SEP-0457-2022 SEPTIC DISPOSAL PERMIT Office Use Only
APPLICATION Permit#: P� "50r- 20 2-ex-
Town ofQvecnsbury Permit Fee:$
Invoice#:
742 Bay Road,Queensbury,IVY 12804
P:518-761-8256 www.gueensbury.net Septic Variance? Yrr--��
Flood Zone? Y VJI/
Wetlands? Y "'V Reviewed By: 6N
Project Location:
Tax Map #: U h .1T/- .
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RESIDENCE INFORMATION:
Year Built Gallons #of bedrooms: X gallons per =total daily flow TOWN OF QUFBNSBURY
per day bedroom ge n_derO��S Y s No
1980 or older 150 Installed? (choose one) ❑
1981-1991 130 Spa or Hot Tub Yes No
1992-Present 110 Installed? (choose one)yd
PARCEL INFORMATION:
Topography Flat Rolling ❑ Steep Slope % Slope
Soil Nature Sand ❑ Loam ❑ Clay ❑ Other, explain:
Groundwater At what depth?
Bedrock/Impervious material At what depth?
Domestic Water Supply Wwunicipal F Vell ❑Lake
(if well or lake, water supply from any septic system absorption is
ft.)
-17
Percolation Test Rate: per minute per inch (test to be completed by a
license engineer/architect)
PROPOSED SYSTEM INFORMATION:
Tank size gallons (min. size 1,000 gallons, add 250 gallons for each garbage cylinder or
spa/hot tub �,11,r/l
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:
Holding Tank System Total required capacity? ; tank size ;
# of tanks
Septic Application Revised April 2021
TOWN OF QUEENSBURY
BUIi_UNG DEPARTMENT
Based on our limiied examination,compliance
with our comments shall not be construed as
indicativig the plans and s,ecifications are in
full compliance with the uiiding Codes of ,
New York Stara. �i/+�f �l
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Date
308.14-1-52 SEP-0457-2022
Forest Park MHP
68 Briwood Cir
Residential septic alteration - tank only
—Y, NEwYORK Department
STATE OF
OPPORTUNITY. of Health
KATHY HOCHUL MARY T.BASSETT,M.D.,M.P.H. KRISTIN M.PROUD
Governor Commissioner Acting Executive Deputy Commissioner
July 20, 2022
Forest Park MHC, LLC �.
Attn: Joel Brown p
31200 Northwestern Hwy
Farmington Hills, MI 48334 JUL 20 2022
RE: Forest Park Mobile Home Court, Facility 56-6822 T®VIiN op QUSENSB
Replacement septic tank at 68 Briwood Circle BU/LDh'VG URy
Queensbury (T), Warren County
Mr. Brown:
We have this day, approved the plans and specifications for the above-referenced
project. Application for this project was duly made by Tyler Schrammel on Form DOH-
154. The project consists of replacing a collapsed metal septic tank with a new pre-cast
1,000-gal tank. Approval of these plans is conditioned on the following:
1. That the proposed works be constructed in complete conformity with the
approved plans or amendments thereto;
2. That all components of the proposed works be installed, operated, and
maintained as per the manufacturer's specifications;
3. That approval be granted by other agencies or municipalities have jurisdiction;
4. That the design professional inspects the construction and provides
certification to this office that construction was completed in accordance with the
approved plans. Certification shall also be provided to the Town Office Building
and Code Enforcement.
The responsibility for the design of the sanitary system lies solely with the design
professional and the proper operation of the sanitary system lies solely with the owner.
The purpose of the Department of Health review is for compliance with the New York
State Sanitary Code and in no way guarantees proper system operation. A set of
approved plans is being retained in our files.
Sincerely,
Brendan O'Connell
Engineer Trainee
Glens Falls District Office,77 Mohican Street,Glens Falls,NY 12801,518-793-38931 gfdo@health.ny.gov
JUL Z 2 2
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