2008-294 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. P20080294 Date Issued: Thursday, August 26, 2010
This is to certify that work requested to be done as shown by Permit Number P20080294
has been completed.
Tax Map Number. 523400-301-012-0003-074-000-0000
Location: 34 ZENAS Dr
Owner JASON & DIANE FOGLIETTA
Applicant: JASON & DIANE FOGLIETTA
This structure may be occupied as a:
Septic Alteration Residential
By Order 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: P20080294 Application Number: A20080294
Tax Map No: 523400-30 1-012-0003-074-000-0000
Permission is hereby granted to: JASON & DIANE FOGLIETTA
For property located at: 34 ZENAS Dr
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: JASON &DIANE FOGLIETTA
34 ZENAS Dr Septic Alteration Residential
QUEENSBURY,NY 12804 Total value
Contractor or Builder's Name /Address Electrical Inspection Agency
Plans&Specifications
2008-294
SEPTIC ALTERATION RESIDENTIAL
$25.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Thursday,June 11,2009
(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 T wn of y, June 11, 2008
tfw
a esda
SIGNED BY for the Town of Queensbury.
Director of Building&Code Enforcement
/__ �J0/ � w___^_�-r'FFICE USE ONLY-----"`_________�_______; %_____________________A
R
TAX MAP NO. HERMIT NO. ERMIT FEE ;
APPROVALS: ZONING TOWN CLERK ; A
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: INSTALLER:
ADDRESS: � V )—r ADDRESS:
d
PHONE NOS—Q61 PHONE NOS.
LOCATION OF INSTALLATI N:
NO.OF RESIDENCE INFORMATION:
BEDROOMS
YEAR BUILT X COMPUTATION= = TOTAL DAILY FLOW
GARBAGE GRINDER
1980 or older X 150 gallon per bedroom = S 6 INSTALLED?
1981 -1991 X 130 gallon per bedroom =
SPA OR HOT TUB
1992-present X 110 gallon per bedroom = INSTALLED?
PARCEL INFORMATION:
✓ TOPOGRAPHY: Flat rolling Steep slope %Slope
✓ SOIL NATURE: Sand Loa�m/ Clay Other
✓ GROUNDWATER: At what depth? /&'
✓ BEDROCK/IMPERVIOUS MATERIAL: At what depthV. /17-->
✓ DOMESTIC WATER SUPLY: Municipal-4)rWell (If well: Water supply from any septic
system absorption is ft.)
✓ PERCOLATION TEST: Rate is per minute 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).
TANK SIZE: 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 lengt ft. Each trench X —
❑ SEEPAGE PIT(S) (WITH NO. 3 STONE) How many? Size?
❑ ALTERNATIVE SYSTEM Bed or other type?
❑ 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 the regulations with respect to this application and
agree to abide y these and all requirements of the Town of QUESTIONS? CALL nsbur .n OR EMAIL
Queensbur nitary Sewage Disposal Ordinance. codes@gueensburv.net
VISIT OUR WEBSI.ci FOR MORE INFORMATION
www.aueensbury.net
nature of Person Responsible Date
Town of Queensbury • Community Development Office • 742 Bay Road, Queensbury, NY 12804
B 5-LGL 6/06
Septic Inspection Report
Office No. (518) 761-8256 Date Ins ctioere
Queensbury Building &Code Enforcement Arrive: t: am/pm
742 Bay Rd., Queensbury, NY 12804 Inspector's InitiaNAME: �l r'�`TA -�cfiWLOCATION: ��7�� ti�et �-�`1 -C��ri
RECHECK:
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.
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
Building to tank
Tank to Distribution Box
Distribution Box to Field / Pit
Opening Sealed: Y 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 PI o _ N
Engineer Report a As-Buil Y N
Location of System on Property:
Front Rear Left Side Right Side Middle Front Middle Rear
System Use S
Approved
Partial Approved and needs to be re-inspected, please call the Building &Codes Office
Disapproved
Last revised 06/18/07 L:\Building&Codes Forms-OLD\Building&Codes\Inspection Forms\Septic Inspection Report.doc
Septic Inspection Rep rt
Office No. (518) 761-8256 Date Ins ction r e r ed:
Queensbury Building &Code Enforcement Arrive: ,9epart: a n<
742 Bay Rd., Queensbury, NY 12804 Inspector's Initia
NAME: f MIT NO.: .2 7
LOCATION: SPECT ON:
RECHECK:
Comments and/or diagram
Soil T Loam / Clay
Ty of Water: ell Water lk-la 5e, i y7 t
Waterline separation distance o ft.
Well separation distance ft. V
Other wells: ft.
Well CasingLength 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
Building to tank
Tank to Distribution Box ii L
Distribution Box leld Pit -5 << �F -
Openiri —Sealed: N
End Ca N
Inlet/Outlet Pipes &Baffles Y N
Location Separations
Foundation to tank r ft.
Foundation to absorption ft. v L1
Separation of Pits
Conforms as per Plot Plan —YZZV
Engineer Report and As-Built _ N
Location of System on Properly:
Front ear Left e�Right Side Middle Front /iddle Rear
S s em Use S tus:
Approved
Partial Approv d ing o es
Disapproved
Last revised 06/18/07 L:\Building&Codes Forms-OLD\Building&Codes\Inspection Forms\Septic Inspection Report.doc
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