2010-101 TOWN OF QUEENSBURY
vro742 Bay Road,Queensbury,NY 12804-5902 (518) 761-8201
Community Development- Building &Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number. P20100101 Date Issued: Friday, April 02, 2010
This is to certify that work requested to be done as shown by Permit Number P20100101
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 Residential
By Order of Town Board
TOWN OF QUEENSBURY
Issuance of this Certificate of Compliance DOES NOT relieve the 4
property 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
com 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development- Building&Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20100101 Application Number. A20100101
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
900 Septic Alteration Residential
PO BOX 790830 Total Value
SAN ANTONIO, TX 78279-0000
Contractor or Builder's Name/Address Electrical Inspection Agency
Plans &Specifications
2010-101
lot 70 Briwood Circle
$25.00 PERMIT FEE PAID- THIS PERMIT EXPIRES: Friday, April 01,2011
(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 T wn of ee xyf ► j sday,April 01, 2010
o/"VJ for the Town of Queensbury.
SIGNED BY Qu ury•
Director of Building&Code Enforcement
(30 - /4—/ OFFICE USE ONLY , D!'; � \\9 I R
TAX MAP NO. + �—' ` PERMIT NO./010 D � PERMIT FEE .G 41� I 1112010
APPROVALS: ZONING TOWN CLERK _ tL
BUi°!�!sN , c `nEs
APPLICATION FOR SEPTIC DISPOSAL SYSTEM PERMIT: h
A PERMIT MUST BE OBTAINED BEFORE WORK BEGINS.APPLICATION IS SUBJECT TO REVIEW BEFOR ISSUANCE OF A VALID
PERMIT. .v '�
OWNER: S l pA, INSTALLER: • f1��
`,,
ADDRESS: ) 2 I �'l.t �� ADDRESS: C) � 5��•�.
PHONE NOS. ,° L12 r0 S C PHONE NOS. Sim ,r LI z — O c7
LOCATION OF INSTALLATION: O 1 1 b..)0
RESIDENCE INFORMATION:
YEAR BUILT NO.OF X COMPUTATION= = TOTAL DAILY FLOW
BEDROOMS GARBAGE GRINDER
1980 or older X 150 gallon per bedroom = 3ICA:=> 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 ✓ Steep slope %Slope
✓ SOIL NATURE: Sand ✓ Loam Clay Other
✓ GROUNDWATER: At what depth? *`i\--
✓ BEDROCK/IMPERVIOUS MATERIAL: At wha epth?
✓ DOMESTIC WATER SUPLY: Municipal Well (If well: Water supply from any septic
system absorption is ft.)
I 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: `per 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: 7-tC-57 v.vORkl.i 6
❑ 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?
❑ 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.
coo f�
Septic Inspection Report
Office No. (518) 761-8256 Date In`action r-- • ,- eiv-s:
Queensbury Building &Code Enforcement Arrive: • 1 1 .-part: s % a • em
742 Bay Rd., Queensbury, NY 12804 Inspector's Initials: ri
NAME: Fc>C? - DT PAR,Y P • IT NO.: 10 —10
LOCATION: i t: _ i i) \ s NSPECT ON: —t��
RECHECK: F-t i C
Comments and/or diagram
Soil Type "J..: ,�..m/ Clay
Type of Water: unici•; ,se ►'ater
Wate • -paration distance ft.
Well separation distance ft. '�
Other wells: ft. --�� vc iT'\�
Well Casing Length 50' + / - Y�N N/A --V ki\
i•Z)\
Absorption Field: Total length ft. v �`
Length of each trench _ft. `t' ` C 7 tom-
Depth of trenches, ft.
Size of Sto
Seepage Pits: N ber
Size: x
Stone Size:
Piping Size Type
Building to tank 4
Tank to Distribution Box y
Distribution Box to Field/ Pit
Opening Sealed: _Y_N
End Cap _N
Inlet/Outlet Pipes&Baffles V Y—N
Location/ Separations
• Foundation to tank 7Th ft. "1-c.
Foundation to absorption 'ft.
Separation of Pits ft.
Conforms as per Plot Plan Y, N
Engineer Report and As-Built Y!N
Location of System on Property:
Front •e ide • t Side Middle Front Middle Rear
• d .
Approved
Partial Approved and needs to be re-inspected, please call the Building &Codes Office
Disapproved
Last revised 06/18/07 L:\Building&Codes Forms-OLD\Building&Codes\Inspection Forms\Septic Inspection Report.doc
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