SEP-0697-2022 IdOM.0%kh, SEPTIC DISPOSAL PERMIT office Use Only
APPLICATION Permit#: 3&P— Okc°i
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Town ofQuccnstiury Permit Fee:S 6�r=r
Invoice#: �.
742 Bay Road,Queensbury,NY 12804
P:518-761-8256 www.gueensbury.net Septic Varianc ? No
Flood Zone?
Reviewed B
Project Location: 12 Hewitt Road
Tax Map #: 279.17-1-55 NOV 2 1 2022
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RESIDENCE INFORMATION: BUILD G&ECUDESRy
Year Built Gallons #of bedrooms: X gallons per =total daily flow
per day bedroom Garbage rl er Yes No
1980 or older 150 2 150 300 Installed? (choose one) ❑ 0
1981-1991 130 Spa or Hot Tub Yes. No
1992-Present 110 Installed? (choose one) ❑ 0
PARCEL INFORMATION:
Topography Flat Rolling ❑ Steep Slope % Slope
Soil Nature ❑■ Sand ❑ Loam ❑ Clay ❑ Other, explain:
Groundwater At what depth? None
Bedrock/Impervious material At what depth? None
Domestic Water Supply ❑ Municipal ❑■ Well ❑Lake
(if well or lake, water supply from any septic system absorption is
100 ft.)
Percolation Test Rate: per minute per inch (test to be completed by a.
licensed'engineer/architect)
PROPOSED SYSTEM INFORMATION:
Tank size 1000 gallons (min. size 1,000 gallons, add 250 gallons for each garbage-cylinder or
spa/hot tub
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: Infiltrator Quick 4 36
Holding Tank System Total required capacity? ; tank size ;
# of tanks
Septic Application Revised July 2022
TOWN OF QUEENSBURY
742 Bay Road, Queensbury, NY. 12804-5902
Septic System Checklist
Plan to scale
Received Deep hole pert 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
X).'V
water line shown Municipal or well 10'separation to any part of system
Xsetback to property lines show 10'or more for any part of system
,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 fo r 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
Aseepage pit 150'from well 50'from septic tank
Seepage Pits 3-times diameter apart
14—Septic tank and pump stations over 30 gallons 50'from watercourse or wetland
distance from bottom of trench or system 24"to bedrock or mottling 36"within 1000'of Lake George
IfiLeech field 100'from watercourse or wetland
jvl—Toe 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
dLDepartment of Health Approval for all mobile home park new systems Flood Plain requirements
c 2'above established flood elevation to bottom of system
WAII tanks anchored or 2'above flood elevation
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BUILDING&CODE $V*
-6 SEP-0692022 7 -1-5 29.175 rI1_5 JJ I .i � i �r I i' �� '
--------- Ball Rentals LLC
12 Hewitt Rd
Residential Septic Alteration
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