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SEP-0329-2021 r SEPTIC DISPOSAL PERMIT office use only APPLICATION. Permit#: ���J �'y Z� ' 2,&zl Town ofQuccnsbury Permit Fee:$ Invoice#: 2 742 Bay Road,Queensbury,NY 12804 P:518-761-8256 www.gueensbury.net Septic Variance? Y ( N 1 Flood Zone? Y N Wetlands? eXr y Project Location: 10 t�o>L.K �'���! Tax Map #: z39. I MAY 0 9 2021 TOWN OF QUEENSBURY RESIDENCE INFORMATION: BUILDING&CODES Year Built Gallons #of bedrooms: X gallons per =total daily flow per day bedroom Garbage Grinder Yes No 1980 or older 150 Installed? (choose one) ❑ X 1981-1991 130 . Spa or Hot Tub Yes No 1992-Presen 110 1 I© }0 Installed? (choose one) ❑ �] -y-u? F%X'rL"M€V PARCEL INFORMATION: Topography Flat Rolling ❑ Steep Slope % Slope Soil Nature g Sand 54Loam ❑.Clay ❑ Other, explain: _Groundwater At what depth? > -7Z:' Bedrock/Impervious material At what depth?7Z' Domestic Water Supply ❑ Municipal ❑ Well ' KLake (if well or lake, water supply from any septic system absorption is >ta0 ft.) Percolation Test_ Rate: C,o per minute per inch (test to be completed by a licensed engineer/architect) PROPOSED SYSTEM INFORMATION: Tank size i7_150 gallons (min. size 1,000 gallons, add 250 gallons for each garbage cylinder or spa/hot tub System Absorption field w/#2 stone Total length yz ft.; Each Trench ft. Seepage Pit w/#3 stone How many: ; Size: Alternative System Bed or other type: 15k'X_A Z' - Holding Tank System Total required capacity? ; tank size ; # of tanks 'f'•��s'�T�rl1L Septic Application Revised April 2021 CONTACT INFORMATION: PLEASE PRINT LEGIBLY OR TYPE, PLEASE INCLUDE AN EMAIL • Applicant: Name(s): {�dLl�t•i U�t2'c5T L-L-G Mailing Address, C/S/Z: Cell Phone: 52-IS 3Co5 -4�145101 Land Line: Z 1 l S Email: c.X=,vv-t • Primary Owner(s): Name(s): G 2tZ5 An!�,E:LF- .Mailing Address, C/S/Z: Cell Phone: 5 tS Land Line: Email: ❑ Check if all work will be performed by property_ owner only • Contractor• Contact Name(s): •C-, A1%+-0^ -L �CA ��` �� C�Z�� Contractor Trade: Mailing Address, C/S/Z: (,3 l�ooeKt u- �? • L--� - �• � Cell Phone: - 1$�{ - � Land Line: 1 -7q3- Zg � � -7c� � � g o�3 Email: chr�acccr,�ol,lc�.t4� �grn� 1 covwl "Workers' Comp documentation must be submitted with this application" • Enkrineer(s): Name(s): Erl�liany-l7yl�►A_- )Ee _D4 ,Li'rN: 1 — . ��� ��lc�i."'�o Mailing Address, C/S/Z: 9O© CALF i o �' - .%_< lZ�� Cell Phone: '5125 37Ca-A-14S5 Land Line: mil$ -11-7G�Zl Email: 8Lysgo c.gaA Q<2tl Cd¢��1l�• c c3v— Contact Person for Compliance in-regards to this project:" GftP,l-0. AV;Nc� Cell Phone: '511a 'j- ice Land Line: Email: covy-, 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 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 agree to abide by these'and all requirements of the Town of Queensbury Sanitary Sewage Disposal Ordinance. PRINT NAME: SIGNATURE: DATE: �. Septic Application Revised April 2021 TOWN OF OUEENSBURY 742 Bay Road, Queensbury, NY. 12804-5902 Septic SystemChecklist Plan to scale Received Deep hole perc test results from engineer/Architect if applicable(Town Approved Engineers and Architects;June 30 to April 15 Town Engineer for unapproved Engineers and Architects) All wells on property and adjacent properties shown Water line shown Municipal or well 10'separation to any part of system —� Setback to property lines show 10'or more for any part of system -)(—Septic tank and pump stations 10'from foundation 50'from any well/lake/wetland 10'from any waterline YSeptic tank to foundation crawl space/slab on grade,grade in crawl space must be above top of septic tank for 0',Separation required (field verification required) YSeptic tank sized for number of bedrooms and add 250 gals for Jacuzzi tubs/garbage grinder each Leech Field 20'from foundation 100'from any well 10'from water line IA-Seepage pit 150'from well 50'from septic tank Seepage Pits 3-times diameter apart Septic tank and pump stations over 30 gallons 50'from watercourse or wetland distance from bottom of trench or system 24"to bedrock or mottlin 36" ' n 1000' of Lake George Leech field 100'from watercourse or wetland 'mod' oe of mound or bottom of retaining wall 10'from property line 100'from well 20'from Foundation Provide Engineer/Architect stamp for bed or design systems Department of Health Approval for all mobile home park new systems Flood Plain requirements 2' above established flood elevation to bottom of system of l7\ t_ All tanks anchored or 2' above flood elevation ENVIRONMENTAL DESIGN PARTNERSHIP, LLP. 900 Route 146 Clifton Park,NY 12065 (P)518.371.7621 (F)518.371.9540 edpllp.com Shaping the physical environment re June 22,2021 D L' I Town of Queensbury Building&Codes JUN 2 4 2021 742 Bay Road Queensbury, NY 12804 TOWN OF QUtENSBURY Attn: Dave Hatin, Charlie Dyer BUILDING&CODES Re: Rockhurst, LLC Residence Wastewater-10 Polk DriveP Dear Dave: In compliance with application approvals granted by the Town of Queensbury I offer the following regarding the referenced project. The design plans, prepared by this office and reviewed and approved by the Town as associated . with the wastewater system application, are as follows: Site Improvements For Rockhurst, LLC 10 Polk Drive. • Sheet S-1 Existing Conditions Sheet S-2 Wastewater System (revised May 12,2021) • Sheet S-3 Details AS B U I LT Dated: May 7, 2021 During the course of construction, I was on the job site to observe key components of the system installation. As you may recall this wastewater system will serve as a replacement system for the existing seasonal residence on the property. The Owner(Abele) intends to use this house for`a couple of summers' until making further improvements to the property. The proposed long term absorption field location and design has been incorporated into this initial design. In the future the septic tank and treatment/pump tank will be relocated to accommodate the future house location. In the meantime,we have a replacement system constructed for the existing seasonal residence which is compliant with the design/permit plan. I have attached a plan of the design layout which is labeled (and serves)as the'as-built' plan. We completed a system test to the pressurized distribution laterals on June 21st with the Town representative(CD) in attendance. Alarm systems were checked and determined functional. Floats and controls were set for system operation. Based on my inspection of the system start-up it is my opinion that the wastewater system is in compliance with the intent of the approved design plan,the subsequent as-built plans and is ready for operation. Also note that the start-up of this system satisfies the requirements of the Queensbury Transfer Law which should now result in the release of Mr.Abele's$2000 refundable deposit. Refer to the attached Extension Approval Resolution for 10 Polk Drive. Sincerely, Pevlvlis Mac:Elro4 Dennis MacElroy Cc: Chris Abele