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2011-615 ..4111ami TOWN OF QUEENSBURY ��� Q^� 742 BayRoad,Queensbury,NY 12804-5902 (518) 761-8201 n', Community Development - Building & Codes (518) 761-8256 CERTIFICATE OF COMPLIANCE Permit Number: P20110615 Date Issued: Friday, December 28, 2012 This is to certify that work requested to be done as shown by Permit Number P20110615 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 By Order of Town Board TOWN OF QUEENSBURY Issuance of this Certificate of Compliance DOES NOT relieve the 1 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 Fors 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201 Community Development-Building&Codes (518) 761-8256 BUILDING PERMIT Permit Number: P20110615 Application Number: A20110615 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 PO BOX 61102 Septic Alteration Commercial CHICAGO IL 60606-0000 Total value Contractor or Builder's Name/Address Electrical Inspection Agency Plans&Specifications 2011-615 89 &91 Briwood- septic alteration commercial $75.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Friday,December 21,2012 (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 To of Bens ;`°, � d ,December 21,2011 ) SIGNED BY t , for the Town of Queensbury. Director of Building&Code Enforcement ECIEIIWIEn Community Development Office Town of Queensbury • 742 Bay Road • Queensbury, New "'aril 12141V: �' 11 LL_,)) Office Use Only TOWN OF QUEENSBURY - BUILDI G ODE :',_% TAX MAP NO.___ PERMIT NO._ /11- £) T PERMIT FEE - __ �.a APPROVALS: ZONING___ TOWN CLERK__ APPLICATION FOR SEPTIC DISPOSAL SYSTEM PERMIT: A PERMIT MUST BE OBTAINED BEFORE WORK BEGINS. APPLICATIONnAIS SUBJECT TO REVIE4/__BEFO SUANCE OF A VALID PERMIT. OWNER:ilk ( CD i-er P _2/C_ INSTALLER: t' �.U_i c PIM ,r4_,/ a 1(CAvl-" 114 ADDRESS: I fl r (rdt V,i. f ) _ ADDRESS: 2 3 V e-(L- °itsT /1-0e- PHONE NOS.01 Q— S)(12.-— 0 6 7 4( PHONE NOS. 1 9 a g-so LOCATION OF INSTALLATION: v9 t 1/ 8 Rt Wv 1) nil_.c�.s___ RESIDENCE INFORMATION: NO.OF COMPUTATION YEAR BUILT X = TOTAL DAILY FLOW BEDROOMS (Gallons per bedroom) GARBAGE GRI 1980 or older X 150 = INSTALLED? 1981 -1991 X 130 = SPA OR HOT TUB 1992-present X 110 = INSTALLED?_ #•Nv PARCEL INFORMATION: tr e_C_ P 6A Wr ✓ TOPOGRAPHY: FLAT ROLLIN _ v STEEP SLOPE____ %SLOPE .1 SOIL NATURE: SAND__ 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 ____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 installedAlanning Board approved subdivision). TANK SIZE: I 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: 0 ABSORPTION FIELD (WITH NO. 2 STONE) Total length_ ft. Each trench X ❑ SEEPAGE PIT(S) (WITH NO. 3 STONE) How many? i� Size? ALTERNATIVE SYSTEM Bed other type? ` X- '( a A ❑ 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 h read the regulations with respect to this application and agree to id by thes and requirements of the Town of Queensbury QUESTIONS? CALL 761-8256 OR EMAIL S ary Se age isposal O dinance. codesesweensburv.net Signature of Person Responsible Date__PA 14 (4-(1( _ ___ VISIT OUR WEBSITE FOR MORE INFORMATION www.queensburv.net Septic Inspectiion Re• •rt Office No. (518)761-8256 Date Inspection . -' f- -part: Queensbury Building&Code Enforcement Arrive: '� - YO:�rW 742 Bay Rd., Queensbury, NY 12804 Inspector's In _ NAME: V1P PE'• NO.: —L© LOCATION: c V3.2_\vOOD➢ C'a-LE. IN' ON: \Z - 2--2 RECHECK: Comments and/or diagram Soil Ty• .1Iil. u-/Clay Type of Wa - �tRi�;:r� !!'- ,- ' afar w. "ration 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 3 ft. UppQ��� Depth of trenches 7_ - i�3i ft. Size of Stone ai- 4 Seepage Pits: Number L ?t Lib �E 7 Size: x Stone Size: Piping Size 'type Building to tank y" Tank to Distribution Box Distribution Box to Field Pit •-" o • 4t 'vii- v Opening Sealed: Y N End Cap ; N z.-ov$ E7 Inlet/Outlet Pipes&Baffles _Yr_N Manholes 12"or less below grade ,/f y.- [provide extension collar if Yes] Y_ 'N Location/ Separations Foundation to tank 0 ft. Foundation to absorption ft. \'‘ - \i1z Separation of Pits ft. Conforms as per Plot Plan Y N Engineer Report and As-Built _Y?N — cE Io\fE�ci21 ETU Maintenance Contract Y_N provided Location of System on Property: Front Rear Left Side Right Side Middle Front Middle Rear -m U S •t ' 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\Sepdc Inspection Repor&-03 29 10.doc