2014-560 TOWN OF QUEENSBURY
.31
742 Bay Road,Queensbury,NY 12804-5902 (518) 761-8201
Community Development - Building & Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: P20140560 Date Issued: Tuesday, November 18, 2014
This is to certify that work requested to be done as shown by Permit Number P20140560
has been completed.
Tax Map Number: 523400-302-014-0003-070-000-0000
Location: 3 LINDEN Ave
Owner: LEONARD ROMEO
Applicant: LEONARD ROMEO
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 � �, P4
property owner of the responsibility for compliance with Site Plan, �--� '" A41 ----:c
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.
9.111 1TOWN OF QUEENSBURY
N 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development- Building& Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20140560 Application Number: A20140560
Tax Map No: 523400-302-014-0003-070-000-0000
Permission is hereby granted to: LEONARD ROMEO
For property located at: 3 LINDEN Ave
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: LEONARD ROMEO
ELIZABETH GAUWENS Septic Alteration Residential
2 GRIFFING PI Total Value
QUEENSBURY,NY 12804-0000
Contractor or Builder's Name /Address Electrical Inspection Agency
SANITARY SEWER
GEORGE DRELLOS 792-7257
PO BOX 224
GLENS FALLS NY
Plans&Specifications
2014-560
Res. Septic Alteration
$40.00 PERMIT FEE PAID -THIS PERMIT EXPIRES: Friday,November 06,2015
(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 Town Quee bury 4Th d ember 06,2014
SIGNED BY for the Town of Queensbury.
Director of Building& Code Enforcement
Office Use Only
Town of Queensbury Building & Codes Received:
NOV 0 5 2014 Tax Map 1D:
SEPTIC DISPOSAL PERMIT Permit No.: l q
A permit must be obtained before beginning construction Permit Fee: $ If . l/t
Approvals:
/ Yf / JApplicant G/ v instaflerlBuilder ✓v� en JC'/v)c�n �jAddress: 1 ( /:-cdr ' 4.--c. Address . ,g`�cU ZZ u
macre ,;J /2c by- /1-'5---- /zf-'y 61/&C-Ji iia 7(f N =v /IPJ/
Phone: Phone --7 -.2 -/2J 2
i
Owner: k/i-le-4.) Location of Installation c /�'�'-
Address:
Phone
Contact Person for Building&Code Compliance: 0r 3 Q 1) d_i Day Phone: 7%-?‘ 37G6)
Residence Information:
Year Built #of Bedrooms x Gallons per bedroom =Total Daily Flow
1980 or older �� x 150 = .3G�. Garbage Grinder installed?
1981-1991 x 130 = Spa or Hot Tub Installed?
1992-Present x 110 =
Parcel Information:
Topography N Flat Rolling _Steep Slope —%Slope
Soil Nature /Sand Loam ,Clay _Other
Groundwater At what depth?
Bedrock/Impervious Material At what depth?
Domestic Water Supply X Municipal Well(if well,water supply from any septic system absorption is ft.)
Percolation Test Rate-/ - ' 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 /c gallon(minimum size 1,000 gallons),add 250 gallons to size of septic tank for each garbage grinder,spa or whirlpool tub
System Type: Absorption Field(with#2 stone) Total length /J 6' ft. Each trench .$ v x 3'
Seepage Pit(S)(with#3 stone) How many? Size?
Alternative System Bed or other type?
Holding Tank System Total required capacity? Tank size? #of tanks?—
NOTE: 1)Alarm system and associated electrical work must be inspected by a Town approved electrical inspection agency-see Certified Electrical form
on Town website; 2) Effective as of March 23, 2006 Septic System-As Built Plot Plan: The Building Department will no longer allow systems to be
covered until such time as an As-Built Plot Plan is received and approved by the Building Inspector. The installed system must match the septic system
layout on file. There will be no exceptions.
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.
Print Name: ,, c. Q {' r2,- `"/ Date: / C---/ If
� ����1 Date: / I - J /
Signature:
Town of Queensbury Building&Codes Septic Disposal Permit 518-761-8256
Town of Queensbury Building & Code Enforcement 1 /PA
Office No. (518) 761-8256 J�u'rs`
Septic Inspection Report
Inspection request received:
Name: ) M C? 0 Inspected on: Jf 1 3—i
Location: 3 ki- Arrive: t 1c a.m.I p.m.
Permit No.: / 9—5 (o Q Inspector's Initials:
Comments an /or diagram
Soil Type: Sand/Loam 1 Clay
Type of Water: Municipal I Well Water
Waterline separation distance ft.
Well separation distance ft.
Other wells: ft.
Well Casing Length 50'+I- Y N N/A
[150'to well required if NO]
Absorption Field: Total length ft.
Length of each trench J ft.
Depth of trenches ` ft.
Size of Stone '`,
Seepage Pits: Number
Size:
Stone Size:
--
Piping n Size Type
Building to tank ��J
Tank to Distribution Box
Distribution Box to Field/Pit �� >
Opening Sealed: f N
End Cap ./Y N r
Inlet/Outlet Pipes&Baffles N
Manholes 12"or less below grade _Y
[provide extension collar if Yes] Y N
Location/Separations
Foundation to tank (ft.
Foundation to absorption :::� ft.
Separation of Pits f✓ '
Conforms as per Plot Plan
Engineer Report and As-Built Y ijprN
ETU Maintenance Contract provided Y Y'"
Location of S stem o•_:._••,li
Front Rear Left Side Right Sid> Middle Front Middle Rear
S stem Use Stat.•
-L Approve.
•a . Approved and needs to be re-inspected, please call the Building &Codes Office
Disapproved
Septic Inspection Report
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1 t IS ELAN TO CE ON PROJECT
S i E AT ALL TIMES FOR THE
DURATION OF CONSTRUCTION ____-____ i
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SEPTIC PLOT PLAN ;'-- 1 /I e '''." Qo
I HAVE SEEN OR OBSERVED ALL BJI_ TS _ . ("
SUCH AS HOUSES, WELLS, TREES, FEN ES, ETC — ------ --—
SHOWN ON THIS DOCUMENT. I HAVE PER ONALLY
MEASU D THE DISTA E SET F RTH ON THIS DI GRAM.
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SIGNATURE TE
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TOWN OF QUE ► Srt .' \(" . 1
BUILDING & C 4 D ,''!D., . . G
Reviewed By: • . �>/ c.
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Date: f3 ca I a
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SHOM ON THIS 0OC N r f ,,E ,
�J, cPERSONALLY
' M.EiA,IRED THE Ei,.:;' �c i "W,I^N THIS DIAGRAM. p
SIGNATURE DATE
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TOWN OF QUE I
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BUILDING & •D7)41 -1 -
I Reviewed By: /��..
Date: ANN — - -...