRAPHY: FLAT ROLLING ✓ 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:1003 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. -711 - ;
SYSTEM TYPE: /�l�V
0 ABSORPTION FIELD (WITH NO. 2 STONE) Total length ft. Each trench X
❑ SEEPAGE PIT(S) (WITH NO. 3 STONE) How many? Size?
0 ALTERNATIVE SYSTEM Bed or other type?
0 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 re•u . '• s with respect to this application and agree to
ab' e . these ane all r-q•'rement f the Town of Q eensbury QUESTIONS? CALL 761-8256 OR EMAIL
S nitary•ewa•,r Dis••sal Erdi e. / codes(a.queensburv.net
1 . _ - - ---- t _Z3 VISIT OUR WEBSITE FOR MORE INFORMATION
Si! a ure of Pers. `esponsible a www.queensbury.net
Septic Inspection Report
Office No. (518) 761-8256 Date Inspection requ-y - = -r:
Queensbury Building &Code Enforcement Arrive: 6 ; a D:-..rt: '11=1`�i�rrm
742 Bay Rd., Queensbury, NY 12804 Inspector's Initials:
NAME: A RC(F=a(? T k)c _ P"MIT NO.: 13— 3-
LOCATION: ZZ (_3(:)(1){) ._F\ NSPECT ON: 2— \ 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 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] TY_ N
Location / Separations
Foundation to tank ft.
Foundation to absorption ft.
Separation of Pits ft.
Conforms as per Plot Plan _ N �cCE ,`1 [\1 -j3u\L`
Engineer Report and As-Built Y N
ETU Maintenance Contract _Y_ N
provided
Location of System on Property:
Front Re Left Side Right Side Middle Front Middle Rear
S stem Use Sta 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
Septic Inspection Report
Office No. (518) 761-8256 Date Inspectio •-• gest r. ed:
Queensbury Building &Code Enforcement Arrive: F% a /p / Depart:
742 Bay Rd., Queensbury, NY 12804 Inspector's Initials: i
NAME: C(F=o?_ P•RMIT NO.: I3
LOCATION: 7 Z_ c.)Jnc�DL11‘.-)D j VA NSPECT ON: 7_ –,ti —1
RECHECK: . ♦ • _
Comments and/or diagranl
Soil Type • ' •am Clay
Type of Water: n. • - Water
Wat -paration distance 1 t` ) 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 F ` 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 LI l l 5�
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 -.f7 ft.
Foundation to absorption _ ____ ft.
Separation of Pits ft.
Conforms as per Plot Plan —Y
Engineer Report and As-Built _.Y N 3
ETU Maintenance Contract _Y_ N 1
provided
Location of System on Prope :
Front Rear Left Sided Right Side Middle Front Middle Rear
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 Reporl`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 F 3 I 203
Glens Falls,NY 12801
RE: Forest Park Community—Queensbury, Warren County
75 Gregwood Circle & 22 Woodland Path—Replacement Septic Tanks
Gentlemen:
This letter is to inform you that we inspected the completed replacement septic tank installation
for 75 Gregwood Circle on 2/1/13 and 22 woodland Path in the Forest Park Community on
2/5/2013.
The septic tanks installed were for 3 bedroom trailers and were 1,000 gallon septic tanks;
replacing aged metal septic tanks, connected to the existing effluent lateral lines. The tank
replacements conform to the requirements of the approved replacement design drawings.
Please call me if you have any questions or concerns.
Sincerely,
IRTA
Thomas R. Center Jr., PE AS
cc: Dave Hatin, TOQ Building Dept.
Marty Mancini, ARC
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