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2004-248 TOWN OF QUEENSBURY 742 Bay Road,Queensbury,NY 12804-5902 (518) 761-8201 Community Development- Building &Codes (518) 761-8256 CERTIFICATE OF COMPLIANCE Permit Number. P20040248 Date Issued: Monday, October 25, 2004 This is to certify that work requested to be done as shown by Permit Number P20040248 has been completed. - Tax Map Number. 523400-239-020-0001-014-000-0000 Location: 1383 DUNHAMS BAY Owner. KENNETH & CAROL FUCHSLOCHER Applicant: KENNETH & CAROL FUCHSLOCHER This structure maybe occupied as a: By Order of Town Board Septic Alteration Residential TOWN OF QUEENSBURY 6 Director of Building&Code Enforcement TOWN OF QUEENSBURY 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201 Community Development-Building&Codes (518) 761-8256 BUILDING PERMIT Permit Number: P20040248 Application Number:. A20040248 Tax Map No: 523400-239-020-0001-014-000-0000 Permission is hereby granted to: KENNF,TH& CAROL FITC;HST,OMER For property located at: 1383 DUNHAMS BAY 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. Tie of Construction Value Owner Address: KENNETH& CAROL FUCHSLOCH 1805 BAY Rd Septic Alteration Residential Total Value LAKE GEORGE, NY 12845 Contractor or Builder's Name /Address Electrical Inspection Agency i Plans&Specifications. 2004-248 SEPTIC ALTERATION $25.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Saturday, April 30, 2005 (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 expirationdate.) Dated at t0own . Que nsb !' April 30, 2004 SIGNED BY for the Town of Queensbury. Director of Building&Code Enforcement Application for Permit=Septic Disposal System Town of Queensbury 742 Bay Road Queensbury,NY 12804 (518) 761-8256 1. OWNER INFORMATION: i f] Office Use Location of installation: $ 1 �«Ca >u n V�c��u s �czv 9 L File Permit No. d Tax Map No. 3 Fee Paid G ,OC' Owner's Name: S-�W v cke ' !....................................................................................................................................... Address: )cf o (vcL!% QJ 2 e0 •-�.�� 1�1 `! ) Z5�15 2. INSTALLER'S NAME l�,��n�n$CL� c,� r>cIn PHONE NO. 1 q 3 --4 2 c(D 3. RESIDENCE INFORMATION: (circle year of dwelling, indicate#bedroom(s) and multiply#of bedrooms with applicable gallons per bedroom to equal total daily flow) Year of House: No. of Bedrooms x Computation = Total Daily Flow 1980 or older x 150 gal/bdrm = 3 O 0 1980—1991 x 130 ga arm = �, ,� 1991—present x 110 gal/bdrin = r k.,y r—W L Garbage Grinder Installed yes_ / no )C A p R 2 q' ?n Q 4 Spa or Hot Tub Installed yes— ./ no _x T07M OF CsJ ^� 4: PARCEL INFORMATION: (circle applicable information&indicate measurements) Toposraphy Soil Nature Ground Water Bedrock or Impervious Material Domestic Water Supply Flat sand at what depth at what depth municipal Rolling loam k6 n i, feet feet well Steep slope clay Pe i'-old. 7�Z QL�� '1 '.4 " if well;water supply slope other from any septic-system depth: absorption is iaa+ft. other Laker Lvo:,�:- Percolation Test: (To be completed by licensed professional engineer or architect) Rate: , I minute per inch 5. 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: gallon (min. size 1,000 gal:) Tile Field: each trench ft. Total System-Lengtli: ft. Seepage Pit(s): number of size of each: ft. by ft. Size of Stone to be used: # / depth or thickness feet Bed System Size: x Alternative System: length and/or size 6. HOLDING TANK SYSTEM: (if required) Number of tanks: / Size of each: gallons /TOTAL Capacity: gallons Note: Alarm System and associated electrical work must be inspected by a Town approved electrical inspection agency. 7. SIGNATURE &INFORMATION FOR RESPONSIBLE PERSON(please read) 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 Queensbury Sanitary Sewage Disposal Ordinance. Signature of responsible person Date ''!owll Of (Illoo»sbuil-v Appoml1 x • A��,�;tJILI��'I(J� I�'lI�1�l,) • POND OND ' SI�:I'/1ItA'I'IW1N ItI��ZI,)IItI�hlI��l�l'!'S ' ...1,• ��i ^ ill. L....� HIP_tt_ rN 1/Attt'R^ \ -: � rt Gt•�v�, . '� '/ • 5ct•tic• , Afij'�r�RPt1G!1 f`fR,Lb � 7. SlrTl`I,Fi►+uRB Vf►INFOPWATIO1.''1 PW`USLIUN4401,4 rzrtowl-, w -.%o"41' •`•"' Septic Inspection Report Office No. (518)761-8256 Date Inspectiorree Queensbury Building&Code Enforcement Arrive: : a 742 Bay Rd., Queeensbuly,NY 12804 InspectorsIniNAME: *�PJ c�c U TvwLOCATION: iJs� %a—/ -Gy RECHECK: - Comments and/or diagram r Soil T e: oam(Cla Type of Water: Municipal! eil Waterline separation distance i- ft. Well separation distance t o ft. Other wells: IC ft. Absorption Field: Total length �f. Length of each trench Depth of trenches ? � '�1 :,� � �t� V.sz Size of Stone Seepage Pits: Number ��'�� Size: x Piping Size T e Building to tank Tank to Distribution Box— Distribution � Distribution Box to Field/Pit Opening Sealed: Y/N/Partial Location/Separations _ Foundation to tank ft• �� '� �� Foundation to absorption ft. Se aration of Pits ft. Conforms as per Plot Plan Y N Location of System on Pro erty: Front Re Left Side Ri t Side Middle Front Middle Rear System Use Status: _ Approved Partial Approved and needs to be re-inspected,please call the Building&Codes Office Disapproved L:\SueHemingway\Building.Codes.Inspection.FORMS\Septic Inspection Report.doe January 28,2003 0 a� Septic Inspection Report Office No. (518)761-8256 Date Inspection YSPECT : Queensbury Building&Code Enforcement Arrive: rt: " any/ 742 Bay Rd., Queensbury,NY 1,2804 Inspector's InitiNAME:LOCATION: ( 3�'� C RECHECK: 7v/ 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. Absorption Field: Total length ft. LL7�SF N Length of each trench ft. Depth of trenches ft• Size of Stone Seepage Pits: Number Size: x Stone Size: Piping Size Type A, Building to tank Tank to Distribution Box Distribution Box to Field/Pit I Opening Sealed: Y/N/Partial Location/Separations Foundation to tank ft. Foundation to absorption ft. Se aration of Pits ft. Conforms as per Plot Plan Y N Location of System on Property: Front Rear Left Side Right Side Middle F• nt Middle Rear System Use S tus: Approved Partial Approved and needs to be re-inspected,please call the Building&Codes Office Disapproved L:1SueHemingway\Building.Codes.Inspection.FORMS�Septic Inspection Report.doc January 28,2003 H. Thomas Jarrett, P.E. Professional Engineering- Kenneth Martin, P.E. August 8,2002 Mr. &Mrs.Kenneth Fuchslocher 1805.Bay Road Lake George,NY 12845 Dear Mr.&Mrs.Fuchslocher: On Friday,"August 8, 2002 staff from this office witnessed a.deep test�pit and 'performed two percolation test on our N YS Route 9L-Dunham's Bay ro e. in the Town of - ueensbu . - - Y Y P P.i,ty._. .. Q ry An area on the property approximately 70'f back.from the road and 1-5'f from the north property line was investigated to determine the presence of suitable.soils to locate a new replacement wastewater disposal system. As you described to us the area investigated consists of primarily"fill material that you had placed on the site between 1989 and 2000. The results and locations of the Test Pit and Percolation Test in this area are as follows: Test Pit#1-:(Excavated'by hand) Location: 73'f from edge,of Road and 1.4'j'south of the stone masonry retaining wall along the north property line: Depth below Grade Soil Description. 0 -60" Medium Brown Fine-Sand w/Some Silt (Stabilized Fill Material) . 60" Bottom of Hole 84" 3/8"diameter probe extended beyond bottom of Hole No Evidence of groundwater or mottling to 60".No Evidence of bedrock to.84 Percolation Test#1 Location: 58'+from edge of Road and 14'f south of the stone masonry retaining wall Along the north property line. 'Depth:24"- Soil: Medium Brown Fine Sand w/Some Silt Stabilized percolation rate of 5 minute 32 seconds-. Percolation.Test#2 Location: 28'f from edge of Road and 12'f south of the stonemasonry retaining wall along the north property line. Depth'24" Soil: Medium Brown Fine Sand w/Some Silt Stabilized percolation rate of 6 minute 09 seconds. .12 East Washington St. a Glens Falls, NY 12801 . 518-792-2907/518-798-1864 Fax r Punted on Recycled Pape Mr. &Mrs. Kenneth Fuchslocher _ Page 2 Re:NYS Route 9L Dunhwn's Bay Property,Town of Queensbury The town of Queensbury On-site Wastewater Code states that a minimum of 3' of vertical separation, when located within 1000' of Lake George; is,-required between the bottom of a leaching device-and seasonal high ground water or bedrock. Since no.evidence of seasonal'high ground water or bedrock . was noted:in the subsurface investigation, the construction of a "conventional wastewater disposal system as described in the New York'State Dept. of. Health "Individual Residential Wastewater Treatment Systems Design Handbook"would be reason able for this site. In addition to maintaining 3' of vertical separation, all horizontal separation distances.required by the Town of:Queensbury and the New York.State.Dept..'of Health (i.e.: 100'/150' setback to a-well {depending on depth of casing}, 100' setback to stream,10' setback to property lines, etc.) must be, provided. No water supplies in.the immediate.area of the investigation site were observed. Prior to construction of a wastewater disposal_system to serve this site, locations of all existing and proposed.water supplies (i.e.:wells, lake source water supplies)must be verified and documented. For further information regarding vertical and horizontal separation requirements refer to:the Town of Queensbury On-Site Wastewater Code and.the New York State Dept. of Health"Individual Residential Wastewater Treatment Systems Design Handbook". If you have any questions or comments regarding this letter please feel free to contact us at 792-2907. Sincerely, JARRETT-MARTIN ENGINEERS,PLLC . Robert U.Holmes Project Engineer For H.Thomas Jarrett,P.E. - Principal F1:2002/2030080802 RECCE NED TOW4JFOUEENSBURY --- 961AY J Z O jC'sOY�° 1 REVIEWED BY 3 � �?� Cry i ��0 U., '�u h• fd r?.d°GeC�q„ s1 I !Jn Ioa ( t EL�'CN ZM-p�l�a6�l S`lTis�1 l.�� f N _ •_- 4--ha— A a$CCyvd-, eF believe 1 n yidennn i�W-tsuch as houses, wells, trees, fences, etc., shown on this do cu ant. also r present that I have person lly me sue the is nc set forth on the diagram." s L GNATURE 7 D E —