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SEP-0756-2018TOWN OF QUEENSBURY 742 Bay Road, Queensbury, NY 12804-5904 (518) 761-8201 Community Development - Building & Codes (518) 761-8256 CERTIFICATE OF COMPLIANCE Permit Number: SEP-0756-2018 Date Issued: Tuesday, April 2, 2019 This is to certify that work requested to be done as shown by Permit Number has been completed. SEP-0756-2018 Tax Map Number: Location: Owner: 308.14-1-52 77 & 79 Briwood CIR FOREST PARK MHC, LLC Applicant:FOREST PARK MHC, LLC This structure may be occupied as a: Residential Septic Alteration 77 & 79 Briwood Circle By Order of Town Board TOWN OF QUEENSBURY Issuance of this Certificate of Compliance DOES NOT relieve the property owner of the responsibility for compliance with Site Plan, Variance, or other issues and conditions as a result of approvals by the Planning Board or Zoning Board of Appeals. Director of Building & Code Enforcement TOWN OF QUEENSBURY -T5-- 742 Bay Road,Queensbury,NY 12804-5904 (518)761-8201 Community Development - Building& Codes (518) 761-8256 BUILDING PERMIT Permit Number: SEP-0756-2018 Tax Map No: 308.14-1-52 Permission is hereby granted to: FOREST PARK MHC, LLC For property located at: 77& 79 Briwood CIR 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 Owner Name: FOREST PARK MHC,LLC Septic Disposal-Residential $0.00 Owner Address: 183 Pitcher RD Total Value $0.00 Queensbury,NY 12804 Contractor or Builder's Name/Address Electrical Inspection Agency Stone Installations 4305 Route 50 Saratoga Springs,NY 12866 Plans&Specifications Residential Septic Alteration 77&79 Briwood Circle $ 75.00 PERMIT FEE PAID -THIS PERMIT EXPIRES: Wednesday,December 4, 2019 (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 th expiration d. e.). Dated at the Town Quee ury; Tu:.., ../ecember 4, 2018 if SIGNED BY: \ for the Town of Queensbury. Director of Building&Code Enforcement SEPTIC DISPOSAL PERMIT APPLICATION Office Use Only -• - -= 742 Bay Road,Queensbury,NY 12804 P:518-761-8256 ,�,°ti e�t-•. t;-t�.;�k Permit#: C.P 1 4- Tax Map ID#: 36pGG t I LE—I 'C Permit Fee:$/ ; Invoice#: 1089 Project Location' �� ICI OM W0061 eirek QSb1 . Septic Variance? Yes No 1 Primary Owners) _ MailingAddress i " 'c r Phone & Email i _� , Installer/Builder ( i Mailing Address '. f Phone & Email ; : v F.�' __ ' t� s=� FOIEn Engineer 6 t Mailing Address \P NOV 2 9 201$ Phone & Email I`�4S2UCtY _ E - TOWN Caw r`; 34`igio, Contact Person for Building&Code Compliance: : ' CO'N TY"V5 \ "'�- __ RESIDENCE INFORMATION: Year Built #of bedrooms X gallons per bedroom =total daily flew Garbage Grinder Yes I No I 1980 or older (6 ' t 0 tOtO O Installed? (circle one) 1981-1991 Spa or Hot Tub Yes N. Installed? (circle one) V 1992-Present PARCEL INFORMATION: / Topography V/. Flat Rolling Steep Slope %Slope Soil Nature \/ Sand }� Loam Clay Other Groundwater At what depth? ooNe- Bedrock/Impervious material At what depth? Of NON Domestic Water Supply Municipal _Well (if well, water supply from any septic system absorption is ft.) Percolation Test Rate: I ! 20 per minute per inch (test to be completed by licensed engineer/architect) PROPOSED SYSTEM FOR NEW CONSTRUCTION: Tank size I,000 gallons (min. size 1,000 gallons, add 250 gallons for each garbage cylinder or spa/hot tub System Absorption field with #2 stone Total length 22,0 ft.; Each Trench 55 ft. Seepage Pit with#3 stone How many: ;Size: Alternative System Bed or other type: Holding Tank System Total required capacity? ;tank size ;#of tanks NOTES: 1.Alarm system &associated electrical work must be inspected by a Town approved electrical inspection agency; 2.We will no longer allow systems to be covered until such time as an as-built plan is received and approved. The installed system must match the septic layout on file—no exceptions. Declaration:Any permit or approval granted which is based upon or is granted in reliance upon any material representation or failure to make a material iai fact or circumstance kuiOvvn by or on behalf of an applicant, Shall be void. I have read the regulations and agree to abide by these and all requirements of the Town of Queensbury Sanitary Sewage Disposal Ordinance. 1 PRINT NAME' (t ` ? ,(-1 11 i;' .;k t DATE: t I1 to� P Pe ',�1 SIGNATURE: ' .1�'/ -.' rr __'i DATE: 1\\g 1 `. Town of Queensbury Building&Code Enforcement Revised February 2017 INSPECTION WORKSHEET (SEP-001741-2019) Town of Queensbury - Building and Codes - Fire Marshal 742 Bay Road - (518) 761-8256 Building (518) 761-8206 Fire Marshal Case Number:SEP-0756-2018 Case Module:Permit Inspection Date:Tue Apr 2, 2019 Inspection Status:Passed Inspector:John O'Brien Inspection Type:Septic Job Address:Parcel Number:77 & 79 Briwood CIR Queensbury, NY 12804 308.14-1-52 Contact Type Company Name Name Primary Owner FOREST PARK MHC, LLC Applicant FOREST PARK MHC, LLC Contractor Stone Installations Granted Permission FOREST PARK MHC, LLC Checklist Item Passed Comments Building Inspector Notes YES 4/2/19 Septic System Approved Type of Water: Municipal / Well Water YES Municipal Absorbtion Fields: Total Length YES 220' of ADS HANCOR ARC24 Graveless Chambers Length of Each Trench YES 4@55' Depth of Trenches YES 18"-24" Building to Tank YES 4" sch40 Tank to Distribution Box YES 4" PVC Apr 02, 2019 Page (1) INSPECTION WORKSHEET (SEP-001741-2019) Checklist Item Passed Comments Distribution box to Field / Pit YES 4" PVC InletOutlet Pipes & Baffles YES Filter installed Foundation to Tank YES As per as-built plan Foundation to Absorption YES As per as-built plan Conforms as per Plot Plan YES As per as-built plan System Use Status YES 4/2/19 Septic System Approved Apr 02, 2019 Page (2) O'Brien, John (Inspector) ENGINEERING, PLLC . . Civil Engineering . Structural Design . Structural Inspection . 225 Ruggles Road Saratoga Springs, New York 12866 Cell: 518.817.0099 e-mail: RyanRiper@RKengineering.us RECORD PLAN DRAWING SUBMISSION FOR SEPTIC SYSTEM REPLACEMENT Date: March 29, 2019 To: Town of Queensbury John O’Brien Building Department 742 Bay Road Queensbury, NY 12804 Re: Forest Park - Mobile Home Park Queensbury, NY 12804 To Whom It May Concern: Find enclosed a septic system record drawing (11x17) depicting the replacement septic system as it was constructed at the below noted address. Replaced Septic Systems at: Forest Park MHP Briwood Circle lots: #73-75 Briwood Circle lots: #77-79 Please let me know if you have any questions. If you have any questions please call. Sincerely, Ryan K. Riper, P.E. 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