2011-613 iA TOWN OF QUEENSBURY
^r 742 BayRoad,Queensbury,NY 12804-5902 (518)761-8201
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Community Development - Building & Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: P20110613 Date Issued: Friday, December 28, 2012
This is to certify that work requested to be done as shown by Permit Number P20110613
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
By Order of Town Board
TOWN OF QUEENSBURY
Issuance of this Certificate of Compliance DOES NOT relieve the '7 1 /,'
a:
property owner of the responsibility for compliance with Site Plan, 'v
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
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Community Development-Building&Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20110613 Application Number: A20110613
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
PO BOX 61102 Septic Alteration Commercial
CHICAGO IL 60606-0000 Total Value
Contractor or Builder's Name/Address Electrical Inspection Agency
RAYMOND JONES
424-0508 P.O. BOX 702
BALLSTON SPA,NY 12020-0000
Plans&Specifications
2011-613
91 & 93 Gregwood Circle- septic alteration
$75.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Wednesday,December 19,2012
(If a longer period is required,an application for an extension must be made to the code Enforcement Officer
of the Town of Queensbury before the expiration date.)
Dated at the Town of-Queens$ ry;, Soi u,.December 19,2011
SIGNED BY - for the Town of Queensbury.
Director of Building&Code Enforcement
OFFICE USE ONLY � . ; ,. `,r
/41 / I/:3 8 ��
TAX MAP NO. PERMIT NO. l/ PERMIT FEE r Y
c ODES
APPROVALS: ZONING TOWN CLERK 1.` . .. 4 `5,1
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. FC Properlys ' INSTALLER: ' l�OWNER: �I ' i�/ JcrusJ �Li"�
ADDRESS: PI k �e r `L/1 ' ADDRESS:W EN1O / CD II )1 I 00C
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PHONE NOS. 7 g — /'6^ (
.J ` Co PHONE NOS. 37 J TOl?'v J 0
LOCATION OF INSTALLATION: BC i w°Q.o f l 9 l 93 v, Wood (i J`40
RESIDENCE INFORMATION:
YEAR BUILT NO.OF X COMPUTATION= = TOTAL DAILY FLOW
BEDROOMS GARBAGE GRINDER
1980 or older X 150 gallon per bedroom = INSTALLED?
1981 -1991 X 130 gallon per bedroom = SPA OR HOT TUB
1992-present X 110 gallon per bedroom = INSTALLED?
PARCEL INFORMATION:
✓ TOPOGRAPHY: Flat rolling X Steep slope %Slope
✓ SOIL NATURE: Sand X Loam Clay Other
✓ GROUNDWATER: At what depth?
✓ BEDROCK/IMPERVIOUS MATERIAL: At what depth?
✓ DOMESTIC WATER SUPLY: Municipal X. Well (If well: Water supply from any septic
system absorption is ft.)
✓ PERCOLATION TEST: Rate is minutes 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: I( 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
O SEEPAGE PIT(S) (WITH NO. 3 STONE) How many? Size?
.ALTERNATIVE SYSTEM Bed or other type? 210d
O 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.
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Septic Inspection Report
Date Inspection request received: am/pm
Office No. (518)761-8256Depart:
Queensbury Building&Code Enforcement Arrive: a pm
NY 1 8. Inspector's Initial 6/3
742 Bay Rd., Queensbury,
PERMIT
NAME: J �V� INSPECT ON: .__. —
LOCATION: /����
RECHECK: rammrnts and/or diagram
Soil T •-: i;;� Loam Cla M11111111111
T .- of Water: '"T
Waterline se••ration distance IIIIIIIIIMIIIIIIIGIIIIII
Well separation distance
INN
Other wells: Or
Well Casing Length 50' + / -
150'to well -•uired if NO
Absor'bon Field: Total tenth 111M0111111 177,64) 5/5IciPdt
-- __
Len•th of each trench NIIIIWLVIIIVIIIIII
Death of trenches
Size of Stone � -
imiumSee•,;,,a Pits: Number
�
Stone Size:
111111111111111111111111111
Buildin• to tank 11111M1111111Gwrioum �,
Tank to Distribution Box '��'”
Distribution Box to Field/ Pit 114101111111111 /11'---'
0.-ni • Sealed: 11113Mairig
End Ca• iffalleill
Ini- Outlet Pia- &Baffles graillall
Manholes 12"or less below grade
NM
•rovide extension collar if Yes /
Location Set.rations 1.40131/41-
�,1�,�'�'y"wi^' t-
Foundation to tank0°�� `�
Foundation to absor• 'on �--
Se..ration of Pits ���
Conforms as •-r Plot Plan AES ►'
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En•ineer Re••rt and As-Built !ter'
ETU Maintenance Contract IMIN
ovided
Location of System on Prope :
Front Rear Left Sid i9
ht Side Middle Front Middle Rear
em - S .t _:
Approved please call the Building&Codes Office
Partial Approved and needs to be re-inspected, f
Disapproved
L:\Pam Whiting\2010\Buiiding Codes Forms\inspectIon Forms\Septic Inspection R -O3 2910.doC
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