2004-873 TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community.Development- Building & Codes (518) 761-8256
:CERTLFICATE_ OF C_OMI'LI��NCE
_ Peft it.Nurnber _P2:0040873, -._ Date_Issued:: Wednesday November 03, 2004
This is to:certify_that work.requested-to-be done as.shown.by,P.ermit Number P20040.873,
has been-completed:=
Tax-.Map Number:._.. 523400-301-012-0003-068-000-0000
Location:- 22.ZENAS Dr
Owner:: -_ DEBORAH L ROMANAZZI
Applicant: DEBORAH.L ROMANAZZI
This structure may be occupied as a:
By Order of Town Board
Septic Alteration Residential - TOWN OF QUEENSBURY
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: P20040873 Application Number: A20040873
Tax Map No: 523400-301-012-0003-068-000-0000
Permission is hereby granted to: DF.ROR'AT-T T,ROMANAZZT;
For propery located at: 22 ZENAS Dr
in the Town of Queensbury, to construct,orIplace;
at die 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 die Queensbury Zoning
Ordinance. j ��:. Tvve of Construction Value
Owner Address: DEBORAH L ROMANAZZI
22 ZENAS Dr Septic Alteration Residential
Total Value
QUEENSBURY,NY 12804 ;
Contractor or Builder's Name /Address :,, Electrical Inspection Agency
SANITARY SEWER
DAN DRELLOS
PO BOX 224
GLENS FALLS NY
Plans&Specifications ?`
2004-873
SEPTIC ALTERATION
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$25.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Wednesday, November 02, 2005
(If a longer period is required,an application for an extension mist be made to the code Enforcement Officer
of the Town of Queensbury before the expiration date.)
i
Dated at the Tpw f Quee ury u` day, November 02;2004
SIGNED BY < it? ' I for••the Town of Queensbury.
Director:bf Buildin &'Co Enforcement
Application for Permit=Septic Disposal System
Town of Queensbury 742 Bay Road Queensbury,NY 12804 (518) 761-8256
1. OWNER INFORMATION: ............................................... ............ ........................
Office Use
Location of installation: 2-2- Z A -Y D(Z W _
File Permit'No.nq
Tax Map No.
Fee Paid
Owner's Name: ry_f 41 ZIa�
......................................
Address:
2. INSTALLER'S NAME 7'VI-j"7 . Law4-t- (4-V/of PHONE No. 7 7a S�7
1
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 =
1980— 1991 x 130 gal/bdrm =
1991 —present x 110 gal/bdrm = P ,F�
a � rc
Garbage Grinder Installed yes— no
Spa or Hot Tub Installed yes— no _(09 OCT 2004
4.' PARCEL INFORMATION: (circle applicable information&indicate measurements)
Too graDhv Soil_Nature. Ground Water Bedrock or Impervious Material Domestic Water Su6bly
at sand at what depth at what depth munici
o ing oam —feet feet
Steep slope clay if well; water supply
%slope other from any septic-system
depth: absorption is
other
Percolation Test: (To be completed by licensed professional engineer or architect)
Rate: minute per inch
5. PROPOSED SYSTEM: -c 7 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: I GOO ' gallon (min. size 1,000 gal)
Tile Field: each trench ft. Total System Length:
Seepage Pit(s): number of_t # size of each: _ft. by_ft.
Size of Stone to be used: # depth or thickness feet
Bed.System Size: x
Alternative System: EL 0-,,i length and/or size
6. HOLDING TANK SYSTEM: (if required)
Number of tanks: 1 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.&anted 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 Sanitary Sewage Disposal Ordinance.
ature of respongible person Date
AW"
:'}ow''ll of Queens}nti•y
�rtvta•a :utt} Scw;tj:c: Disvosal (:Itstpter
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7. SICFN A►TURE &INFopjdkTjC)N FOIE
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Septic Inspection Report 1 j
Office No. (518)761-8256 Date Inspection re que cei .
Queensbury Building&Code Enforcement Arrive: p art: t : an J ll
742 Bay Rd., Queensbury,NY 12804 Inspector's Initia
NAME: a}-1 P IT NO.:
w .
LOCATION: INSPECT ON:
RECHECK:
Comments and/or diagram
Soil Typ<San Clay
Type of a er: 1 unicip Well Water
Waterline se aratlo stance ft.
Well separation distance ft.
Other wells: ft.
Absorption Field: Total lengdh
Length of each trench ft. �J -►I`�
Depth of trenches ft.
Size of Stone �bPlf�D
Seepage Pits: Number
Size: x
Stone Size:
Piping Size Type
Building to tank XbX ,,Z>
Tank to Distribution Box `
Distribution Box to Field/Pit
Opening Sealed Partial
Location/Separations
Foundation to tank ft.
Foundation to absorption ft.
Separation of Pits ft.
Conforms as per Plot Plan N
Location of System on Property:
Front Rear Left Side Right Side
Middle Front Middle Rear
S stem Use Stat :
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.doc January 28,2003
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REVIEWED B
DATE � °
OCT 9 2004
TQr��''�rQ�Dd1C�[�gp CJ, r (��..CJU�a.I.
"I have seen or observed, or believe I saw evidence of,
all objects such as houses, wells, trees, fences, etc., I
shown on this document. I also represent that 1 have
measured the di ces set orth on the diagrms.'°a
sl NATURE DATE