SEP-0506-2018
TOWN OF QUEENSBURY
742 Bay Road, Queensbury, NY 12804-5904 (518) 761-8201
Community Development - Building & Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: SEP-0506-2018Date Issued: Tuesday, January 8, 2019
This is to certify that work requested to be done as shown by Permit Number
SEP-0506-2018
has been completed.
301.8-2-80
Tax Map Number:
43 HILLCREST AVE
Location:
Derek Slayton
Owner:
Dave Clarke
Applicant:
This structure may be occupied as a: Residential Septic Alteration
By Order 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 & Code Enforcement
Planning Board or Zoning Board of Appeals.
- TOWN OF QUEENSBURY
i
u. '' ,,, 1 742 Bay Road,Queensbury,NY 12804-5904 (518)761-8201
S' ._.. Community Development-Building& Codes (518) 761-8256
BUILDING PERMIT
Permit Number: SEP-0506-2018
Tax Map No: 301.8-2-80
Permission is hereby granted to: Derek Slayton
For property located at: 43 HILLCREST 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
Owner Name: Derek Slayton Septic Disposal-Residential $0.00
Owner Address: 38 Thunderbird DR Total Value $0.00
Queensbury,NY 12804
Contractor or Builder's Name/Address Electrical Inspection Agency
Dave Clarke
11 Thunderbird DR
Queensbury,NY 12804
Plans&Specifications
Residential Septic Alteration
$ 75.00 PERMIT FEE PAID -THIS PERMIT EXPIRES: Friday,August 9,2019
(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 o ueen j 4hur st 9,2018
SIGNED BY: for the Town of Queensbury.
Director of Building&Code Enforcement
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SEPTIC DISPOSAL PERMIT APPLICATION 'uaffi-e"Ose OnIv
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Tax Map ID ff,
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1� ariance? Yes No
Project Locatic_.�'
iPrimary Owner(s) avl
Mailing Address k�~u'
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Phone & Email 612_ /�7� ��'� ��� ��/� k7 /� ��/^ cvv�
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Mailing Address -�� 'T�^ ��-
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Phone & Email �� `� -7Q�L_- �/i°L��l
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Engineer
Mailing Address ,~�----
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Phone & Email ~,~------
/Comtact Person for Building&&Code Compliance: . ' Phone: �5Q 7W -
RESIDENCE INFORMATION:
Year Built Gallons #ofbedrooms X gallons per =total daily flow
_ Installed?perday � Garbage Grinder Yes ^*�-
- (circle one)
_-'�-19DD��mn|der 150 ^ '
or-older - Spa or Hot Tub Yes N15__
1981-1991 130 - -
_ |n�taUed? _�1ideone)
1993'Present 11O '- --- �--- ' �`
7,
PARCEL INFORMATION:
Topography VIXF1,2t Rolling Steep Slope %3lop
Soil Nature *° &and Loam Clay Other
Groundwater At what depth? V-3 06
8ednonk/|mnperviousrneteria| depth? #0N
Domestic Water Supply =cipal. __VVeU/ifxxe|Lxvotersupp|yfnornanysepticsystennabsorptionis___ft.\
Percolation Test Rate: per minute per inch (test tmbe completed 6V licensed emB1neer/axchitec6
PROPOSED SYSTEM FOR NEW CONSTRUCTION: '
Tank size 8mrDo gallons(min.size 1,000 gallons,add 250 gallons for each garbage cylinder or spa/hot tub
System Absorption field with#2stone Total length .104;6 ft.; Each Trench ft.
Seepage Pit with#3stone How many: Size:
Alternative System Bed or other type:
Holding Tank System Total required capacity? tank size #oftanks
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 and approved.
The installed system must match the septic 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 known by or on behalf of an applicant,shall be void. I
have read the regulations and agree to abide by these and all requirements of the Town of Queensbmry Sanitary Sewage
isposal(]rdinance.
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