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2013-295 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: P20130295 Date Issued: Thursday, July 11, 2013 This is to certify that work requested to be done as shown by Permit Number P20130295 has been completed. Tax Map Number: 523400-308-014-0001-052-000-0000 Location: 183 PITCHER Rd Owner: FOREST PARK MHC, LLC Applicant: FOREST PARK MHC, LLC This structure may be occupied as a: Septic Alteration Residential By Order of Town Board TOWN OF QUEENSBURY Issuance of this Certificate of Compliance DOES NOT relieve the • /G property745t--- 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 128045902 (518)761-8201 Community Development - Building& Codes (518) 761-8256 BUILDING PERMIT Permit Number: P20130295 Application Number: A20130295 Tax Map No: 523400-308-014-0001-052-000-0000 Permission is hereby granted to: FOREST PARK MHC. 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 31200 NORTHWESTERN Hwy Septic Alteration Residential FARMINGTON HILLS MI 48834-00 Total Value Contractor or Builder's Name/Address Electrical Inspection Agency MORNING STAR SEPTIC 793-2290 744-8139 107 JEWELL Rd GANSEVOORT NY 12831-0000 Plans&Specifications 2013 - 295 41 Gregwood Circle SEPTIC ALTERATION $40.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Wednesday,July 09,2014 (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 uee bury- ee• • 4y/.a 19,2013 SIGNED BY \ for the Town of Queensbury. Director of Building&Code Enforcement Office Use Only Town of Queensbury Building & Codes Received: SEPTIC DISPOSAL PERMIT Tax Map ID: , , ^^ 3 dR,141 -1-6-. Permit No.: /3- �X is A permit must be obtained before beginning construction Permit Fee: $ zi d eit,f Approvals: Applicant: /i InstallerlBuilder Address: t�'7 2v Address .F' 4.A.,'--- Phone: 7` .72 IRO Phone Owner: ! Grt 57 )- r,--, R4/C, L.L C Location of Installation q l - i. Address: / 3 Pi 717-7,cr /Carr( cl 6Pctif4(517f) , A, y Phone 74/S-- 77-7 -) Contact Person for Building&Code Compliance: �n.i,J 4. -w Day Phone: ')'y 9 8/31 Residence Information: Year Built #of Bedrooms x Gallons per bedroom =Total Daily Flow 1980 or older x 150 = Garbage Grinder installed? 1981-1991 x 130 = Spa or Hot Tub Installed? 1992-Present x 110 = Parcel Information: TopographyFI_ Rolling Steep Slope —%Slope Soil Nature _0 Loam _Clay Other Groundwater At wha •epth? Bedrockllmpervious Material At what depth? Domestic Water Supply Municipal Well(if well,water supply from any septic system absorption is ft.) Percolation Test Rate- per minute per inch(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). -7- A0 ac Tank size /&c 9 gallon(minimum size 1,000 gallons),add 250 gallons to size of septic tank for each garbage grinder,spa or whirlpool tub System Type: Absorption Field(with#2 stone) Total length ft. Each trench X Seepage Pit(S)(with#3 stone) How many? Size? Alternative System Bed or other type? Holding Tank System Total required capacity? Tank size? #of tanks? NOTE: 1)Alarm system and associated electrical work must be inspected by a Town approved electrical inspection agency-see Certified Electrical form on Town website; 2) Effective as of March 23, 2006 Septic System-As Built Plot Plan: The Building Department will no longer allow systems to be covered until such time as an As-Built Plot Plan is received and approved by the Building Inspector. The installed system must match the septic system layout on file. There will be no exceptions. 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 regulations with respect to this application and agree to abide by these and all requirements of the Town of Queensbury Sanitary Sewage Disposal Ordinance. Print Name: Fni 1c Lr M c5 RAW Date: WI _ 13 Signature: ,.,,,�.,_.a- c Date: 0. '- -13 Town of Queensbury Building&Codes Septic Disposal Permit 518-761-8256 5kKev Septic Inspection Report Office No. (518) 761-8256 Date Inspection requ-. : ‘,/ ,.: Queensbury Building &Code Enforcement Arrive: (� - pm� '�:•.rt: ' pm 742 Bay Rd., Queensbury, NY 12804 Inspector's Initi..- NAME: es-k Par K PE' IT NO.: /3 - 019 5 LOCATION: '~I/ Iten wefe31 G Ut SPECT ON: '7-f-/3 RECHECK: Comments and/or diagram Soil Ty . S oa Clay Type of Water: uni' ell Water y _ $ 13`i r r n aNI I< _ Waterline separation distance ft. Well separation distance ft. Md r n 1.155+14f- , Other 5+14 - 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 /111 Jj --- Tank Tank to Distribution Box /-i'1 S©12---3 c –CC) �`ID Distribution Box to Field/ Pit Opening Sealed: Y _ N End Cap N — Inlet/Outlet Pipes&Baffles N Manholes 12"or less below grade Y [provide extension collar if Yes] Y_ N Location Separations Foundation to tnk ft. – d1 PoS B U I IT Foundation to absorption . Separation of Pits ft. Conforms as per P Ian N Engineer Report a As-Bu' Y— N ETU Maintenance ontract _Y_ N provided Location of System on Property: Front ar Left Side Right Side Middle Front Middle Rear S stem Use Stat 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 6 13- a615 518-793-2290 Fax#518-793-2115 iia 376 • j E-mail: morningstarseptic@hotmail.corn www.morningstarseptic.corn PTHC l.RVIC$ Date: 72E7/ 107 Jewel Road,Gansevoort, NY 12831 TO: /-.0/-c='5 71- 1.0 rcod- MAP 4)„,ev! S�cJr y --'LVD (1-A—A) )A E_ Duo C.,AL r `����c TA►J� 3 epeN_ct k It * LE_pic!N OWN OF QJE. (ZEk BUILDING & • 114/..' Reviewed B, • //i. Date: Amos AS BUILT S PT P P N I.C. LOT � I HAVE SEEN OR OBSERVED ALL OBJECTS SUCH AS HOUSES, WELLS, TREES, FENCES, ETC SHOWN ON THIS DOCUMENT.I HAVE PERSONALLY MEASURED E DISTANCE TH ON THIS p�,I I SIGNATURE • PA E ( ( 3 - p.57 6 518-793-2290 Fax#518-793-2115 I�Q 376 . I - E-mail: morningstarseptic@hotmail.com ' www.morningstarseptic.com �yPTIC CCRVIC■ Date: / S-7f 3 "' "". 107 Jewel Road,Gansevoort, NY 12831 TO: / «5 / / fir coci MAP IJC v!_S1 07. . • P.9:Y-9. ,f 4_, /4141c) F.. TOWN OF QU - B la BUILDING & ,Oti :73- ? Reviewed B ./! - �!! Date: ,zin . • JJ/4-7---err9" t7 F' P N I.0 .LCAT .6 I HAVE SEEN OR OBSERVED ALL OBJECTS SUCH AS HOUSES, WELLS, TREES, FENCES, ETC SHOWN ON THIS DOCUMENT.I HAVE PERSONALLY MEASURED THE DISTANCE SE 0TH ON THIS 4 • F� SIGNATURE A E