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2011-610 .4 _ TOWN OF QUEENSBURY too742 Bay Road,Queensbury,NY 12804-5902 (518) 761-8201 Community Development - Building & Codes (518) 761-8256 CERTIFICATE OF COMPLIANCE Permit Number: P20110610 Date Issued: Monday, February 09, 2015 This is to certify that work requested to be done as shown by Permit Number P20110610 has been completed. Tax Map Number: 523400-308-014-0001-052-000-0000 Location: 183 PITCHER Rd Owner: FOREST PARK MHC, LLC Applicant: ARC This structure may be occupied as a: Septic Alteration Commercial By Order of Town Board TOWN OF QUEENSBURY Issuance of this Certificate of Compliance DOES NOT relieve the A property owner of the responsibility for compliance with Site Plan, ,,11 Variance, or other issues and conditions as a result of approvals by the Director of Building&Code force nt Planning Board or Zoning Board of Appeals. TOWN OF QUEENSBURY 411111ft 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201 Community Development-Building&Codes (518) 761-8256 BUILDING PERMIT Permit Number: P20110610 Application Number: A20110610 Tax Map No: 523400-308-014-0001-052-000-0000 Permission is hereby granted to: ARC 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 PO BOX 61102 Septic Alteration Commercial CHICAGO IL 60606-0000 Total value Contractor or Builder's Name/Address Electrical Inspection Agency FRED SMITH 796-0850 23 VERMONT Ave QUEENSBURY NY 12804-0000 Plans&Specifications 2011-610 81 & 83 Briwood Circle $75.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Wednesday,December 19,2012 (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 Town of-Qnecnsburr;; �� Monday,December 19,2011 / SIGNED BY / ' r 7; • for the Town of Queensbury. Director of Building&Code Enforcement ., _ Community Development Office Town of Queensbury • 742 Bay Road • Queensbury, New York •12804 Office Use O I • T' I Ni. ,....... s ` 1 S-2-- PERMIT NO. i/..- (/1V '//t PERMIT FEE ?,_5 APPROVALS: ZONING TOWN CLERK APPLICATION FOR SEPTIC DISPOSAL SYSTEM PERMIT: A PERMIT MUST BE OBTAINED BEFORE //��WORK BEGINS.APPLICATION IS SUBJECT TO REVI�d.•G'tSS IANC OSA VALID y �rN OWNER:fin_ C, At_Aih/re v P - INSTALLE : �t /. d(t� ,y ADDRESS: l P3 I/ i/Ch L..� A7 ADDRESS: 2S i' A d�tr3 N I AL L-- PHONE NOS.(g/© -' P4 Z C (o 7 CI PHONE NOS. -7q� -D e .c d y� LOCATION OF INSTALLATION: - p r a3 ,��z,tCwi,o°a 1 1/1 e 6 RESIDENCE INFORMATION: NO.OF X COMPUTATION YEAR BUILT = TOTAL DAILY FLOW BEDROOMS (Gallons per bedroom) GARBAGE GRI �R3 1980 or older X 150 = INSTALLED?_ f� 1981 -1991 X 130 = SPA OR HOT TUIW 1992-present X 110jj ���� = INSTALLED? PARCEL INFORMATION: f-4 P C-Ai"f ✓ TOPOGRAPHY: FLAT ROLLING 07. STEEP SLOPE %SLOPE ✓ SOIL NATURE: SAND LOAM CLAY OTHER ✓ GROUNDWATER: AT WHAT DEPTH? ✓ BEDROCK/IMPERVIOUS MATERIAL: AT WHA,pEPTH? I DOMESTIC WATER SUPLY: MUNICIPALc//WELL (If well:water supply from any septic system absorption is: ft) ✓ PERCOLATION TEST: RATE IS _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/66 Z 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: r J e' Pi-ABSORPTION FIELD(WITH NO.2 STONE) Total length3 0-0 - ft. Each trench� _X ❑ 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,-gul ' ns with respect to this application and agree to •• by the - . d I requirements of the Town of Queensbury QUESTIONS? CALL 761-8256 OR EMAIL _ S- 1:ry Sys.'.se D. poral Or finance. 6 4/S/lit I codes(a queensbury.net O-- VISIT OUR WEBSITE FOR MORE INFORMATION S gnature of Person Responsible Date www.queensbury.net 1 Septic Inspection Re. • Office No. (518) 761-8256 Date Inspection =.-�"' -ived: Queensbury Building &Code Enforcement Arrive: = .e VP De•-• . am/pm 742 Bay Rd., Queensbury, NY 12804 Inspector's Initial , Air NAME: 5 PA Q_Y- PER I NO.: 1\—(.471 O LOCATION: c61 i$3 too) rt ort_ INS' ON: ?- "q— %J RECHECK: 6—‘"•3 c 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 1 Size: x ° Stone Size: Piping Size Type / Building to tank Tank to Distribution Box Distribution Box to Field/ Pit Opening Sealed: _Y_N f� End Cap Y N A° Inlet/Outlet Pipes&Baffles Y N � Manholes 12"or less below grade _Y!N [provide extension collar if Yes] Y T.N Location/ Separations Foundation to tank Foundation to absorption ft. Separation of Pits ft. Conforms as per Plot Plan Y N Engineer Report and As-Built Y N ETU Maintenance Contract _Y_ N provided Location of System on Property: Front ar Left Side Right Side Middle Front Middle Rear st m U Sta s: 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 (2 : oc) Septic Inspection Report Office No. (518)761-8256 Date Inspestipn req k- - •: r".. -- Queensbury Building&Code Enforcement Arrive: i+ 10 a .•;�0 •-part: 'Y am( 742 Bay Rd., Qu bury, NY _ 804 Inspector's Initials: /,,� NAME: (e-� - C(A) •in NO.: LOCATION: '/ B61, Jr-d--J I ' ON: RECHECK: Comments and/or diagram Soil Type: .- •.m/ Clay Type of Water: unici i.. Well Water Waterli - •.ration distance 1 p _ft.* Well separation distance ft. Other wells: ft. Well Casing Length 50'+/- Y N NIA [150'to well required if NO] Absorption Held: Total length O O ft. Length of each trench c7 ft. Depth of trenches 1 -2) ft. Size of Stone I.Z, Seepage Pits: Number Size: Stone Size: Piping Size Type Building to tank 'y" ti yp Tank to Distribution Box Distribution Box to Field Pit " 0 L: c L-1" $30k35 QERF Opening Sealed: N End Cap N Inlet/Outlet Pipes&Baffles ✓Y N Manholes 12"or less below grade VifN [provide extension collar if Yes] Y Location/ Separations Foundation to tank$$' 1 O ft. MN 4 Folinflatlewto absorption 9- Separation of Pits Conforms as per Plot Plan . Vi Engineer Report and As-Built _Y } aEF� ETU Maintenance Contract Y N E provided t V- V C F ALL Location of System on Property: 77 Front Rear Left Side Right Side Middle Front Middle Rear em _ - S.t . Approved Partial Approved and needs re-inspected, please call the Building&Codes Office Disapproved L:\Pam Whiting\2010\Building Codes Forms\Inspectlon For s\Septic Inspection Report_03 29 10.doc < < 9 0 EFS HN z O N. 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