SEP-0272-2022 1
SEPTIC DISPOSAL PERMIT Office use Only
APPLICATION Permit#: �P_
To»a of Quecnsbun ��
Permit Fee:$
f - -�-�, � � � � Invoice#: b�
742 Bay Road,Qaeensbury,NY 12NP:518-761-8256 www. ueensbuPet Flood Zon ? Y �N�/ Reviewed y-
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TOWN OF QUEENSBURY
Project Locatio : 13 B,.�,gUK,P,HIRE TEER,Fi,4CE
Tax Map#: 308.18-1-8
RESIDENCE INFORMATION:
Year Built Gallons #of bedrooms: X gallons per =total daily flow
per day bedroom Garbage Grinder Yes IVo
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 Vsand V 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
Percolation Test Rate:1-5MI.N per minute per inch (test to be completed by a.
licensed.,engineer/architect),
PROPOSED SYSTEM INFORMATION:
Tank size 1250 gallons (min, size 1,000 gall ons, 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 Hove many: Size:
Alternative System Bed or other type:20 FT X 30 FT
Holding Tank System Total required capacity? tank size ;
#of to n ks- -
Septic Application Revised January 2021
CONTACT INFORMATION: PLEASE PRINT LEGIBLY OR TYPE, PLEASE INCLUDE AN EMAIL
• Applicant: ..
Name(s):ROBERT ROSSELL.
Mailing Address, C/S/Z:'13 BROOKSHIRE,TERRACE,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 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 factor circumstance known by or on behalf of an applicant,shall be
void. I have read the regulatio d agree to abide.by these.and all requirements of the Town of Queensbury
Sanitary Sewage Disposal in ce.
PRINT NAME:GEORGE E S
SIGNATURE: DATE:
Septic Application Revised January 2021
TO WN OF Q UEENSE UR.Y
742 Bay Road, Queensbury, NY. 12804-5902
Septic -System -Checklist
NO—Plan to scale
h[�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)
lyaAll wells on property and adjacent properties shown
%Water line shown Municipal or well 10'separation to any part of system
19Setback to property lines show 10' or more for any part of system
16Septic tank and pump stations 10'from foundation 50'from any well/lake/wetland 10' from any waterline
MASeptic 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)
1-6Septic tank sized for number of bedrooms and add 250 gals for Jacuzzi tubs/garbage grinder each
MLeech Field 20' from foundation 100'from any well 10' from water line
Seepage pit 150'from well 50'from septic tank
Seepage Pits 3-times diameter apart
!6Septic tank and pump stations over 30.gallons 50'from watercourse or wetland
NLkd' istance from bottom of trench or system 24"to bedrock or mottling 36" within 1000' of Lake George
Leech field 100'from watercourse orwetland
J-r►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
&A-Department of Health Approval for all mobile home park new systems Flood Plain requirements
R2' above established flood elevation to bottom of system
WAll tanks anchored or 2' above flood elevation
Revised 4/15/2021
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TOWN
TOWN OF QUEENSBURY
BUILDING & CODE F_ ?
Reviewerl y'
Date:
Q
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TOWN OF QUEEN BURY
J BUILDING DEPART MENT
Based on our limited examin- ion,compliance
with our comments shall not 3e construed as
indicating the plans and sppe ifications are in
full compliance with the B ilding Codes of
New York State.
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308.18-1-8 SEP-0272-2022
Rossell, Robert
13 Brookshire Terr
Residential Septic Alteration
73 Sheridan Street, Glens Falls,NY 12801
Phone-518-796-2515
May 8,2022
Project#366
George Drellos
Sanitary Sewer Service
Queensbury,NY 12804
Re: Proposed Replacement Septic
13 Brookshire Terrace, Queensbury,NY
Dear George:
At your request, we have reviewed your proposed replacement septic system design of the
existing 4-bedroom house at 13 Brookshire Terrace 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.
Please feel free to contact me at 796-2515 if you have any questions and that you for your
assistance with this request.
Sincere FTOWN
E ��Thomas R. Center Jr,P.E. �f=OUEENSBURY1NI � GODBS
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