2008-440 TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518) 761-8201
Community Development- Building &Codes (518) 761-8256
CERTIFICATE C-N-Ar" COMPLIANCE
Permit Number. P20080440 Date Issued: Monday, July 06, 2009
This is to certify that work requested to be done as shown by Permit Number P20080440
has been completed.
Tax Map Number. 523400-239-020-0001-014-000-0000
Location: 2948 State Route 9L
Owner. KENNETH & CAROL FUCHSLOCHER
Applicant: KENNETH & CAROL FUCHSLOCHER
This structure maybe occupied as a:
Septic Alteration Residential
By Older of Town Board
TOWN OF QUEENSBURY
Issuance of this Certificate of Compliance DOES NOT relieve the
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
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development- Building&Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20080440 Application Number. A20080440
Tax Map No: 523400-239-020-0001-014-000-0000
Permission is hereby granted to: KENNETH & CAROL FUCHSLOCHER
For property located at: 2948 State Route 9L
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. Tyne of Construction Value
Owner Address: KENNETH & CAROL FUCHSLOCH
1805 BAY Rd Septic Alteration Residential
LAKE GEORGE, NY 12845 Total value
Contractor or Builder's Name/ Address Electrical Inspection Agency
Plans &Specifications
2008-440
septic alteration residential - tank replacement
$25.00 PERMIT FEE PAID- THIS PERMIT EXPIRES: Thursday,August 20, 2009
(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 eensb 4r, H �?9ded sday, August 20, 2008
SIGNED BY for the Town of Queensbury.
Director of Building&Code Enforcement
.................r......_..._................................r.�r.... ..__......____•__•�•__)
iJ OFFICE USE ONLY ' ;
/� qum,TFEE
0
TAX MA l PERMITNO.
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: K w= bl� T re �I.c[ Loote.. INSTALLER: WV,
ADDRESS: - AS 4"E: ..9 q'3 51a-t-4 to-ZL 'ADDRESS: Lak. /Xl5(
PHONE NOS. PHONE NOS. SI 7 y 3 7 Z 4 0
LOCATION OF INSTALLATION: 2,1 q R' S G"t-- Rt, 4L.. L.a Ill 1 I L Fs g s
RESIDENCE INFORMATION:
»»•».......»»»•»......�..... ». . »»»...:»»..».»»....•............
YEAR BUILT w»BEDROOMS X w - -COMPUTATION= =w TOTAL DAILY FLOW
�1980 or older » p -X- » i 50 gaiton W» GARBAGE GRIN,D�€`R
.»». -». .•. -»�. »».»...»»... ». ...•.•.•....»Per bedroom.. ' ». 00 µ.» .».»•......,. INSTALLED?
µ 1981-1991 X i30 gallon per bedroom : SPA OR HOT TUB
x1992-present»N .....».».»».»•.»..r. ».»».»Nr.x»».d.1r10 gallon per bedroom... ».`».......». »..»»».». ...�_» .......
INSTALLED? /alb
PARCEL INFORMATION:
✓ TOPOGRAPHY: FLAT ROLLING STEEP SLOPE ✓ %SLOPE 2.6 o
✓ SOIL NATURE:SAND_ LOAMY_ CLAY � OTHER ! R�41, Led
✓ GROUNDWATER: AT WHAT DEPTH? s BEDROCK/IMPERVIOUS MATERIAL: AT
WHAT DEPTH? aNk�s
✓ DOMESTIC WATER SUPLY: MUNICIPAL_,d�L WELL_f& L"L, w "
(IF WELL:WATER SUPPLY FROM ANY SEPTIC-SYSTEM ABSORPTION IS teo FT, ) ,—
✓ PERCOLATION TEST: RATE IS PER MIINUTE PER INCH (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).Add 250
gallons to the size of the septic tank and leach field for each garbage grinder,spa or whirlpool tub.
✓ SEPTIC TANK:_LQQjL—GALLON(MIN. SIZE IS 1,000 GAL.) TILE FIELD: EACH TRENCH FT.
✓ TOTAL SYSTEM L NFL GTH: _FT. SEEPAGE PIT(S): HOW MANY?
✓ SIZE OF EACH6(A- -FT.X 4Li, FT.
✓ SIZE OF STONE TO BE USED #__4Lkr_/DEPTH OR THICKNESS FT.
✓ BED SYSTEM SIZE:—1h. X Zy I)-
✓ ALTERNATIVE SYSTEM: LENGTH AND/OR SIZE f�
✓ HOLDING TANK SYSTEM:(If required) NO,OF TANKS: A- /SIZE OF EACH
✓ GALLONS./TOTAL CAPACITY: GAL.
1•IrIN.NNNNIN•NINWI4.Nl.IxNN.I......I.N!.!....•1.1.1•pl•1•Ir1.HN!•HN{.1.1,...NNI......pHNNpI...1.1•1........HIxNNN4.NNpI•pM•!V•!•1•I.N!•!•.•!.lxN•I•I•N!•!•1.1•!•1•...•IN.H............ .i.l•!•INN•!x•»N•4.14.1.lxWNHI.1.1....•I.pIN•.4N....w.lx.lvYp1.N1•pl•NIx•••Ix• ,
NOTE: ALARM SYSTEM AND ASSOCIATED ELECTRICAL WORK MUST BE INSPECTED BY A TOWN
APPROVED ELECTRICAL INSPECTION AGENCY. PLEASE REVIEW LIST PROVIDED.
lxn4•NlypiNWIrIWI•NHIx444•YNi•Nlx•1•N!•!V•I•!r!•1•Irl•14•I•N!N•NHIN•1•HI•pHHIN•I.1•!•INrI.1.l•1.1.1•Np!•NNI•I•I.1•lN•IN•Ix•HHI•!rp1.1.!•IN•!•H!•!.!•pHlN.1.1•W4.HpINx•!•1•HI............ .H...•..NpNpp NH1•NNNppp.x•HNNI.plwl.......•..p••.....N......I...........
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 regulations with respect to this application and
agree to abide by these and all requirements of the Town of =CALL1-1SM OR EMAIL
Queensbury Sanitary Sewage Disposal Ordinance. bumpetVIMORE INFORMATION
)IJ
urv.etei
L 4
S nature Ztrson Responsible Date
�u �Yo�• mop �.7rcc�
Town of Queensbury- Community Development Office- 742 Bay Road, Queensbury,NY 12804
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Septic Inspection Report
Office No. (518) 761-8256 Date Ins ion uest received:
Queensbury Building &Code Enforcement Arrive: m/,pin art: am/pm
742 Bay Rd., Queensbury, NY 12804 Inspect r's•Initials: V/`—
77
NAME: ro C k'5L C)C Gt6-1c- PERMIT NO.:
LOCATION: �— INSPECT ON:
RECHECK:
Comments and/or diagram
Soil Type: Sand Loam Clay
Type of Water. Municipal Well Water
Waterline separation distance
Well separation distance ft.
Other wells: ft.
Well Casing Length 50' + / - Y N _N/A
Absorption Field: Total length ft.
Length of each trench ft.
Depth of trenches ft.
Size of Stone
Seepage Pits: Number
Size: x
Stone Size:
Piping Size T e
Building to tank
Tank to Distribution Box
Distributio x to Field Pit
Opening Sealed: N
End Cap N
Inle Outlet Pipes &Baffles Y N
Location Separations
Foundation to tank ft.
Foundation to absorption ft.
Separation of Pits ft.
Conforms as per Plot Plan Y N
Engineer Report and As-Built i Y N
Location of System/rLeft
erty:
Front R Side Right Side Middle Front Middle Rear
System Use
Approved
Partial Approved and needs to be re-inspected, please call the Building &Codes Office
Disapproved
Last revised 06/18/07 U\Building&Codes Forms-01-1)\Building&Codes\Inspection Forms\Septic Inspection Report.doc
2-4
Septic Inspection Report
Office No. (518) 761-8256 Date Ins ection request received:
Queensbury Building &Code Enforcement Arrive: ` 0 am/pm �Depart: am/pm
742 Bay Rd., Queensbury, NY 12804 Inspector's Initials:
NAME: 9PERMIT NO.:
LOCATION: INSPECT ON: •
RECHECK:
Comments and/or diagram
Soil Type: Sand Loam/ Clay
—Typeof water: municipal/ Well Water
Waterline separation distance ft.
Well separation distance ft.
Other wells: ft.
Well Casing Length 50' + / - Y N N/A
Absorption Field: Total length ft.
Length of each trench ft.
Depth of trenches ft.
Size of Stone
Seepage Pits: Number
Size: x
Stone Size:
Piping Size Type I
Building to tank FO
Tank to Distribution Box ►i
Distribution Box to Field/ Pit
Opening Sealed: rY N
End Ca Y N
Inlet/Outlet Pipes&Baffles Y N
Location Separations
Foundation to tank ft.
Foundation to absorption ft.
Separation of Pits ft.
Conforms as per Plot Plan Y N
Engineer Report and As-Built Y N
r�
Location of System on Property:
Front R r Left Side Right Side Middle Front Middle R r '~ �00-rrk �r�C'
S s Use S t
Approved
Partial Approved and needs to be re-inspected, please call the Building &Codes Office
Disapproved
Last revised 06/18/07 L:\Building&Codes Fonns-OLD\Building&Codes\Inspection Forms\Septic Inspection Report.doc
e4
MAP REFERENCES.
MAP OF LANDS OF
STANLEY J. WAWREJKO
DATED:FEBRUARY 4, 1988
BY. COULTER&McCORMACK
MAP OF SUBDIVISION OF 10 ACRES or helleve I SaW evIIIEu
DEEDED DAILEY TO ALLEN SAID cPe� Or pi1ser ie�' fences,etc., �,
LANDS BEING ON THE EAST have V "Ises, %Neils,trBeshave
z
L.G. N.Y. all Qb ects ,I� ram• C
SHORE OF DUNHAMS BAY, r� �� �!i,:.�'�, 1 a4sp rc ry�fi0rt that
t g diag �
1.
BY:H.D. CHAMBERS ShpWf1 S)� ��;5 Ci `� ,� tS !�C s2 51
DATED:JUNE, 1908
FILED.DECEMBER 15, 1908 ACE i
MAP OF PART OF _
'THE BURNT RIDGE LOT` S`
x
DATED:NOVEMBER 8, 1968
LAST REVISED:MARCH 12, 1985 Q
BY. COULTER&McCORMACK
DEED REFERENCE:
EMIL G. FUCHSLOCHER s
IRMA E. FUCHSLOCHER LANDS N/F OF
KENNETH E. FUCHSLOCHER ROBERT R. CLEMENS ill
to
TO
KENNETH E. FUCHSLOCHER 981/284 co
DATED: OCTOBER 29, 1986 �� i `o
BOOK 686 PAGE 1057
197.8104
' w
C N86002 20 E . . . . . . . . . . . o f w
m
APPROXIMATE SEPi�C 9Y5TETA � o
0
O
� _ ------------ . . . . `_ . . . . . . . F � LEGEND: ti
BUS o gcmz`K UtTE O IPF=IRON PIPE FOUND t-
= 1 5 o Q O lRF=IRON ROD FOUND G�
WOOD FRAME " PROPOSED
00 O 1. PIN=IRON PIN FOUND of
QocK o o SE _ GARAGE b 10,255 sq. ft. � O IRS=IRON ROD SET/TO BE SET co
'o t ADDITION N acres =UTILITY POLE
�M Q
o'Ln LO
coNCRErE
\` z CABIN GARAGE 45.5G •
KIP ME 0
�� T� 4 O u S860 � i "W E-10 IM? Z 1 �� •
192.62` —C- 5tiE0
ADSOtNER9 OOGK PROPOSED NEW
O PROPOSED SEPTIC TANK
e DECK ( LE j
61± r EXISTING Rev'iav d
SEPTIC TANK LANDS N/F OF
DANIE 2 A.977/6MBARDI Dat
Date, December 3, 2007
" Use
tiNAUTNALTERATIONZEALTERATION OR ADDITION TO A SURVEY ScQte 1'=20'
YAP BEARING A LICENSED LAND SURVEYORS SEAL IS A Map of a Survey made for
&9 VIOLA110N OF SECTION 7209,SUB-DIVISION2,OF THE
NEW YORK STATE EDUCATION LAW.'
MARKED
COPIES ORIGINAL
THE OF THE OF THIS SURVEY
PARKED WITH AN ORSgNAL OF THE LAND SURVEYORS
SEAL SHALL BE CONSIDERED TO BE VAl1D TRUE COPIES.''CERTIFICATIONS INDICATED HEREON SIGNIFY THAT Kenneth E . Fuchs 1 o c h e r
THIS SURVEY WAS PREPARED IN ACGXXtOANCE WITH THE
g T CODE OF PRACTICE FOR LAND SURVEYORS ADOPT BY
L ® BY THE NEWYDRIC STATE ASSOCIATION OF PROFESSIONAL
LAND SURVEYORS.SAID CERTIFICATIONS SHALL RUN ONLY
TO THE PERSON FOR WHOM THE SURVEY IS PREPARED,AND
SHEET 1 OF 1
ON
HIS BEHALF TO THE TITLE COMPANY,GOVERNMENTAL, New York 1280E AGENCY AND LENDING INSTITUITION LISTED HEREON,AND Town of Queensbury, Warren County, New York
169 Haviland Road Queensbur y TO THE ASSIGNEES OF THE LENDING INSTITUTION.• 1 12118107 PROPOSED ADDITIONS FUCHSLOCHER
(518) 792-8474 New York Lie. No. 50135 NO. DATE DESCRIPTION DWG. NO. 07202
239.20-1-14 C2177