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SEP-0427-2021 SEPTIC DISPOSAL PERMIT- Office use,bnly APPLICATION Permit#:40W • 04Z�-• ?�21 Town ofQueensbury Permit Fee:$ Invoice#: 742 Bay Road,Queensbury,NY 12804 P:518-761-8256 www.queensburv.net Flood Zone? Y N Reviewed By: Project Location: 34 CLARK STREET Tax Map#: 302.17-2 75 F RESIDENCE INFORMATION: Year Built Gallons #of bedrooms: X gallons per =total daily flow 1perday bedroom Garbage Grinder Yes No 1980 or older 150 Installed? (choose one) X 1981-1991 130 Spa or Hot'Tub Yes No 1992-Present 110 3 110 1330 Installed?. (choose one) X PARCEL INFORMATION: Topography Flat Rolling Steep Slope % Slope Soil Nature Sand -Loam - Clay Other, explain: Groundwater At what depth? GREATER THAN 6 FT Bedrock/Impervious material At what depth? GREATER THAN 6 FT Domestic Water Supply Municipal Well Lake (if well or lake, water supply from any septic system absorption is ft.) Percolation Test Rate: 1-5MIN per minute per inch (test to be completed by.a licensed engineer/architect) PROPOSED SYSTEM INFORMATION: Tank size l000 gallons'(min. size 1,000 gallons, add M'gallons for each garbage cylinder or Spa/hot tub NEW 1000 GAL CONCRETE System Absorption field w/#2 stone. Total,length ft.; Each Trench ft. Seepage Pit w/#3 stone How many: ; Size: Alternative System Bed or other type:15 FT X 30 FT' Holding Tank System Total required capacity? ; tank size # of tanks Septic Application Revised January 2021 CONTACT INFORMATION: PLEASE PRINT LEGIBLY OR TYPE; PLEASUNCLUDE AN EMAIL • Applicant:' Name(s): ROBERT TRIPP Mailing Address, C/S/Z: 34 CLARK STREET. QUEENSBURY,NY 12804 Cell Phone: Land Line: Email: • Primary Owner(s): Name(s):SAME AS APPLICANT Mailing Address, C/S/Z: Cell Phone: Land Line: Email: Check if all work will be performed by property owner only • Contractor: __ -- -- -- - - Contact Name(s):SANITARY SEWER SERVICES Contractor Trade:- Mailing Address, C/S/Z:LUZERNE RD, QUEENSBURY Cell Phone: Land Line:518-796-3760 Email: **Workers' Comp documentation must be submitted with this application** • Enaineer(s)• Name(s):CENTER PROJECT SERVICES Mailing Address, C/S/Z:73 SHERIDAN STREET, GLENS FALLS NY 12801 Cell Phone: Land Line: Email: Contact Person for Compliance in regards to this project:GEORGE DRELLOS Cell Phone: Land Line: 518-796-3760 Email: 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.4. If,for any reason,the buildi.ng.permit application is withdrawn, 30% of the fee is retained by the Town of Queensbury. After 1 year from the initial application date, 100%of the fee is retained. 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 Or n nce PRINT NAME:GEORGE D LL S SIGNATURE: DATE: Septic Application Revised January 2021 SEPTIC DISPOSAL PERMIT Office Use only d. r� APPLICATION Permit#: Z�ep— IPAA�— ) Town of Quccnsbu7 5 D2 � � Lf n � � rmit Fee:$ a L n oice#: 742 Bay Road,Queensbury,NY 12804 P:518-761-8256 www.aueensbury.net JUN 0 3 2021 F od Zone? Y N Reviewed By: TOWN OF QUEENSBURY Y t Q BUILDING& CODES Project Location: 34 CLARK STREET Tax Map#: 302.17-2-75 RESIDENCE INFORMATION: Year Built Gallons #of bedrooms; X gallons per =total daily flow , 1perday bedroom Garbage Grinder Yes No 1980 or older 150 Installed? (choose one) X 1981-1991 130 Spa or Hot Tub Yes No 1992-Present 110 3 110 330 Installed? (choose one) X PARCEL INFORMATION: Topography ✓ Flat Rolling Steep Slope % Slope Soil Nature V Sand Loam Clay Other, explain: Groundwater At what depth? GREATER THAN 6 FT Bedrock/Impervious material At What depth? GREATER THAN 6 FT Domestic Water Supply Municipal Well Lake (if well or lake, water supply from any septic system absorption" is ft.) Percolation Test . Rate: 1-5MIN per minute per inch (test to be completed by a licensed engineer/architect) PROPOSED SYSTEM INFORMATION: Tank size l000 gallons (min, size 1,000 gallons, add 250 gallons for each garbage cylinder or spa/hot tub EXISTING 1000 GAL CONCRETE System 'Absorption field w/#2 stone Total length ft.; Each Trench ft. Seepage Pit w/#3 stone How many: ; Size: Alternative System Bed or other type:20 FT X 25 FT Holding Tank System Total required capacity? ; tank size ; # of tanks Septic Application Revised January 2021 CONTACT INFORMATION: "PLEASE PRINT LEGIBLY..OR TYPE.; PLEASE INCLUDE AN EMAIL Name(s): ROBERT TRIPP Mailing Address, C/S/Z: 34 CL)� STREET. QUEENSBURY,NY 12804 Cell Phone: Land Line: ►c.•.� Email:. • Primary.Owrie'r(s): SAME AS APPLICANT Mailing Address, C/S/Z: Cell Phone: Land Line: Email Check if all work will be performed by property owner only • Contractor: Contact Name(s)':,SANITARY.SEWER SERVICES Contractor.Trade:.- Mailing Address, C/S/Z:LUZERNE RD, QUEENSBURY Cell Phone... Land Line:,518,796-3760 - Email: **Workers' Comp documentation-must be submitted with this__appiication** • Enll;ineer(s): . Name(s):CENTER PROJECT SERVICES- Mailing Address, C/S/Z:73 SHERIDAN STREET,,-GLENS FALLS NY 12801; . Cell Phone: Land Line: Email: Contact Person for Compliance in regards to tlils-project:GEORGE DRELLOS Cell Phone: Land Line: 518-796-3760 . Email: 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.s,ubmitted plans.4. If, for any reason, the building permit application is-withdrawn, 30% of the-fee is retained by the Town of Queensbury. After 1 year from the initial application date, 100% of the fee is retained. 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 a ree to abide by these,and all requirements of the Town of Queensbury Sanitary Sewage Disposal Ordinal e. PRINT NAME:GEORGE DRELL S SIGNATURE: DATE: Septic Application Revised January 2021 CENTER PROJECT SERVICES 73 Sheridan Street, Glens Falls,NY 12801 Phone-518-796-2515 June 6, 2021. Project# 339 George Drellos Sanitary Sewer Service Queensbury,NY 12804 Re: Proposed Replacement Septic .34 Clark Street, Queensbury,NY Dear George: At your request, we have reviewed your proposed replacement septic system design of the existing 3-bedroom house at 34 Clark Street 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 330 GPD and a percolation rate of 1 to 5 minutes, you will need a minimum of 367 sf of absorption area. We recommend using 20 ft wide by 25 ft long absorption bed with 4 —20 ft long laterals. The absorption system can be constructed with the new 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.,Center Jr, P.E. D ECC0WE EUNi 0 3 Z021 TOWN OF QUEENSBURY BUILDING& CODAS Ro •p 0 r O z N J zLL- oo . To __._ ._..._..__ _ � t— m Ix N � u N � N � JUN 0 3 2021 CL .....�..,....�_,...: _... ,m..,..,:�r �: ._.�� . .�.. „m.• TOWN OF QUEENS13 to N BUILD}N �1RY N G& CODE; N pY ++ 1` Q i (ODrl a c3 U � cl. i SERVICES 73 Sheridan Street, Glens Falls,NY 12801 Phone-518-796-2515 June 16,2021 Project#339 George Drellos Sanitary Sewer Service Queensbury,NY 12804 Re: Proposed Replacement Septic 34 Clark Street, Queensbury,NY Dear George: At your request, we have reviewed your proposed replacement septic system design of the existing 3-bedroom house at 34 Clark Street 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 330 GPD and a percolation rate of 1 to 5 minutes,you will need a minimum of 367 sf of absorption area. We recommend using 15 ft wide by 30 ft long absorption bed with 3 —25 ft long laterals. The absorption system can be constructed with the new 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. Center Jr,P.E. REVISED 4 1 '7 REVISED ' t4 4' 6 if �6 b c� 4 t