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SEPTIC DISPOSAL PERMIT APP}Office Use Only 142 Bay Road,Queensbury,NY 12804 ~—ne psig71g2s6 OS3S woTaxMapip#:___2S.(Sr Per 75.00;invoice #:RUEY1dPeProjectLocation:HF ycamore Dr,[sete varie ves No Project Location: HF ©CT —— tese|“Mailing Address AFL.Sycamore De.—_—Phone &Email|S14 iy—49Sy —~—|Installer/6uiéer |TRS Septic 1)my)Mailing Address|Hk)Lower WarrtrStQueenshacyILI__|Phone &Ema |SIG-TFRIS --:-|Engineer Mailing Address Phone &Email Contact Person for Building &Code Compliance:kL ris _Phone:5 Ik 3 G2 65|RESIDENCE INFORMATION - total daily flow |Year Built|Gallons|#of bedrooms |X gallons per |per day bedroom Garbage Grinder Yes|Ni 1980 or older)150 r "gate||installed?(circle one)7 ~~~7 |Spa or Hot Tub Yes|Ni1981-1991 230 | °|iM \%o 50 Installed?(circle one)|t992-Present | 110 |Se gs Bye OY —aPARCELINFORMATION:-_f.__-__]|Topography —¢Fllat Rolling Steep Slope %Slope _|Soil Nature -Sand loam Clay OtherGroundwaterAtwhatdepth?——_-_|Bedrock/impervious material|At yhiat depth?-_Domestic Water Sup}‘Municipal___Well (if well,water supply from any septic system absorption is|Percolation Test Rate:per minute per inch (test to be completed by licensed engineer/a PROPOSED SYS;R ‘ONSTRUCTION:__|[Tank size@ Xi sting ganbAe(min,size 1,000 allons,add 250 gallons for each garbage cylinder or spa/hot tub _System,Absorption field with #2 stone|Total length 40 ft;Each Trench_G0 ft. Seepage Pit with #3 stone How many:Size:—_ __|Alternative System -Bed or other type:_| Holding Tank System _[Total required capacity?jtank size j#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 Fepresentation or failure to make a material fact or circumstance known by or on behalf of an applicant,shall be void.|have read the regulations and agree to abide by these and all requirements of the Town of Queensbury Sanitary SewageDisposalOrdinance.rm Christopher Bell naw 623-20 SIGNATURE:Deisibn (BLl a oat:6-32O. Town of Queensbury Building &Code Enforcement Revised March 2018