SEP-0377-2021 SEPTIC DISPOSAL PERMIT office use only
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APPLICATION Permit#: �2�- d37-7- Zo 2-
Town of CLccnsbury E M
D '° Permit Fee:$ $5 '
742 Bay Road,Queensbury,NY 12804
MAY .2 4 2021 I nvoice
P:518-761-8256 www.gueensburv.net eptic Variance? Y ICN
TOBUNLD NG&CODES Y
lood Zone? Y N
Wetlands? Y N Reviewed By:
Project Location: 6017 LAN
Tax Map #: 3c�t. /i� -Z -xi -
RESIDENCE INFORMATION:
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). ❑ 0
1981-1991 130 Spa or Hot-Tub Yes No
1992- resent 110 Installed? (choose one) ❑. ET
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_ ® Municipal ❑ ell ❑Lake
(if we1J or lake, water supply from any septic system absorption is
ft.) . . ..
Percolation Test ate: per minute per inch (test to be completed by a
licensed engineer/architect)..
PROPOSED SYSTEM INFORMATION:
Tank size 600 - gallons'(mih. size'1,obO gallons, add 250 gallons for each garbage cylinder or
spa/hot tub
System Absorption field w/#2 stone Total length F' ft.; Each Trench c ft.
Seepage Pit w/#3 stone How'm'any Size:
Alternative System Bed or.other type: L,_(2gw(,e-Sr *A9#6f
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
• A licant•
Name(s): L F MAI -F adlLP . rl '94r296w.; gA40S'r7C6?_t>
Mailing Address, C/S/Z: 7b 6410 AJ'r' 54rzq Toh d S (ZS(P 6,
Cell Phone: Land Line: 't'8'-' o'h..;7'SZ�;�(
Email: .,nn, ?, rir��c�•
• Primary Owner(s):
Name(s): &CA-MrAir C.
Mailing Address, C/S/Z: �Z Lt MvyLeivt /A (V-` 10tJ6G/J_r r//g' AJ� t F4
Cell Phone: �i P, 3zl �loLand Line:
Email: _ v r (o -�CW,-0_AA> , L6w1
❑ Check if all work will be performed by property owner only..
• Contractor:
Contact Name(s): S �,.'DGs IG lJ 4- 'Bu 1-D
Contractor Trade: 6--)E:NCi-LAr C.�CavL_
Mailing Address, C/S/Z: �'('�' (� (C-iu ��) S� (1s11 c b� S, r,)—C Z��
Cell Phone: l i 72 7 5322, Land Line: ht y--3b(. -Sz_3`(
E m a i l: r S r �n-)4z-
**Workers' Comp documentation must be submitted with this application**
•- Engineer(s):
Name(s): F_DW A�� IC• l-G �o I1J ��
Mailing Address, C/S/Z: V:1 C_ \n1�,Y'e A,�,) 6 e 0-9 L S
Cell Phone: fj t;o - -7 V y _ q t I Land Line:
Email: j21�1 Q L--�p Ck %k r. C_b w\�
Contact Person for Compliance in regards to this project:
Cell Phone: `J I �-.Z22.- S3z3 Land Line:
Email: Aav_,n�_,t s-sa S7 _c7eSi �„e v- • C ,�n,�
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:
LIZ
Septic Application Revised April 2021
TOWN OF Q UEENSB URY
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 prop�r^ttyy and adjacent properties shown
MOON
OON
_�(Water line show Municipal r ell 10'separation to any part of system
Setback to property lines show 10'or more for any part of system
1 Septic tank and pump stations 10'from foundation 50'from any well/lake/wetland 10'from any waterline
N 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
YLeech 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
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
eech field 100'from watercourse or wetland
Toe of mound or bottom of retainin w II 10'frcy roperty 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 i �.J4
All tanks anchored or 2' above flood elevation
77
AA N-,f-A IA',3
Edward K. Lapoint, PE Geo-technical & Structural Engineer
14 Hudson Ave.#307 Glens Falls,NY 12801 518-744-4411 /eklapointpe@gmail.com
August 1, 2022
Ben & Julia Rapple "Owners" E GC ' I
5 Timmons Lane
Queensbury, NY 12804 OCT 0 7 2022
Re: Inspection Report TOWN OF QUEENSBURY
Acceptable onsite septic system BUILDING&CODE.$
5 Timmons Lane, Queensbury, NY 12804
Dear Ben and Julia,
You have retained this Engineer"Edward K LaPoint" to inspect, evaluate, and provide
recommendations on the above referenced subjects. Specifically.
1. The as-built septic system at specified site is
a. In accordance with NYS Building code 75A. This engineer finds that the system
is in fact in excellent condition in falls within the requirements if not exceeds per
NYS Building Code 75A.
b. The as-built septic system in correlation to site-plan and septic system plans.
This engineer finds that the existing system was installed according to said plans
and is acceptable.
To conclude, this engineer finds the system has been installed correctly, structural
integrity is in excellent condition and advise that the owners proceed as planned.
Please contact this Engineer for any additional information and/or concerns.
�E OF NEkV
Sincerely, cjQ Pip KEfty� y9,f
m
Edward K. LaPoint, PE �o y a �2 � ZZ
._. A9OFESSIONP�'��
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