2015-391 TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 128045902 (518) 761-8201
Community Development- Building & Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: P20150391 Date Issued: Thursday, October 01, 2015
This is to certify that work requested to be done as shown by Permit Number P20150391
has been completed.
Tax Map Number: 523400-309-018-0001-044-000-0000
Location: 123 BIG BOOM Rd
Owner: DAVID OGBURN
Applicant: DAVID OGBURN
This structure may be occupied as a:
Septic Alteration Residential
By Order of Town Board
TOWN OF QUUEENSBURY
Issuance of this Certificate of Compliance DOES NOT relieve the � _ t/ J
property owner of the responsibility for compliance with Site Plan, GGG���"' 4
V
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
f.�
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development-Building& Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20150391 Application Number: A20150391
Tax Map No: 523400-309-018-0001-044-000-0000
Permission is hereby granted to: DAVID OGBURN
For property located at: 123 BIG BOOM Rd
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: DAVID OGBURN Septic Alteration Residential
BECKY CHARLTON Total Value
123 BIG BOOM Rd
QUEENSBURY,NY 12804
Contractor or Builder's Name/Address Electrical Inspection Agency
FREDERICK SMITH
23 VERMONT Ave
QUEENSBURY,NY 12804-0000
Plans&Specifications
2015-391
Residential Septic Alteration
$40.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Sunday,August 28,2016
(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 n o ueen r' , ugust 28,2015
SIGNED BY for the Town of Queensbury.
Director of Building&Code Enforcement
.. .
, co.- iii[�va n�ht F, !'
�,- Town lihti eensbury • 742 Bay • 4 Queensbury, New York •12804
111 2015
Office Use Only 1 1
TAX MAP NO. TOWN OF QUEENSBURY I� _3C, 1 PERMIT FEE
APPROVALS: ZONING ]LDING&C N CLERK
1
APPLICATION FOR SEPTIC DISPOSAL SYSTEM PERMIT: A PERMIT MUST BE OBTAINED
BEFORE WORK BEGINS. APPLICATION IS SUBJECT TO REVIEW BEFOR ISS ANCE OF A VALID PERMIT.
OWNER:; 11 U I 0lj 0 2 �INSTALLER: (% j7'/r 6A 3y-yl 1 1+\ r,ICJL6.u NCAr
ADDRESS:I r1"1 � ADDRESS: /� If( S 5- Y y •i t wxlu
PHONE NOS. L/eD445-94 PHONE NOS. 7 - t/ a d 1 7 /
LOCATION OF INSTALLATION: 1 3 £)f° ADM i\d
/ RESIDENCE INFORMATION:
YEAR BUILT NO.OF X COMPUTATION = TOTAL DAILY FLOW
BEDROOMS (Gallons per bedroom) GARBAGE GRIN
1980 or older X 150 = INSTALLED?
1981 -1991 3 X 130 = 5 0 SPA OR HOT T�
1992-presenti X 110 = INSTALLED?
PARCEL INFORMATION:
./
✓ TOPOGRAPHY: FLAT ROL2IG v STEEP SLOPE %SLOPE
✓ SOIL NATURE: SAND LOAM CLAY OTHER
✓ GROUNDWATER: AT WHAT DEPTH? J,/ '
✓ BEDROCK/IMPERVIOUS MATERIAL: ATWHATDEPTH?PA
V DOMESTIC WATER SUPLY: MUNICIPAL `� WELL (If well:water supply from any septic system absorption is: ft)
✓ PERCOLATION TEST: RATE IS PER MIINUTE PER INCH[mpi] (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 installe 'aPiOr'ng Board approved subdivision).
TANK SIZEJO 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 length/O ft. Each trench t. ll X Ce
❑ 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 ro:d e rej. ations ith respect to this application and agree to
abide,,. e .iT• all re irements of the Town of Queensbury QUESTIONS? CALL 761-8256 OR EMAIL
1 S- . 2 IOrdinance. codes(o)queensburv.net
/// �/�r , g /r VISIT OUR WEBSITE FOR MORE INFORMATION
igna re of Person Responsible ate www.queensbury.net
Town of Queensbury Budding &Code Enforcement
Office No. (518)761-8256 ^'
Septic Inspection Report
Inspection request received: 9�705
Name: Inspected on: C 29
Location: 1L,2::, Ii a &,Q wn QEt • Arrive: t? -- m.
Permit No.: Inspector's Initials:
C m ents and/or diagram
Soil Typ * an y
Type of a er: unict ater
Waterline separation istance ft. = A�
Well separation distance ft.
Other wells: ft.
Well Casing Length 50'+/- Y_N_NIA
[150'to well required if NO]
Absorption Field: Total length lw(�> ft.
Length of each trencho' fL
Depth of trenches ft.
Size of Stone
Seepage Pits: Number
Size: x
Stone Size:
Piping Size gType r e
Building to tank �Tank to Distribution Box Distribution Box to Field I Pit
Opening Sealed: -ZY,, N
End Cap N
Inlet/Outlet Pipes&Baffles N
Manholes 1T or less below grade Yy_
[provide extension collar if Yes] Y
Location/Separations
Foundation to tank ft.
Foundation to absorption 2ft.
Separation of Pits ft.
Conforms as per Plot Plan _N
Engineer Report and As-Built _Y_N
ETU Maintenance Contract provided _Y_N
Location of System on Property:
Front Rear Left Side Right Side Middle Fr tMiddle Rea
System Use Sta :
Approved
Partial Approved and needs to be re-inspected, please call the Building&Codes Office
Disapproved
Septic Inspection Report
t I I ;
5b ICU s�
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�y Reviewed BDate
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