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SEP-0753-2018TOWN 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-0753-2018 Date Issued: Thursday, March 21, 2019 This is to certify that work requested to be done as shown by Permit Number has been completed. SEP-0753-2018 Tax Map Number: Location: Owner: 308.14-1-52 95 Gregwood CIR FOREST PARK MHC, LLC Applicant:FOREST PARK MHC, LLC This structure may be occupied as a: Residential Septic Alteration 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 742 Bay Road,Queensbury,NY 12804-5904 (518)761-8201 Community Development - Building& Codes (518) 761-8256 BUILDING PERMIT Permit Number: SEP-0753-2018 Tax Map No: 308.14-1-52 Permission is hereby granted to: FOREST PARK MHC,LLC For property located at: 95 Gregwood 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 $ 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 the expiration dat-.) Dated at the Town of ee 4ues, . :/cember 4,2018 SIGNED BY: 1 for the Town of Queensbury. Director of Building&Code Enforcement j SEPTIC DISPOSAL PERMIT APPLICATION Office Use Only r- 6—' 742 Bay Road,Queensbury,NY 12804 P:518-761-8256 1r' VI..:ueer.s Permit#: �s-r C __,,, Tax Map ID#: /s . l`(` S . Permit Fee:$ r) ; Invoice#: Project Location: q_ G .�..tioc1 �I re i f £ b y Septic Variance? Yes No Primary Owner(s) fr-t' i i :J f' I I Mailing Address I' 3 ;(:. Phone & Email - ` JIB t t i ',..{��` IT ; ,-_ r'' installer/Builder 3 4 I r !S! , th.'�iL A. t Mailing Address r11--�--5 ' al-OA-Dr-0 I . , . "_ � , f (;; — Phone & Email � . t , ?-1 — ' D -C Engineer R�f Cut. I, per Mailing Address _1 NOV 2 9 2018 J Phone & Email (51 5� !1 - OCA q TOWN OF OU _ENSBURY COpMMI�gif -rer\D � F raT_ Contact Person for Building&Code Compliance: i �` s ; .,i Ph.,ne. ) I € i RESIDENCE INFORMATION: Year Built #of bedrooms X gallons per bedroom =total daily flow Garbage Grinder Yes I Nof 1980 or older Installed? (circle one) I./ 1981-1991 Spa or Hot Tub Yes N✓, Installed? (circle one) 1992-Present 3 / I 0 3 3 o PARCEL INFORMATION: Topography V./ Flat Rolling Steep Slope %Slope Soil Nature 4V Sand Loam Clay Other Groundwater At what depth? 0 NONE Bedrock/Impervious material At what depth? Vj NONE Domestic Water Supply Municipal _Well (if well,water supply from any septic system absorption is_ft.) Percolation Test Rate: I' 2...0 per minute per inch (test to be completed by licensed engineer/architect) PROPOSED SYSTEM FOR NEW CONSTRUCTION: Tank size 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 f 1 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 fact Or circumstance known 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. PRINT NAME: ii ( \ J I 71-11 DATE: 1 j 12(190 )-) SIGNATURE: i ' : './% 4 k `G1 �LILV I l% DATE: II Iau1I 0? ,I A Town of Queensbury Building&Code Enforcement Revised February 2017 INSPECTION WORKSHEET (SEP-001543-2019) Town of Queensbury - Building and Codes - Fire Marshal 742 Bay Road - (518) 761-8256 Building (518) 761-8206 Fire Marshal Case Number:SEP-0753-2018 Case Module:Permit Inspection Date:Thu Mar 21, 2019 Inspection Status:Passed Inspector:John O'Brien Inspection Type:Septic Job Address:Parcel Number:95 Gregwood 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 3/18/19 Septic System Not Approved Remaining Item: - Revise record drawing reflecting correct orientation of septic tank showing inlet and outlet locations. - No measurements to tank and field off mobile home. Note : Ok to backfill field only until I have received the updated record drawing and report. Leave inlet and outlet pipe into tank exposed. 3/21/19 Septic System Approved - Received revised as-built & final report. Type of Water: Municipal / Well Water YES Municipal Absorbtion Fields: Total Length YES 110' of ADS HANCOR ARC24 CHAMBERS Length of Each Trench YES 2@55' Mar 21, 2019 Page (1) INSPECTION WORKSHEET (SEP-001543-2019) Checklist Item Passed Comments Depth of Trenches YES 18"-24" Building to Tank YES 4" sch40 pvc Tank to Distribution Box YES 4" sch40 pvc Distribution box to Field / Pit YES 4" pvc to ADS HANCOR ARC24 CHAMBERS Foundation to Tank YES 19' Foundation to Absorption YES 19' Conforms as per Plot Plan YES 3/18/19 Septic System Not Approved Remaining Item: - Revise record drawing reflecting correct orientation of septic tank showing inlet and outlet locations. - No measurements to tank and field off mobile home. Note : Ok to backfill field only until I have received the updated record drawing and report. Leave inlet and outlet pipe into tank exposed. 3/21/19 Septic System Approved - Received revised as-built & final report. Engineer Report and As-Built YES 3/18/19 Septic System Not Approved Remaining Item: - Revise record drawing reflecting correct orientation of septic tank showing inlet and outlet locations. - No measurements to tank and field off mobile home. Note : Ok to backfill field only until I have received the updated record drawing and report. Leave inlet and outlet pipe exposed of septic . 3/21/19 Septic System Approved - Received revised as-built & final report. Mar 21, 2019 Page (2) INSPECTION WORKSHEET (SEP-001543-2019) Checklist Item Passed Comments System Use Status YES 3/18/19 Septic System Not Approved Remaining Item: - Revise record drawing reflecting correct orientation of septic tank showing inlet and outlet locations. - No measurements to tank and field off mobile home. Note : Ok to backfill field only until I have received the updated record drawing and report. Leave inlet and outlet pipe into tank exposed. 3/21/19 Septic System Approved - Received revised as-built & final report. Mar 21, 2019 Page (3) O'Brien, John (Inspector) INSPECTION WORKSHEET (SEP-001494-2019) Town of Queensbury - Building and Codes - Fire Marshal 742 Bay Road - (518) 761-8256 Building (518) 761-8206 Fire Marshal Case Number:SEP-0753-2018 Case Module:Permit Inspection Date:Mon Mar 18, 2019 Inspection Status:Failed Inspector:John O'Brien Inspection Type:Septic Job Address:Parcel Number:95 Gregwood CIR Queensbury, NY 12804 308.14-1-52 Contact Type Company Name Name Primary Owner FOREST PARK MHC, LLC Contractor Stone Installations Granted Permission FOREST PARK MHC, LLC Applicant FOREST PARK MHC, LLC Checklist Item Passed Comments Building Inspector Notes NO 3/18/19 Septic System Not Approved Remaining Item: - Revise record drawing reflecting correct orientation of septic tank showing inlet and outlet locations. - No measurements to tank and field off mobile home. Note : Ok to backfill field only until I have received the updated record drawing and report. Leave inlet and outlet pipe into tank exposed. Type of Water: Municipal / Well Water YES Municipal Absorbtion Fields: Total Length YES 110' of ADS HANCOR ARC24 CHAMBERS Length of Each Trench YES 2@55' Depth of Trenches YES 18"-24" Mar 18, 2019 Page (1) INSPECTION WORKSHEET (SEP-001494-2019) Checklist Item Passed Comments Stone Size:NO Building to Tank YES 4" sch40 pvc Tank to Distribution Box YES 4" sch40 pvc Distribution box to Field / Pit YES 4" pvc to ADS HANCOR ARC24 CHAMBERS Foundation to Tank YES 19' Foundation to Absorption YES 19' Conforms as per Plot Plan NO 3/18/19 Septic System Not Approved Remaining Item: - Revise record drawing reflecting correct orientation of septic tank showing inlet and outlet locations. - No measurements to tank and field off mobile home. Note : Ok to backfill field only until I have received the updated record drawing and report. Leave inlet and outlet pipe into tank exposed. Engineer Report and As-Built NO 3/18/19 Septic System Not Approved Remaining Item: - Revise record drawing reflecting correct orientation of septic tank showing inlet and outlet locations. - No measurements to tank and field off mobile home. Note : Ok to backfill field only until I have received the updated record drawing and report. Leave inlet and outlet pipe into tank exposed. Mar 18, 2019 Page (2) INSPECTION WORKSHEET (SEP-001494-2019) Checklist Item Passed Comments System Use Status NO 3/18/19 Septic System Not Approved Remaining Item: - Revise record drawing reflecting correct orientation of septic tank showing inlet and outlet locations. - No measurements to tank and field off mobile home. Note : Ok to backfill field only until I have received the updated record drawing and report. Leave inlet and outlet pipe into tank exposed. Mar 18, 2019 Page (3) O'Brien, John (Inspector) ENGINEERING, PLLC 015 3 -Z©tc6 . Civil Engineering . Structural Design . Structural Inspection . RECORD PLAN DRAWING SUBMISSION FOR SEPTIC SYSTEM REPLACEMENT Date:March 19, 2019 AS BUILT 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 Gregwood Circle lot: #95 Please let me know if you have any questions. If you have any questions please call. Sincerely, Ryan K. Riper, P.E. Encl. 225 Ruggles Road Saratoga Springs,New York 12866 Cell:518.817.0099 e-mail:RyanRiper@RKengineering.us