Loading...
septic application liSEPTIC DISPOSAL PERMIT APPLICATION mice Use Only 05h4 742 Bay Road,Queensbury,; 17.:i nn w r t P:518-761-8256 www.q,JeC... 0 emit#: --� ZU Q Tax Map ID#: 302.18-3-34 ii hermit Fee:$ IS OO ; Invoice#: z-O .111 HP ' 3 2019 Wd Project Location: 105 COOLIDGE AVE i Septic Variance? 1)* Yes ✓ No TOWN OF QULCNSCt1RY J Primary Owner(s) MARIA KRUG BUILDING&CODES Mailing Address 105 COOLIDGE AVE QUEENBSURY NY Phone & Email Installer/Builder SANITARY SEWER SERVICES Mailing Address LUZERNE ROAD,QUEENSBURY NY Phone & Email 5187963760 Engineer HUTCHINS ENGINEERING,TOM CENTER Mailing Address 169 HAVILAND ROAD,QUEENSBURY,NY 12804 Phone & Email TCENTER36@YAHOO.COM Contact Person for Building&Code Compliance: GEORGE DRELLOS Phone: 5187963760 RESIDENCE INFORMATION: Year Built #of bedrooms X gallons per bedroom =total daily flow Garbage Grinder Yes No 1980 or older Installed? (circle one) 1981-1991 Spa or Hot Tub Yes ©o Installed? (circle one) 1992-Present 3 110 330 PARCEL INFORMATION: Topography ✓ Flat Rolling Steep Slope %Slope Soil Nature Sand Loam Clay Other Groundwater At what depth? DEEPER THAN 6' Bedrock/Impervious material At what depth? NONE Domestic Water Supply J/ Municipal _Well (if well,water supply from any septic system absorption is_ft.) Percolation Test Rate: 1.-5' per minute per inch (test to be completed by licensed engineer/architect) PROPOSED SYSTEM FOR NEW CONSTRUCTION: Tank size 1000 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. Seepage Pit with#3 stone How many: ;Size: Alternative System Bed or other type: 15 X 30 FT BED 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. 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 abi e by these and all requirements of the Town of Queensbury Sanitary Sewage Disposal Ordinance PRINT NAME: ./ DATE: '`"/I--7, C. SIGNATURE: Town of Queensbury Building&Code Enforcement Revised February 2017