2007-588 TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518) 761-8201
4z Community Development- Building &Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number. P20070588 Date Issued: Thursday, September 20, 2007
This is to certify that work requested to be done as shown by Permit Number P20070588
has been completed.
Tax Map Number. 523400-226-019-0001-095-000-0000
Location: 246 ASSEMBLY PT. Rd
Owner. FREDERICK & ALICE SCHMALKUCHE
Applicant: FREDERICK & ALICE SCHMALKUCHE
This structure maybe occupied as a:
Septic Alteration Residential
By Omer of Town Bowl
TOWN OF QUEENSBURY
44
Issuance of this Certificate of Compliance DOES NOT relieve the
property owner of the responsibility for compliance with Site Plan,
r:2)j A-
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.
.40" TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518) 761-8201
Community Development-Building& Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20070588 Application Number: A20070588
Tax Map No: 523400-226-019-0001-095-000-0000
Permission is hereby granted to: FREDERICK& ALICE SCHMALKUCHE
For property located at: 246 ASSEMBLY PT. 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: FREDERICK& ALICE SCHMALKU
144 PERKINSVILLE Rd Septic Alteration Residential
HIGHLAND, NY 12528-0000 Total Value
Contractor or Builder's Name /Address Electrical Inspection Agency
IBS SEPTIC & DRAIN
ATTN: IVAN BELL
2 LOWER WARREN St
QUEENSBURY, NY 12804
Plans&Specifications
2007-588
septic alteration
$25.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Thursday, September 18, 2008
(If a longer period is required,an application for an extension must be made to the code Enforcement Officer
of the Town of Queensbu beforeJbW
iration date.)
Dated at the Town f Que n T ember 18, 2007
SIGNED BY for the Town of Queensbury.
Director of Building&Code Enforcement
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TAX MAP NO. PE m NO. PERMIT FEE
o APPROVALS: ZONING TOWN CLERK
: _____________________________________________
APPLICATION FOR SEPTIC DISPOSAL SYSTEM P N � �GDE
A PERMIT MUST BE OBTAINED BEFORE WORK BEGINS.APPLICATION IS SUBJECT TO REVIEW BEFORE ISSUANCE OF A VALID
PERMIT.OWNER: J JVl F G f /,(,1 G4�NSTALLER: S t r G ADDRESS: C1 t 6 �4&/ ADDRESS: )�O z e4 r t uGL P "r—Al 5
PHONE NOS. Ur �� ) �� PHONE NOS. itJf
LOCATION OF INSTALLATION:
......... ........-.....................,....-................................._............e....t........................................................-................ .............................................................. RESIDENCE INFORMATION.
YEAR BUILT BEDROOMS X { COMPUTATION= } = TOTAL DAILY FLOW t
......... ......... .............._. ............... ........................}......., F......... ............................................................:...........I GARBAGE GRINDER
}. a. .................} 1980 or older I -i X .150 gallon per bedroom = } INSTALLED?
1981 1991 X 1 130 gallon per bedroom
i.......................................................................................................;........................................._..,........................... } S OR HOT TUB
j 1992-present : X 1 110 gallon per bedroom _ IN TALLED?
..................._.................-.._................................................;........ _...............................................................,.......1.................................................................................
.....}
PARCEL INFORMATION:
✓ TOPOGRAPHY: FLA OLLING (. STEEP SLOPE %SLOPE
✓ SOIL NATURE: SAND LOAM CLAY OTHER_____
✓ GROUNDWATER: AT WHAT DEPTH? AIA BEDROCK/IMPERVIOUS MATERIAL: AT
WHAT DEPTH?
✓ DOMESTIC WATER SUPLY: MUNICIPAL WELL f rOAJ
(IF WELL:WATER SUPPLY FROM ANY SEPTIC-SYSTEM ABSORPTION IS 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 etch garbage grinder, spa or whirlpool tub.
✓ SEPTIC TANK:0 `=) GALLON (MIN. SIZE IS 1,000 GAL.) TILE FIELD: EACH TRENCH FT.
✓ TOTAL SYSTEM LENGTH: FT. SEEPAGE PIT(S): HOW MANY?
✓ SIZE OF EACH FT. X FT
✓ SIZE OF STONE TO BE USED: # /L'.EPTH OR THICKNESS FT.
✓ BED SYSTEM SIZE: X
✓ ALTERNATIVE SYSTEM: LENGTH AND/OR SIZE
✓ HOLDING TANK SYSTEM:(If required) NO. OF TANKS: /SIZE OF EACH
✓ GALLONS./TOTAL CAPACITY.• Gf4'
...
;..:... :...:..... .........................:...:.:.:.............:...............,.................................:.:.:.:.:.:.:...........
;.,.,.,;
f NOTE: ALARM SYSTEM AND ASSOCIATED ELECTRICAL WORK MUST BE INSPECTED BY A TOWN 1
APPROVED ELECTRICAL INSPECTION AGENCY. VLEASE REVIEW LIST PROVIDED. p
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 b hese and all requirements.of the Town of QUESTIONS? CALL 86 OR EMAIL
g codesCaueensbusburv.net
Queensbury ary Sewage Disposal Ordinance.
VISIT OUR WEBSITE FOR MORE INFORMATION
www.aueensburv.net
ature of Person Responsi le Date
ULTown of Queensbury • Community Development Office a 742 Bay Road, Queensbury, NY 12804
Foundation Inspection Report
Office No.(518)761-8256 Date Inspection req st r iv
Queensbury Building&Code Enforcement Arrive: m Depart:
742 Bay Rd.,Queensbury,NY 12804 Inspector's Initi s:
NAME: ��E HJ T#:
LOCATION: Z C�(Z_�uJQ y\ SPECT ON:
TYPE OF STRUCTURE:
Comments
Footings Y IN N/A
PLE 1E V166
Piers
Monolithic Slab s
Reinforcement in Place
The contractor is responsible for
providing protection from freezing
for 48 hours following the placement
of the concrete.
Materials for this purpose on site.
Foundation/Wallpour
Reinforcement in Place
Footing Dowels or Keyway in place
Foundation Dampproofing
Foundation Waterproofing
Footing Drain Daylight or Sump
Footing Drain Stone:
12 inch width
6 inches above footing
6 mil poly for wet areas under slab
Backfill Approval
Plumbing Under Slab
PVC/Cast/Copper
Foundation Insulation Interior/Exterior
R-
Rough Grade 6 inch drop within 10 t.
L:\Building&Codes Forms\Building&Codes\Inspection Forms\Foundation Inspection Report.doc
Last printed 12/20/2005 9:24:00 AM
4� Septic Inspection Report
Office No. (518) 761-8256 Date Ins request received:
Queensbury Building&Code Enforcement Arrive: am/pm Depart: am/pm
742 Bay Rd., Queensbury, NY 12804 Inspector's Initials:
NAME: ,k V alePERMIT NO.:
LOCATION: o ` INSPECT ON:
RECHECK:
Comments and/or diagram
Sal T Sand Loam Clay
Type of Water: Munici i Well Watery
Waterline separation distance ft.
Well separation distance ft.
Other wells: ft,
Absorption Field: Total lengthft,
-Length of each trench ft,
Depth of trenches ft,
Size of Stone
Seepage Pits: Number
Size: x
Stone Size:
-Piping Sizet T
.Building to tank
Tank to Distribution Box tl ct
Distribution Box Wield Pit
Openina Sealed: N Partial
End Ca
Inlet/Outlet Pipes&Baffles A
N
Location I 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
Location of System on Property:
Front Rear Side Right Side
Middle Front Middle Rear
System Uto :
Approved
Partial Approved and needs to be re-inspected, please call the Building&Codes Office
Disapproved
Last revised 021006
Last revised 1/6/05
Inspection for Permit to Occupy
Fire Marshal's Office Request Rec'd Permit No. ��2
Town of Queensbury742 g/
Bay Road Tim
Que: d,
Queensbury,NY 12804 Scheduled Inspection Date:
Phone: (518)761-8206 Business Name:
Fax: (518) 745-4437 Location:
Type of Inspection N/A Yes No
EXITS:
Exit Access
Exit Enclosure COMMENTS
Exit Discharge
AISLES: Lam, t �VV7
Main Aisle Width
Secondary Aisle Width
EXIT SIGNAGE
Sion-normal
Sign-batterattery
EVAC signs in rooms
TRUSS ID SIGNAGEk
EMERGENCY LIGHTING
L
FIRE EXTINGUISHER:
HungInspection of extinguisher
FIRE ALARM SYSTEM f�� G
Fan Shutdown
Fire Sprinkler System
Fire Suppression-kitchen
Fire Suppression-Gas Islan
Generator 41
Hood Installation -i�ce� L P
Elevator `� )¢)f G LIr f �J
Interior Finishes a�- f /lCl9�LGC.
Storage
Compressed Gas 4.
Clearance to Sprinklers
Clearance to Electrical X
Hect6c Wiring Enclosed/Labeled �+ �j�v✓t' �� `� `'�/�
Combustible Waste
Vehicle Impact Protection
Knox Box
F.D.Si na e-Utility Rooms
No Smoking Signs
Maximum Occupancy Sign,
Emergency Evacuation Plan
❑ Approved (If no other approvals apply,the B&C Office will issue the Certificate of Occupancy)
Denied / call for Recheck
Inspected By: - -
LAHreMarshal\New Folder\permitto occupyform.doc