2012-523 .41% TOWN OF QUEENSBURY
742 BayRoad, ucensbu NY 12804-5902 (518) 761-8201
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Community Development - Building & Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: P20120523 Date Issued: Tuesday, February 12, 2013
This is to certify that work requested to be done as shown by Permit Number P20120523
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
cg. Q r u900,-1 1
r - TOWN OF QUEENSBURY
Issuance of this Certificate of Compliance DOES NOT relieve the ( 1.
property owner of the responsibility for compliance with Site Plan, c�
Variance, or other issues and conditions as a result of approvals by the Director of Building&Code Enf\cement
Planning Board or Zoning Board of Appeals.
TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development-Building&Codes (518)761-8256
BUILDING PERMIT
Permit Number: P20120523 Application Number: A20120523
Tax 1v1ap 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: FOREST PARK MHC, LLC Septic Alteration Commercial
31200 NORTHWESTERN Hwy Total Value
FARMINGTON HILLS MI 48834-0(
Contractor or Builders Name/Address Electrical Inspection Agency
Plans&Specifications
2012-523
Septic Alteration- 82 &84 Briwood Circle
$75.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Tuesday,November 05,2013
(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 Queensbury; Monday,November 05,2012
SIGNED BY for the Town of Queensbury.
Director of Building&Code Enforcement
Community Development Office
Town of Queensbury • 742 Bay Road • Queensbury, New York •12804
NOV U <: 2012
Office Use Only
c�
TAX MAP NO. 3 O �, )14-/-5c1 PERMIT NO. `"� 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.�.1
OWNER: L/ INSTALLER: CiU Wl�% D .)
r,�
ADDRESS: ADDRESS: o ciS,l o'I'\-S4
D ' -I q -b ^ l J
PHONE NOS.' — ( J �> ��� L � u �� � LI PHONE NOS. �
LOCATION OF INSTALLATION: �'T ;�(K.L-30 47273.rn74- � 1-)
RESIDENCE INFORMATION:
YEAR BUILT NO.OF COMPUTATION
X = 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:
✓ TOPOGRAP FLAT OLLING STEEP SLOPE %SLOPE
✓ SOIL NATURE: SANO�� LOAM CLAY OTHER
✓ GROUNDWATER: AT WHAT DEPTH?
✓ BEDROCK/IMPERVIOUS MATERI • AT WHAT DEPTH?
✓ DOMESTIC WATER SUPLY: MUNICIPAL WELL (If well:water supply from any septic system absorption is: ft)
I PERCOLATION TEST: RATE IS L Gd 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: 1, OU 0 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 2- 't x I' O
❑SEEPAGE PIT(S)(WITH NO.3 STONE) How many? Size?
❑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 e regulations with respect to this application and agree to
abide by these-an , ,Ilrequirements of the Town of Queensbury QUESTIONS? CALL 761-8256 OR EMAIL
Sanitary Se Dis al Ordinance. codes(a�pueensburv.net
VISIT OUR WEBSITE FOR MORE INFORMATION
Signature of Person Resp Date www.queensbury.net
Septic Inspection Report
Office No. (518) 761-8256 Date Inspection request received:
Queensbury Building &Code Enforcement Arrive: am/pm Depart: 7 , i am/pm
742 Bay Rd., Queensbury, NY 12804 Inspector's Initials: ) -11
NAME: a --�L `
PERMIT . 2 `)
LOCATION: ?
4— 1 1?i.k,c% \ (1-.1Z__ INSPECT ON: 2 I i.i l i3
RECHECK:
Comments and/or diagram
I
Soil Type: Sand/ Lo. / CI;y
Type of Water: Municipal / . ell Wat-r
Waterline separa ion distanie 7/7.,,,_._ft.
Well separation distance ft.
Other well.: ft.
Well Casing -ngth 50' + - N N/A
[150'to ell required if No]
Absorpti•• Field: Total lengih ft.
ength of each tren oh _ ft.
Depth of trench;s, ft.
Size of Sto
Seepage Pits: Numb<r
S :: ___r _ _x
Stone Sizz:
Pipin Size - Type i'&V
Building n to to
ovi \tor
Tank to Distribution B xx �'
Distributn Box to Field//Pit ~l
I Opening Sealed: N
7 'r‘ F--C2--
End Cap Y T N \ i
A
Inlet/Outlet Pipes &baffles _Y N
Manholes 12"Or less below grade Y— N
[provide extension collalr if Yes] __-__Y 1_ N
i
Locatr n / Separations
Fo ridafion to tank 1 ft.
Foundation fo absorption I ft.
Separation of Pits <- _--
__ ft.
_
CQns-as per Plot Plan , _ N
Engineer Rev rt and As-Built V Y N
-• 'aintenance Contract _ N
provided
Location of System on Property:
Front Rear Left Side Right Side Middle Front Middle Rear
System Use Statu .-----
Appro
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 Repor_03 29 10.doc
NACE ENGINEERING, P.C.
169 Haviland Road, Queensbury, NY 12804
Phone-518-745-4400 Fax -518-792-8511
PI
November 21, 2011
Job #49335
Ms. Kristine Wheeler
New York State Dept. of Health
77 Mohican Street
Glens Falls,NY 12801
f— , 2013
RE: Forest Park Community–Queensbury, Warren County
82 & 84 Briwood Circle–Replacement Septic System
Gentlemen:
This letter is to inform you that we inspected the completed replacement septic system for 82 &
84 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,
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 Building &Code Enforcement Arrive: am/pm Depart: /1,le.-2.c am/pm
742 Bay Rd., Queensbury, NY 12804 Inspector's Initials: ('
NAME: f-,,,_0„...„ �` +✓ Pi 42-A<--'
-->r= PERMIT NO.: t / I
LOCATION: e2--,-t- `e:%4- P,o:_i_t,:�7:,t71) &k.i INSPECT ON: t, t ` i Z
RECHECK:
'`•--", Comments and/or diagram
Soil Type: (ani'Loam / Clay I
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 _1:1, ,.---.L__ft.
Length of each trench -7-___):_c____- ,±_____ft.(h)
Depth of trenches ;' C.< ft.
Size of Stone
Seepage Pits: Number
Size: -��
Stone Size:
Piping Size Type
Building to tank /t"- -.;? -3
Tank to Distribution Box �t)r -1;
/ t{ 1
Distribution Box to Field/ Pit l `' �V)1) ' ,:.1 �''�`r'�i
Opening Sealed: __ N
End Cap N
Inlet/Outlet Pipes &Baffles .‘ N
Manholes 12"or less below grade _Y ✓ "
[provide extension collar if Yes] Y T/N I fl t
Location/ Separations
Foundation to tank ft.
Foundation to absorption ft. � � Ft
,j
Separation of Pits ft. -2s.i.,iI'`�
Conforms as per Plot Plan —Yk
Engineer Report and As-Built Y �'N --l� �,� �/ -il� te :-- �-,
a,, n
ETU Maintenance Contract Y -N � ��/` 7
provided
Location of System on Property:
Front Rear Left Side Right Side Middle Front Middle Rear
System Use Statu
Approved
artial Approv d-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