2008-619 TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518) 761-8201
4E Community Development- Building &Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number. P20080619 Date Issued: Friday, November 21, 2008
This is to certify that work requested to be done as shown by Permit Number P20080619
-has been completed.
Tax Map Number. 523400-302-009-0001-014-000-0000
Location: 63 ZENAS Dr
Owner: RICKEY & DONNA ROTHSTEIN
Applicant: RICKEY & DONNA ROTHSTEIN
This structure may be occupied as a:
Septic Alteration Residential
By Omer 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&Cdde Enfbkement
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: P20080619 Application Number. A20080619
Tax Map No: 523400-302-009-0001-014-000-0000
Permission is hereby granted to: RICKEY&DONNA ROTHSTEIN
For property located at: 63 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: RICKEY &DONNA ROTHSTEIN
Septic Alteration Residential
63 ZENAS Dr
QUEENSBURY,NY 12804 Total value
Contractor or Builder's Name/ Address Electrical Inspection Agency
Plans &Specifications
2008-619
SEPTIC ALTERATION RESIDENTIAL
$25.00 PERMIT FEE PAID- THIS PERMIT EXPIRES: Friday,November 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 Qwensbury before the expiration date.)
Dated at the To of Queensbury, Thursday,November 20,2008
SIGNED BY for the Town of Queensbury.
Director of Bull Enforcement
_._ _-`-'/_,' OFFICE USE ONLY r_______ -_/
TAX MAP NO, PCR IT NO. 0 , /
PERMIT FEE , "
APPROVALS: ZONING / % / Nu v f'
TOWN CLERK ; ;
h--------------------------------------------------------------------I -----------------
APPLICATION
FOR SEPTIC DISPOSAL SYSTEM PERMIT:
A PERMIT MUST BE OBTAINED BEFORE WORK BEGINS.APPLICATION IS SUBJEC TO REVIEW BEFORE ISSUANCE OF A VALID
PERMIT.
a
OWNER: Q Tom/ INSTALLER: 1
ADDRESS: ICJ �cT �Q�(�I� ADDRESS: o '� Z�Y �
PHONE NOS. 7 / (P-- PHONE NOS.
LOCATION OF INSTALLATION:
YEAR BUILT NO.OF RESIDENCE INFORMATION:
BEDROOMS X COMPUTATION= = TOTAL DAILY FLOW
1980 or older X 150 gallon per bedroom = GARBAGE GRINDER
INSTALLED? M?
1981 .19 11 X 130 gallon per bedroom = O
SPA OR HOT TUB
1992-present X 110 gallon per bedroom INSTALLED? VV
PARCEL INFORMATION:
✓ TOPOGRAPHY: Flat rolling Steep slope %Slope
✓ SOIL NATURE: Sand Loam Clay Other
✓ GROUNDWATER: At what depth?
✓ BEDROCKAMPERVIOUS MATERIAL: At what depth?
✓ DOMESTIC WATER SUPLY: Municipal Y Well (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: 00 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:
� s
ABSORPTION FIELD (WITH NO. 2 STONE) Total length jP
_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 by these and all requirements of the Town of QUESTIONS? CALL 761-8256 OR EMAIL
ueensb an'tary Sewage Disposal Ordinance. codes @aueensburv.net
VISIT OUR WEBSITE FOR MORE INFORMATION
www.aueensbury.net
Signature of PeiToin Responsible Date
Town of Queensbury - Community Development Office - 742 Bay Road, Queensbury, NY 12804
Septic Inspection Report
Office No. (518) 761-8256 Date Inspection request received: C�
Queensbury Building&Code Enforcement Arrive: am/ Depart: am pm
742 Bay Rd., Queensbury, NY 12804 Inspecto s Initials: p �✓
NAME: fL` I-Pi S � .'� PERMIT NO.: d — i
LOCATION: T.7 Zen A D7 — INSPECT ON:
RECHECK:
—;� Comments and/or diagram
Soil T • San oam Clay
Type of : uni . i Well Water
Waterline sepapra distance ft.
Well separation distance ft•
Other wells: ft.
Absorption Field: Total length
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 I NJ Partial
End Ca
In Outlet Pipes&Baffles Y N
Location rations
Foundation to tank ft•
Foundation to absorption
Separation of Pits P
Conforms as r Plot Plan N
Engineer Repqrt and As-Built Y N
Location of System, Property:
Front Rear Left Side Right Side
Middle Front die Rear
m s•
Approved
Partial Approved and needs to be re-inspected, please call the Building &Codes Office
Disapproved
Last revised 021006
Last revised 1/6/05
Community Development Office
ice
Town of Queensbury • 742 Bay Rd.
Queensbury, New York •12804 PLOT PLAN
Show all existing and proposed structures. Indicate the setbacks of all structures and buildings from all property lines.
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