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SEP-0466-2021
SEPTIC DISPOSAL PERMBT office Use Only Q APPLICATION Permit#• �o �' .l A-L - Z Z TO(m oECZeensbun• Permit Fee:$ 742 Bay Road,Queensbury,NY 12804 Invoice#:—" P:s18-761-8256 Flood Zone? Y Revlewe r&V-I — O� Project Location: 11 LINETTE LANE IDC�UN 16 2021Tax Map#: 308.10-1-33OF OUEENSBURYRESIDENCE INFORMATION: ®I 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-Present 110 4 110 440 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 EX12,90. gallons (min. size 1,000 gallons, add 250 gallons for"each'garbage cylinder or spa/hot tub EXISTING 1250 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 30 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 e Applicant: Name(s): LISA RYAN - Mailing Address, C/S/Z: 11 LINETTE LANE.QUEENSBURY,NY 12804 Cell Phone: Land Line: Email: © PrImara Qwner(s)o 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 oA ® 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' Camp documentation mast be submitted with this application** EngineerW.. 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 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:GEORG D OS SIGNATURE: DATE: �/(<J -'2, 1 Septic Application Revised January W21 TOWW OF QUEENSBURY 742 Bay Road, Queensbury, NY. 12804-5902 Septic System Checklist 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 N�v�®cam'V[ water line shown Municipal or well 10'separation to any part of system Ysetbackto property lines show 10'or more for any part of system N(—Septic tank and pump stations 10'from foundation 50'from any well/lake/wetland 10'from any waterline Septic 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) —�(Septic 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 Seepage pit 150'from well 50'from septic tank kD[Seepage Pits 3-times diameter apart 1 Septic tank and pump stations over 30 gallons 50'from watercourse or wetland distance from bottom of trench or syste 24" edrock or mottling 36"within 1000'of Lake George Leech field 100'from watercourse or wetland —IlToe 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 L��T F F(Zo i' TOR C� Department of Health Approval for all mobile home park new systems Flood Plain requirements �2' above established flood elevation to bottom of system All tanks anchored or 2' above flood elevation DEC0WE LUN16 2021 308.10-1-33 SEP-0466-2021 TOWN OF QUEENSEURY BUILDING&C(�D�S Ryan, Lisa F�L� COPS 11 Linette Ln Residential Septic Alteration f r f I f 3 3 � f I TOWN OF QIE BUILDING &Reviewed By Date: u CENTER PROJECT SERVICES 73 Sheridan Street,Glens Falls,NY 12801 Phone-518-796-2515 June 16,2021 Project#344 George Drellos Sanitary Sewer Service E Queensbury,NY 12804 D C E 0 I Re: Proposed Replacement Septic JUN 17 2021 11 Linette Lane, Queensbury,NY TOWN OF QUBENSBURY Dear George: BUi! ►r.; . .. CODES At your request, we have reviewed your proposed replacement septic system design of the existing 4-bedroom .house at 11 Linette Lane 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 440 GPD and a percolation rate of 1 to 5 minutes,you will need a minimum of 489 sf of absorption area. We recommend using 20 ft wide by 30 ft long absorption bed with 4 —25 ft long laterals. The absorption system can be constructed with the existing 1,250-gallon septic tank, new distribution box, and 4-inch diameter perforated pipe and stone. The absorption bed will require an air vent connected to the end of of the system due to the depth of the existing septic tank. Please feel free to contact me at 796-2515 if you have any questions and that you for your assistance with this request. Sincerely, 4 Thomas R. Center Jr,P.E. kBUILT 1 ---- 1.� Fs�- Ive 3 �9s P . fJy Jy'j