SEP-0551-2021SEPTIC DISPOSAL PERMIT office use Only
APPLICATION Permit#: 0 ':20 21
Totim of Queens6un•
Permit Fee:$
Invoice#:
742 Bay Road,Queensbury,NY 12804
P:518-761-8256 www.gueensbury.net Septic Variance? Y.
6_
N
Flood Zone?
Wetlands? Bx,
d
Project Location:44 Northwood Dr.
Tax Map#: 288.16-1-82
7Q
RESIDENCE INFORMATION:4 `.
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) . M
1981-1991 130 Spa or.Hot Tub Yes No
1992-Present 110 Installed?-(choose one El [4 110 440
PARCEL INFORMATION:'
Topography Flat Rolling Steep Slope Slope
Soil Nature Sand Loam Clay --Other; explain:
Groundwater At what depth? 8'+
Bedrock/Impervious material At what depth? 8'+
Domestic Water Supply Municipal, Well Lake
if well or lake;-water supply from any septic system absorption is
Percolation Test Rate: .2:00 _-.per:minute-per inch (test to be-completed by a
licensed engineer/architect)
PROPOSED SYSTEM INFORMATION:.
Tank size 1250 .. gallons (min. size 1,000 gallons, add 2.50 gallons for-each garbage cylinder or
spa/hot tub
System Absorption field w/#2 stone Total length 250 ft.; Each Trench 50 ft.
Seepage.Pit w/#3 stone How many: --- ; Size:
Alternative.System Bed.or.other type: ---
Holding Tank System Total-required capacity? ---tank size --- ;
of tanks ---
Septic Application Revised April 2021
CONTACT. INFORMATION:-PLEASE PRINT LEGIBLY.OR TYPE, PLEASE INCLUDE AN EMAIL
Applicant: ,
Name(s): Richard Baker
Mailing Address, C/S/Z: 44 Northwood Dr., Lake George NY 12845
Cell Phone: (518)232-6411 Land Line: (518)798-1119
Email:
Primary Owner(s): ,
Name(s): same as above -
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):.Crandall Excavating
Contractor.Trade:-. Excavation
Mailing Address, C/S/Z: 63'Woodchuck Hill Rd. Lake George, NY 12845
Cell Phone: (518) :470-4694 : Land Line: (518)793-0431
Email:
Workers' Comp documentation must be submitted-with this application"
Engineer(s): ...
Name(s : ----"
Mailing Address, C/S/Z:
Cell Phone: Land Line: -
Email:
Contact Person for Compliance in regards to this project: Chris Crandall
Cell Phone: (518)470-4694 Land,Line: (518)793-0431 „
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._t6be 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. I 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,per"nit 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 by1hese and all requirements`of'fhe Town of Queensbury
Sanitary Sewage Disposal Ordinance.
PRINT NAME: Chris Crandall
SIGNATURE: DATE: 7/15/21
Septic Application Revised April 2021
TOWT OF QUEENSBURY
742 Bay Road, Queensbury, NY. 12804-5902
Septic System Checklist
X116Plan to scale
Received Deep hol ,erc test esults 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
16Water line shown Municipal or well 10'separation to any part of system
9Setback to property lines show 10'or more for any part of system
l 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
t6 Leech Field 20'from foundation 100'from any well 10'from water line
L4 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
LAdistance from bottom of trench or system 24"to bedrock or mottling 36"within 1000'of Lake George
Leech field 100'from watercourse or wetland
A'Toe of mound or bottom of retaining wall 10'from property line 100'from well 20'from
Foundation
AtIA Provide Engineer/Architect stamp for bed or design systems
tAkDepartment of Health Approval for all mobile home park new systems Flood Plain requirements
2' above established flood elevation to bottom of system
it tanks anchored or 2'above flood elevation
FILLCOPY
TOWNOFQUEENSBURY
BUILDINGDEPARTMENT
Rasedonourlimitedexamination,compliance
withourcommentsshallnoi,hec ,tr-edas
indicatingtheplansandspgrein
fullcompliancewiththeBuildingCodesof
INewYorkState.
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4-ZD
TONOFQUEENSBURYCryZ_
BUILDING & CODIESDEP
ReviewedB
Date:
4,
288.16-1-82SEP-0551-2021 Baker, Richard
44NorthwoodDr
ResidentialSepticAlteration
Z6