application SEPTIC DISPOSAL PERMIT APPLICATION Office Use Only
742 Bay Road,Queensbury,NY 12804
Town dC'i<?eensbory C p
P:518-761-8256 www•gueensbury.net Permit#:
Tax Map ID#: 308.15-1-30 Permit Fee:$ V r Invoice
Project Location: 20 VAN DUSEN ROAD I Septic Variance? Yes No
Primary Owner(s) WILLIAM MATTISON
Mailing Address 39 SPRING STREET SOUTH GLENS FALLS,NY 12803
Phone & Email
Installer/Builder SANITARY SEWER SERVICE
Mailing Address LUZERNE ROAD,QUEENSBURY NY
Phone & Email 518-796-3760
Engineer CENTER PROJECT SERVICES TOWN OF QUEE SBUR
Mailing Address 73 SHERIDAN STREET,GLENS FALLS,NY
Phone & Email 518-796-2515 TCENTER36@YAHOO.COM
Contact Person for Building&Code Compliance: GEORGE DRELLOS Phone: 518-796-3760
RESIDENCE INFORMATION:
Year Built Gallons #of bedrooms X gallons per =total daily flow
per day bedroom Garbage Grinder Yes No
1980 or older 150 Installed? (circle one)
1981-1991 130 Spa or Hot Tub Yes No
Installed? (circle one)
1992-Present 110 2 110 220
PARCEL INFORMATION:
Topography ✓ Flat Rolling Steep Slope %Slope
Soil Nature ✓ Sand Loam Clay Other
Groundwater At what depth?
Bedrock/Impervious material At what depth?
Domestic Water Suppl _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 1,000 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: 20x20 pipe-in-stone absorption 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 abide by these and all requirements of the Town of Queensbury Sanitary Sewage
Disposal Ordinance. 1
PRINT NAME: DATE:
SIGNATURE:
Town of Queensbury Building&Code Enforcement Revised March 2018
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TOWN OF QUEENSBURY
.BUILDING&CODES
TOWN OF QUEENSBURY
BUILDING DEPARTMENT
Based on our limited examination,compliance
with our comments shall not be construed as
Indicating the plans and sppecifications are in
full compliance with the 8uiiding Codes of
New York State.
C
TOWN OF QUEENSBURY .
BUILDING & CODES DEPT.
Reviewed By:
®ate: �
i
l
308.15-1-30 SEP-0159-2021
Mattison, William
20 Van Dusen Rd
Residential Septic Alteration
SERVICESCENTER PROJECT
73 Sheridan Street, Glens Falls, NY 12801
Phone-518-796-2515
V E rch 25, 2021
George Drellos
D roject#329
Sanitary Sewer Service MAR 2 6 2021
Queensbury,NY 12804
TOWN OF QUEENSBURY
Re: Proposed Replacement Septic BUILDING&CODES
20 Van Dusen Road Queensbury,NY
Dear George:
At your request, we have reviewed your proposed replacement septic system design of the
existing 2-bedroom house at 20 Van Dusen Road in Queensbury. As per our conversation the
residence has an existing failed septic system.
We have reviewed the proposed replacement septic system design and we agree that a standard
absorption bed is acceptable. Based upon a design flow rate of 220 GPD and a percolation rate of
1 to 5 minutes, you will need a minimum of 245 sf of absorption area. We recommend using 20
ft wide by 20 ft long absorption bed with 4 — 15 ft long laterals. The absorption system can be
constructed with the existing 1,000-gallon septic tank, new distribution box, and 4-inch diameter
perforated pipe and stone.
Please feel free to contact me at 796-2515 if you have any questions and that you for your
assistance with this request.
Sincerely,
Thomas R. enter Jr, P.E.