print Office Use Only
Permit#: 5�P- p 100 1 - 2Q� j
`�. SEPTIC DISPOSAL PERMIT APPLICATION
Permit Fee: $ 45 ; Invoice#: 19 f)
Septic Variance? Yes No
r)`" rz, ,;n _ REVISED
74•B �, ��er�ur8, v .1 P: -1 1 ?cA unurw nlaanc.urv.ne�
SEP 24 2019 _ ' c jE II b
reo
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T N 0 OUEENSBURY SEP 0 4
BUILDIN &CQDES \ 2079
Pi ujett Lucation. \ \�U ( 1� �j u B\
T BUILDING NG&EENSBURY
CODES
• Applicant:
Name(s): C)�i,, R\L\-\(a R n -� h f R1 c gE v 1
Mailing Address, C/S/Z: \?) \-\�;L\--k�/j C c C PN
Cell Phone:_( ) Land Line: _(\?) 'l `A(2) -�c-1\LA
Email: fT\cuT1 (`\c V-Aa_c cJ rCjOa A. C' n cc)
V
• Primary Owner(s):
Name(s): •A Po ME.._E kb N \C
Mailing Address, C/S/Z:
Cell Phone: _( ) Land Line: _(F1 c ) 1 ok(>--XT m
Email:
El Check if all work will be performed by homeowner only
• Contractor: Workers' Comp documentatio must be submitted with this application
Contact Name(s): \U.... P)R� ���
Contractor Trade: E'/x ( 1(!T\ k)(2, c_k)oTRiptC\D1iL
Mailing Address, C/S/Z: HI 1 Ci\. 9C1 OD Co Ri* T-\) \� 12 ?7
Cell Phone:_(,_\', -) `,)7,\ —(ici!�t-\ Land Line: _( 1�T`s ) (( '.-!— (5,.)-)‘ ,
Email:
• Engineer(s
Name(s): TEll\\ --TE. 1`1�„a_0 ,
Mailing Address, C/S/Z: \' T lxE)-)"\-- \c) 0 lx 0,i tint Lb rrr16l J i \Z
Cell Phone:_( ) Land Line: _(}5-\?) ) T—(V,\9`'\
Email: 31p n 71-\( co mot....\`o CP>n
Contact Person for Building & Code Compliance: V)\ \,.-, ,,
Cell Phone: (_c\ , ) .")Z\ - (e\5-{ Land Line: (L5�, ) (0,\5LA — (0_( l
rt
Email:
Septic Application Revised February 2019
/ \ t•-: i-kts 0
RESIDENCE INFORMATION:
Year Built Gallons #of bedrooms: X gallons p =total daily flow
per day bedroom Garbage Grinder Yes ` -
1980 or older 150 j r�� , '7 2 Installed? (circle one)
1981-1991 130 Spa or Hot Tub Yes N31
Installed? (circle one)
1992-Present 110
/
PARCEL INFORMATION:
Topography J Flat Rolling Steep Slope %Slope
Soil Nature "Sand _Loam _Clay _Other(explain: )
Groundwater At what depth? :ries 3 t-\"
Bedrock/Impervious material At what depth?
Domestic Water Supply /Municipal _Well(if well,water supply from any septic system absorption is ft.)
Percolation Test Rate:5--,C, per minute per inch (test to be completed by licensed engineer/architect)
PROPOSED SYSTEM FOR NEW CONSTRUCTION: N tJc c;•‘.J> p., Q17 �s0,v_ P.-tAco —ttTl(AD
Tank size ki,:LC+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 ft.; Each Trench ft. eniftil Cil
Seepage Pit with#3 stone How many: ;Size: 3 [QJ.— Zy
Alternative System Bed or other type: Etz-Ft6-rts—vpi2,4M
Holding Tank System Total required capacity? ;tank size ;#of tanks
NOTES: 1.Alarm system and 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. 3. As-built drawings must be
submitted prior to the inspection, if there has been a change to the submitted plans.
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 Queensbury
Sanitary Sewage Disposal Ordinance.
PRINT NAME: Al ndrold7 ‘- DATE: gM/
SIGNATURE: // (74au 1 V DATE: /// /9
!
Septic Aoolication Revised February 2019
{s e ¢ezq° i,'STT�s a, x9 �t.« t' ?�•rr ".e. Nt _'y+"' ,n.,
4.119
V
ugust 2019
SFp ®A
2019
T BU LD QUEEN
• NG COOgSRY
Dr. Richard Garrett
18 Hughes Court
Queensbury, NY
RE: Soil absorption system inspection FILE Capy
Overview
I was contacted by Bryant Kolner of Bear Paw LLC regarding an issue at the above listed
address. I arranged a date to conduct my investigation and.arrived onsite at the time and date
we agreed upon. I.was met on site by the homeowner, Peter Jensen, PE, and Bill Bradley of
Bradley's Septic Service.The system is a 3-bedroom design at 330 gallons per day.The
percolation rate is listed as 5-10 minutes per inch and the required leaching area required 60
linear feet of Eljen B43 modules.The system is configured in a split trench design with two
laterals consisting of 7 and 8 B43 modules.The first lateral of 7 modules runs south to north,
inlet to distal end and the second lateral of 8 modules runs north to south, inlet to distal end.
Observations
I began a walking inspection of the system.The ground above the leachfield was firm and dry.
The distribution box cover was exposed and open upon my arrival and the effluent level was
almost to the top of the box.There was a white substance floating throughout the effluent
within the box. I obtained a sample of the effluent for testing.The samples were submitted to
Adirondack Environmental Services for testing and a report is attached. I located the distal end
of the first lateral, Bill Bradley excavated the end to expose the modules.There was no
evidence of effluent at this end of the system. I collected a system sand sample for sieve
testing.This sample was submitted to Allied Testing, Springfield, MA and a report of the results
is attached. I located the distal end of the second lateral and dug a hole to the top of the
modules with a posthole digger.This hole immediately filled with fluid to a level just below
finished grade. I next located the middle of the first lateral and dug a hole to the top of the
modules.Again,the hole immediately began filling with fluid.
During a conversation with Mrs. Garrett it was disclosed that the original installer advised her
to introduce bakers yeast into their system on a regular basis due to her,use of bleach as a
cleaning agent within the home.
• 155 Ten Mile Brook Rd..Bristol, NH—Phone(774)271-1045—Fax(603)217-0078—racaskat@verizon.net
Particle Size Distribution Report
Cs.
C C C sC --C- Ep o oO N
o M N - C 7Z It 7e V- Y(• Y Yt Yl bt
100 1 1 I I 11 b i1 t i. " ` I ( 1 }� I I I I I I-- • ASiAA C 33-Sand
" t::uiL1
iIII I 1 1 }1 I_1_hII 11 1- \ ,'a --11---1.__1 1._1.�-__..
• ' 1 1 II I ' Ili 1 .. 1 I I i�
1 1 I l i. . _b I j it'lli I 1 li ti --- ��--�
70- 1 1 1 ! I- �-I- ,---- , '10.
- I I f-I TI I1 f k`
I I
1 1 I ' I III !, 1 ! 1 I� 1 i ! 1;
W - I tI ,
'11
•
I I Ili I I:II I I , 1 1 I
[J I I I I ,Iti1i
I. I
U I I I L I I 1 ttL
I ! II I I I II I • II !i II I I i I 1 i I
i .___i
20 -'--- ._-1 I --1 i --i- 1-'
i --i-1--(- -_.. I ---I -,-,_1..-r- ._-F- , I I
I 1 . ! I I i I i 1 1 ( III ) ' �\ I 11
I I •--11
I --1I. .._1I-1 {- _I---- __-..I1 _1----1 �1-i- 4�-1 1
j
0 I 1 1 I i! i III I I 1 i � rl ;
II 1 I I'r f i ( I 1
100 10 1 0.1 0.01 0.001
GRAIN SIZE-mm.
i _ %+3„ %Gravel 1 %Sand - %Silt --1-- %Clay_
- 0.() ~--._- I.9 I 96.6 1.5
• TEST RESULTS(ASTM C 136) Material Description
• Opening Percent Spec.* Pass?
septic sand
Size Finer (Percent) (X=Fail)
1/2 100.0
3/8 99.8 I00.0 X Atterberg Limits(ASTM-D p318)
a.
1i4 98.1 95.0- 100.0 PL= LL=
lib 95.0 . 80.0- 100.0 Classification
# 0 70.1 } 25.0-60.0 I X USCS(D 2487)= AASHTO(M 145)= •
!'3U 70.6 25.0-(iUA X
1140 52.6 - Coefficients
,EEO
29.6 5.0-30.0 D90= 1.2567 D85= 0.9459 D60= 0.4817
4100 6.4 OA- 10.0 p50' 0.4082 p30=•0.30 19 D18= 0.2176
4200 1.5 0.0 3.0 I D10= 0.1820 C„= 2.65 Cc= 1.04
Remarks
Date Received: 7-2-201.9__-__-. Date Tested: 7-3-2019 .
1 Tested By: . _ -
1 1 Checked By: JM .. -------------�_... --- `
Title: Dir.of T esting Services _--
- ' AST(vl C'33-Sand
Sample Number: 7208 Date Sampled: 7_2-2019
ALLIED TESTING , ' Client: Raccas Kat LAX
\ LABORATORIESNC. Project: I Qucensbua)'•NY
_-- --_--- Figure _______
Spr^�ngfiield,Massachuse is 1_Profect No____._____.___- ----
•
Adirondack Environmental Services, Inc Date: 15-Jul-19
• CLIENT: RacCasKat,LLC Client Sample ID: 18 Hughes Ct D Box
Work Order: 190702034 Collection Date: 7/2/2019 10:30:00 AM
Reference: 18 Hughes Ct / / LabSample ID: 190702034-001
PO#: Matrix: WATER
•
Analyses Result RL Qual Units DF Date Analyzed Armids i`
ICP METALS-EPA 200.7 REV 4.4 Analyst: SM
( Prep: - 7/3/2019
Sodium 69.1 0.500 mg/L 10 7/9/2019 4:46:13 PM
H1,5 1 BOD,5 DAY,20°C-SM 5210B-2011 Analyst: SH
/OD-3vo ,vy
Biochemical Oxygen Demand 474 200 BS+ mg/L 1 7/3/2019 2:25:00 PM
!/'n��t� Analyst: JW
TOTAL SUSPENDED SOLIDS-SM 2540D-2011
I, t ( Prep: Gen Prep - 7/3/2019
TSS(Residue,Non-Filterable) 622 20.0 mg/L 1 7/3/2019 f 00-39 Ju�
O fL ) OIL AND GREASE-EPA 1664A Analyst: TSZ
( Prep: E1664 - 7/11/2019 )
Oil&Grease 27.9 5.6 mg/L 1 7/12/2019 30 .0►51
•
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Page 3 or3
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7 L*u•itifitiOrV Albany, New York 12207 Irtt s Weric order#
,,,-460-000:67 6.0 wittil 0 518-434-4546/434-0891 FAX l 1 ',r,:1
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Experience is the solution A full service analytical research laboratory offering solutions to environmental concerns ',,,:..,.•
Client Name:
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Send Report To: 1-0-C.C.ri. ‘4A-les Project Name(Location) Samplers:(Names)'
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Turnaround Time Request: 1-9-19
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Bali quish y:(Signature) / • Received by:(Signature) Date/Time
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--------------
WHITE-Lab Copy . — YELLOW-Sampler Copy
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Adirondack Environmental Ser: 111111111'Demo 111 0 1
19071121114
— — —