2012-524 . " TOWN OF QUEENSBURY
111 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development - Building & Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: P20120524 Date Issued: Tuesday, February 12, 2013
This is to certify that work requested to be done as shown by Permit Number P20120524
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
SJ xl L�rc,�N� By Order of Town Board
6, rlTOWN OF QUEENSBURY
Issuance of this Certificate of Compliance DOES NOT relieve the aN7P
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
712 Ki,v Road,Qucensbury',NY 12804-5902 (518)7G1-8201
(2L Community Development-Building&Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20120524 Application Number: A20120524
Ta% Nlap No: 523400-308-014-0001-052-000-0000
Permission is hereby granted to: ARCCOMMUNITIES 14 1-150
For property located at: 183 PITCHER Rd
in thcTown of QUeCilsbury, to constrUCt Or J)LICC
at the above location in accordance withapplication together with plot plansand other information hereto filed
and approved acid in compliance with the NYS LInifortri, Building(.:odes and the Queensbuxy Zollirig
Ordinance. Type of Construction Value
OwiterAddress: FOREIST PARK MFIC, LLC Septic Alteration Commercial
31200 NOR11-1WEISTERN llwy Total Value
FARMINGTON HILLS Ml 48834-0(
Contractor or Builder's Name / Address Electrical Inspcction Agency
Plans& SixcificatiOrls
2012-524
Septic Alteration - 86 & 88 Briwooci Circle
S75.00 PERMIT FEE PAID -Ti-iis PERMIT EXPIRES: Tuesday, November 05, 2013
(if a longer period is required,art application for an extension must be madc to the code Enforcement Officer
of the"'town of Queensbury before tire expiration(Lite.)
Dated at the Town of Queertsbury; Mowlay, Noveruber 05,2012
SIGNI-M BY for the Town of Queensbury.
Director of Building&Code Enforcement
7cfr
Community Development Office NI[;',. 'i 2012
Town of Queensbury • 742 Bay Road • Queensbury, New York •12804
Office Use Only
TAX MAP NO. 30 g1<1` 7 -5-el, PERMIT NO.Jc —5� /�j
PERMIT FEE
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.
OWNER: INSTALLER: �t<e (—�-,yam--�U.Nr�' `�6 iA-�e--A }
ADDRESS: ,/ ADDRESS: 'PO R �D tc l�OL�t�< ,"--)a-----
PHONE
"
PHONE NOS. g_5-1C¶ T 74.^v s-`� PHONE NOS. C.:-/g) Ltd-L(- 6'5.6 g /
LOCATION OF INSTALLATION: �.? B�l`t�U 0 CL �, 31 4- L C! '7 Lk Z-, '
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 X 110 = INSTALLED?
PARCEL INFORMATION:
✓ TOPOGRAPHY: FLAT R DLLING STEEP SLOPE %SLOPE
✓ SOIL NATURE: ;--A-1715--, LOAM CLAY OTHER
✓ GROUNDWATER: AT WHAT DEPTH?
✓ BEDROCK/IMPERVIOUS MATERIAL: AT WHAT DEPTH?
✓ DOMESTIC WATER SUPLY: MUNICIPAL WELL (If well:water supply from any septic system absorption is: ft)
✓ PERCOLATION TEST: RATE IS C' 7) 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: I (13(-10 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
❑SEEPAGE PIT(S)(WITH NO.3 STONE) How many? Size?
o ALTERNATIVE SYSTEM Bed or other type?
0 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 reg lations with respect to this application and agree to
abide by these and equirements of the Town of Queensbury QUESTIONS? CALL 761-8256 OR EMAIL
S nitary Se a Dispo I Ordinance. codes(@.queensburv.net
Signature of Person Responsi a 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: ` f _am/pm
742 Bay Rd., Queensbury, NY 12804 Inspector's Initials: -{ .) `
NAME: ',rt., ; \--. '- �1�L PERMIT NO.: -7 C.:-.)1-7 - c2•4-
LOCATION: � (3-I2�.LLn 70 CLt,; _ INSPECT ON: 2,I A \\7)
RECHECK:
Comments and/or diagram
Soil Type: Sand / Loa / Clay
Type of Water: Municipal / Well ater
Waterline separation dis .nce ft.
Well separation dis ;nce ft.
Other w-lls: ft.
Well Casing Length 50' + - N N/A
[150'to well required if Nei]
Absorption Field: Total lengt `__ ft.
Length of each trench ft.
Depth of trenches _ ft.
I Size of Stone
_ See e Pits: Number _
Size: x
Stone Size:
Piping Size Type Bui ding to tankr,-.) ,,, ,,-)
Tank to Dis ribution Box
Distribution Box to Field / Pit
Op=Hing Sealed: Y N4. `qV cx€N\-r:A...--;(•-•-//-•L..
i
End Cap YN ti
Inlet/Outlet Pit-s & Baffles Y N f :420-f
Manholes 12"or less •-low grad- _Y N
[provide extension Lollar if Yes, Y N ,
Location / '-paratio s
Foundation to k ft.
Foundation to �bsorp on ft.
Separatibbn of Pits ft.
rfo rfl as per tplo Plan 7 N
Engineer R-•att and -Built w Y N
-". aintenance ontractY_ N
provided i \,
Location of System on Property:
Front Rear Left Side Right Side Middle Front Middle Rear
System Use Stat -------
\PApprove
a► -ia31'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
irAt
November 21, 2014.1
Job#49335
Ms. Kristine Wheeler
New York State Dept. of Health
77 Mohican Street
Glens Falls, NY 12801
RE: Forest Park Community—Queensbury, Warren County F r J ' 1013
86 & 88 Briwood Circle—Replacement Septic System
Gentlemen:
This letter is to inform you that we inspected the completed replacement septic system for 86 &
88 Briwood Circle in the Forest Park Community on 11/9/2012.
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,
; L-t 6 4--1)
Thomas R. Center Jr., PE
cc: Dave Hatin,TOQ Building Dept.
Marty Mancini, ARC
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Septic Inspection Report
Office No. (518) 761-8256 Date Inspection request received:
Queensbury Budding &Code Enforcement Arrive: am/pm Depart: 1/ Q I) am/pm
742 Bay Rd., Queensbury, NY 12804 Inspector's Initials:
NAME: c E--e-�` A 40..1`C PERMIT NO.: )t 6
LOCATION: '-'zt>� C2-;1/4-n f>F�- � INSPECT ON: 1 "t 1-L.--
RECHECK: —RECHECK:
Comments and/or diagram
Soil Type: n1 Loam / Clay
Type of Water: nic' / Well Water
Waterline separation distance ft.
Well separation distance r / /% ft.
Other wells: �` ft.
Well Casing Length 50' + / - Y N N/A
[150'to well required if NO]
Absorption Field: Total length L-7 ft.
Z
Length of each trench �� T ft.
Depth of trenches
Size of Stone t - ._.
Seepage Pits: Number )�J'�n
Size: , C
Stone Size:
Piping Size Type
Building to tank
Tank to Distribution Box J.'-`
Distribution Box to Field / Pit k` ,°--�
Opening Sealed: +��F N
End Cap ✓YN
Inlet/Outlet Pipes &Baffles
Manholes 12"or less below grade _Y J1
[provide extension collar if Yes] .�Y 1' N
Location/ Separations
Foundation to tank ft.
Foundation to absorption
Separation of Pits ft.
Conforms as per Plot Plan VY //4_
Engineer Report and As-Built Y^t/ N FR /::-/L-5-6 4 j:. -�? f
ETU Maintenance Contract _Y N
provided
Location of System on Property:
Front Rear Left Side Right Side Middle Front Middle Rear
System Use Status:
Paprovd
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