SEP-0278-2018
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-0278-2018Date Issued: Thursday, May 31, 2018
This is to certify that work requested to be done as shown by Permit Number
SEP-0278-2018
has been completed.
295.10-2-13
Tax Map Number:
7 SHALLOW CREEK RD
Location:
Lisa Calby
Owner:
Sanitary Sewer Service
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.
,f
-4 TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5904 (518)761-8201
Community Development- Building& Codes (518) 761-8256
BUILDING PERMIT
Permit Number: SEP-0278-2018
Tax Map No: 295.10-2-13
Permission is hereby granted to: Sanitary Sewer Service
For property located at: 7 SHALLOW CREEK 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
IVe of Construction
Owner Name: Lisa Calby Septic Disposal-Residential $0.00
Owner Address: 7 SHALLOW CREEK RD Total Value $0.00
Queensbury,NY 12804
Contractor or Builder's Name/Address Electrical Inspection Agency
Sanitary Sewer Service
PO Box 224
Glens Falls,NY 12801
Plans&Specifications
Residential Septic Alteration
$ 75.00 PERMIT FEE PAID -THIS PERMIT EXPIRES: Tuesday,May 21, 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 of nsbury; A Mo y 1,2018
0
SIGNED BY: 4QJ for the Town of Queensbury.
Director of Building&Code Enforcement
SEPTIC DISPOSAL PERMIT APPLICATION Office Use Oniv
742 Bay Road,Queensbury,NY 12804
--1-Q----' P`518-761-825G wwvj.�Iu�&nsbjinj.nat it
Tax Map 8D M
Ov`cek AS
Project Location: /1'PW 61 Septic Variance? Yes No
Primary Owner(s)
Mailing Address zjh4(6)c�' C'-1"'10a_k
Installer/Builder e,,- S, C-11ce
Engineer
Mailing Address
Phone & Email
RESIDENCE INFORMAT(6N�__.,
Year Built #of�edr r""! Xg�ltq total daily flow Garbage Grinder Yes
Installed? (circle one)
1980 or older
01 Spa or Hot Tub Yes No
1981-19'.. i Installed? (circle one) 1X_
PARCEL INFORMATION:
Topography X-Flat Rolling Steep Slope %Slope
Soil Nature _,V_sand Loam Clay Other
Groundwater At what depth? 111,4
Bed rock/Im pervious material At what depth?
Domestic Water Supply �&Iunicipal _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 engineer/architect)
PROPOSED SYSTEM FOR NEW CONSTRUCTION:
Tank size 1 1,07V gallons(min.size 1,000 gallons,add 250 gallons for each garbage cylinder or spa/hot tub
System Absorption field with#2 stone Total length -0 ft.; Each Trench -5-0 ft.
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 and approved.
The installed system must match the septic layout on file—no exceptions.
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 Queensbury Sanitary Sewage
Disposal O di
PRINT NAME: DATE:
SIGNATURE: DATE: `/F''
Town vrQueensbury Building&Code Enforcement Revised February zu1r
L I'S (fir C cLPERMIT PLO', PL.Arj
I HAVE PERSONALLY MEASURED THE DISTANCE
FROM THE PROPERTY LINES TO THE
PRO SED ST R�J TL;R (S) OR SIGN(S)
/ ( ' sig k!"�� 5= �•- Y
! S Ft"L(o 6 f e- � � NATURE pATE
--- / /
y�.,--- FILE COPY
MAY 18 201
�--- --�►
�VL >3(oc(c �,,,i t I
ov
I
z
p
e. LA.)LA.) \-A
t
s
TOWN OF Q
U BUILDING
29;.10-2-13 SEP-0278-2018 Reviewed
Caby,
Lisa
7 Shallow Creek Road Date: .
Residential Septic Alteration