BOTH-000341-2015 TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5904 (518)761-8201
QL Community Development-Building& Codes (518)761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: BOTH-000341-2015 Date Issued: Monday,November 28, 2016
This is to certify that work requested to be done as shown by Permit Number BOTH-000341-2015
has been completed.
Tax Map Number: 316.10-1-2
Location: 324 BIG BOOM RD
Owner: Scott Lee
Applicant: Scott Lee
This structure may be occupied as a: Residential Septic Alteration
By Order of Town Board
TOWN OF QUEEENNSBUURY ��
Issuance of this Certificate of Compliance DOES NOT relieve the I/ �,J �ot
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 12804-5904 (518)761-8201
Community Development-Building&Codes (518)761-8256
BUILDING PERMIT
Permit Number: BOTH-000341-2015
Tax Map No: 316.10-1-2
Permission is hereby granted to: TenEyck Septic Service Inc.
For property located at: 324 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
Tvce of Construction
Owner Name: Soon Lee Septic Disposal $0.00
Owner Address: 324 Big Boom RD Total Value $0.00
Queensbury,NY 12804
Contractor or Builders Name/Address Electrical Inspection Agency
TenEyck Septic Service Inc.
669 Rock City Falls RD
Ballston Spa,NY 12020
Plans&Specifications
Residential Septic Alteration
$40.00 PERMIT FEE PAID-TIES PERMIT EXPIRES: Friday,November 11,2016
(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 Town ween n /� Tu mer 17,2015
SIGNED BY: (,-iVfr(/ �V1 for the Town of Queensbury.
Director of Building&Code Enforcement
SEPTIC DISPOSAL PERMIT - Office Use Only
DATE 11/-)5ii - 15 J r - Received
IO NOV 13 Z �� Map ID o-1
TAXMAPID Permit No. DOTR OD 1
Big
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Permit Fee cy
LOCATION OF INSTALLATION I � D+ DING & Approvals: 113
T L7
APPLICANT �IA.Mec r&7I;.4CX IUILM/ OI.JtA'el.�llnGe. \ PHONE/E-MAIL 376-9A7oZ,Jyvt7ene)/tJC4�ad.ta„
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ADDRESS mr Qcek C;{ , !0. AOLIISIM Spa .#,Y. 12-0;- 0
INSTALLERIBUILDER: Te�C-K S /L 3ef-vie Inc, PHONE/E-MAIL 885-73;LY SQ°hc a5 Ngavt
ADDRESS: 60 &(K cii. fo. pct llJ(rf I SOS .Ay /�2 C)d 0
WNER SCO4'1- Lee , PHONE/E-MAIL 972 -632 -,Yg17
Address 12q /34 Room /UJ (MmSbag
CONTACT PERSON FOR BUILDING&CODES COMPLIANCE: .l!p9 TP1I 6N ck PHONE 376-4a 79L
J
RESIDENCE INFORMATION
Year Built #of bedrooms X Gallons per bedroom =Total Daily Flow
1980 or older Garbage grinder installed Y N
1981-1991 130 w ? f3 9 Spa or Hot Tub installed _Y _N
1992-Present
PARCEL INFORMATION
Topography Flat rolling _Steep slope _%slope
Soil Nature Sand _Loam _Clay _Other
Groundwater Atwhatdepth? ND cuaA, P all
Bedrock/Impervious Material At what depth? VA
Domestic Water Supply 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 licensed engineering/architect)
PROPOSED SYSTEM FOR NEW CONSTRUCTION
Tank Size /�gallons(minimum size 1,000 gallons,add 250 gallons to size for each garbage grinder or spa or hot tub)
System Type Absorption field with#2 stone Total length Afos t ft.;Each trench 2 x
Seepage Pit with#3 stone How many: -;size
Alternative System Bed or other type?
Holding Tank System Total required capacity? Tank size #of tanks
Notes: 1)Alarm system&associated electrical work must be inspected by a Town approved electrical inspection agency;2)We will no longer
allow systems to be covered until such time as an As-Built plan is received &approved. The installed system must match the septic system
layout on file-no exceptions.
DECLARATION: Any permit or approval granted which is based upon or is granted in reliance upon any material representation or
failure to make a material fact or circumstance know by or on behalf of an applicant, shall be void. I have read the regulations
and agree to abide¢y these and all requirements of the Town of Queensbury Sanitary Sewage Disposal Ordinance.
Print Name: QmeS TPnfi.L Date: 11-15^0-
Signature:
Signature: ` T Date: N-If-lf
Town of Queensb Building&Codes Septic Disposal Permit July 2014
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SHOWN ON THIS DOCUMENT.I HAVE PERSONALLY !
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