2012-520 e.,111111% TOWN OF QUEENSBURY
742 Bay Road,Queensbuq,NY 12804-5902 (518)761-8201
Community Development - Building & Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: P20120520 Date Issued: Tuesday, February 12, 2013
This is to certify that work requested to be done as shown by Permit Number P20120520
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
5 k W ovcA`ck,c1�' � �1 By Order Town Board
TOWN OF QUEENSBURY
Issuance of this Certificate of Compliance DOES NOT relieve the
owner of the responsibility for compliance with Site Plan, :DJ
//it-
propertyVariance, or other issues and conditions as a result of approvals by theDirector of Building& Code ent
Planning Board or Zoning Board of Appeals.
TOWN OF QUEENSBURY
742 Kiv Road,QueenSbUry,NY 12804-5902 (518)761-820t
Community Development- Building& Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20120520 Application Number: A20120520
Ta-, N I a p No: 523400-308-014-0001-052-000-0000
Pertnission is hereby granted to: ARC COMM UNITI ES 14 LLC
For property located at: 183 PITCFIER Rd
in theTown of Queensbui-,, 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 Unifoun Building(,odes and the Queensbury Zoning
Ordinance. Type of Construction Value
Owner.-Wdress: FOREST PARK MFIC, LLC
Septic Alteration Coniniercial
31200 NORTHWESTERN Hwy Total Value
FARMINGTON HIIA.,S MI 48834-0(
Contractor or Builder's Nance/ .\ddress I-11cctrical Inspection \gency
RAYMOND JONES
518-424-0508
PO BOX 702
BALLSTON SPA NY 12020-0000
Plans&Specifications
2012-520
Septic Alteratioti - 5 & 7 Woodland Path
575.00 PERMIT FEE PAID -THIS PERMIT EXPIRES: Tuesday, November 05, 2013
(If a tonger period is required,an application foran extension nnist be made to the code Enforcement Officer
of the ToNvii of Queensbury before the expiration date.)
Dated at the Town of Qtieensbury; Monday, November 05, 2012
SIGNI'D BY for the'romm of Queensbury.
Director of Building&Code l"'Aiforcernent
Community Development Office
Town of Queensbury • 742 Bay Road • Queensbury, New York •12804
rpt.] 20/2
Office Use Only G
TAX MAP NO. `?t g, PERMIT NO. ,�'S�l� PERMIT FEE 7
APPROVALS: ZONING 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.
n
OWNER: ' I `` J `jINSTALLER: 6. .. r <-i
ADDRESS: ADDRESS: PU eCt < 7o ScCCt S 'by `ict /0-
PHONE
LPHONE NOS. ( S t 9 �f r 0 O 1 PHONE NOS. r7(6)� �}'4 4 -o5( f
LOCATION OF INSTALLATION: $ 7 1/00 C 1 �C'�`(�� �J�� j� n-f o✓/J'Cr L\oke
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:
✓ TOPOGRAPH . FLAT OLLINGSTEEP SLOPE %SLOPE
✓ SOIL NATURE: SANQ LOAM CLAY OTHER
✓ GROUNDWATER: AT WHAT DEPTH?
✓ BEDROCK/IMPERVIOUS MATERIAL: AT WHAT DEPTH?
✓ DOMESTIC WATER SUPLY: MUNICIPA '1 WELL (If well:water supply from any septic system absorption is: ft)
//
✓ PERCOLATION TEST: RATE IS (o b--1) 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 DO X LI 0
❑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 :ulations with respect to this application and agree to
abide b •h-se and, I requirements of the Town of Queensbury QUESTIONS? CALL 761-8256 OR EMAIL
Sanitary Se, .•e Disp. al Ordinance. codest queensbury.net
Signature of Person '•s•tingible Date VISIT OUR WEBSITE FOR MORE INFORMATION
www.queensbury.net
Septic Inspection Report
Office No. (518) 761-8256 Date Inspection request received:
Queensbury Building &Code Enforcement Arrive: am/pm Depart: (-am/pm am/pm
742 Bay Rd., Queensbury, NY 12804 Inspector's Initials: ` c )
NAME: c�ARr. PERMIT NO.: '_
LOCATION: _7 t.'- \ 'vJLA) v l INSPECT ON: UI '—
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 tankc)cLd,V
Tank to Distribution Box
Distribution Box to Field/ Pit C,=) )-b-r‘Nf-f-Q_
Opening Sealed: Y N
End Cap _Y N
Inlet/Outlet Pipes & Baffles Y N _I
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.
. C-enforms as per Plot Plan A' N
i'gineer and As-Built Y N
t Maintenance Contract Y_ N
provided
Location of System on Property:
Front Rear Left 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
NACE ENGINEERING, P.C.
169 Haviland Road, Queensbury, N Y 12804
Phone-518-745-4400 Fax -518-792-8511
rrt-
November 21,201L
Job#49335
Ms. Kristine Wheeler
New York State Dept. of Health
77 Mohican Street
Glens Falls,NY 12801
F_3 2013
RE: Forest Park Community—Queensbury, Warren County
5 & 7 Woodland Path—Replacement Septic System
Gentlemen:
This letter is to inform you that we inspected the completed replacement septic system for 5 & 7
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
w
Lv
Y �J
LL-
c
J azm < o Z i5 " u 3 F.
Qddgi
bl €x €�m� �W� €m�q�m a°d a �
m9�
F W3i0 q W F'•�wj fj Lf 0
6M% P ems '=W ==LL-
u�W a z z a
FG w F �tir0 w H <m 4. N II
m a m=
QF
�R 0
�rzdi��a3o�3_��Og� MO �7JO
80 g; is�
OG 5 i SZ u
Z > " FWJ � NIB '60Sdz_
zIN
cl ri a ui ui n a6 cd .� P'+
�I' m
a
a
€ Q c
how
� V
Vl
m
o m
I
t3 lV
K < X
=K "' Gp'j d Nil Z LSC N ,`1`1M11 f.rll!lIl11 a
m9 — =8� (fir.''
iV YF.- F�� VZNY � � jOm J ,?�O•vU, ear •,,� Z�'}
.Ellll
a 3 R `n a cD z
rbff $ o� D MO 40 =0 Lt . Z¢W
gig7 �'rd r W M Z)
2 Eli ' Z m C7
I- 3b z
z �� ip
b o w m
z v�
N11 a
31 NO
z�8 ��
�^ xx
® J
N
W�
=m
n 3 3— d itl
s
Z Y
# 3 �
>j ' m
-3 3 agg
�'N�w� 0F M w 2
wa�`i S
z o
z
s �
12at �s
Septic Inspection Report
Office No. (518) 761-8256 Date Inspection request received:
Queensbury Building &Code Enforcement Arrive: am/p Depart: 1 :/5". am/pm
742 Bay Rd., Queensbury, NY 12804 Inspector's Initials: L !
NAME: -�-- ��•� `' P PERMIT NO.: o lZ S71 z
LOCATION: ,'��'� �' n� ?4 4 INSPECT ON: t�k \
RECHECK:
Comments and/or diagram
Soil Type: _.:„J• / Loam/ Clay
Type of Water: u. cipal/Well Water
Water -• •.ration distance ft.
Well separation distance
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 3 ft. 9 ZOXA0
Depth of trenches Y�ft.
Size of Stone
Seepage Pits: Number
Size: x
Stone Size: �� j'
Piping Size Type T5 c''`yrr''-C
Building to tank 4" jet4-AC)
Tank to Distribution Box kik 61)Q_ �c
Distribution Box to Field/ Pit - BIZ.
Opening Sealed: v N
End Cap
Inlet/Outlet Pipes &Baffles Y
Manholes 12"or less below grade _Y
[provide extension collar if Yes] Y
Location/ Separations
Foundation to tank _ ft. ,4 � 'f
Foundation to absorption ft. _ Jt''4�
465
Separation of Pits �ft.
Conforms as per Plot Plan _
Engineer Report and As-Built —Y N �LeX- 1
ETU Maintenance Contract Y_N
- provided I4 -3 cj t
Location of System on Property:
Front Rear Left Side Right Side Middle Front Middle Rear
System Use Status:
pproved
k Partial Approved and needs to be re-inspected, please call the Building &Codes Office
Disapproved
L:\Pam Whiting\2010\Building Codes F=orms\Inspection Forms\Septic Inspection Report_03 29 10.doc