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SEP-0488-2022 ,., Offic e Use Only Permit#: mL&U- ZQ_.?.Z Permit Pee: 74 Say Road;,Queeiesbucy NY-128©4 Pi 518-76 -8256..www;g Lgenslsary,"e (nV01Ce.#.i 25 Flour!Zone? Y iy evlewed.`Sy: � SEPTIC.DISPOSAL OSAL PERMIT APPLICATION /� IEC E9W Project Location: Fq5 Yfo.1Qey ni AUG 0 4 2072 Tax:Map#: 2-7q , 1-7 ` 1-5fo TOWN QE QUEENSBURY BUILa94�C GOCtES RESIDENCE,INFORMATION Year Built : ..Gallons #of bedrooms;; ,X plions per ' =total daily flow . ...... per.day bedroom r Carbage..,.rineler: Yes No ► 1980 or.older 15o -- .: ._.]- Vto l a Instaitecl. (c►rcle„ono) 1981-1991 13© Spa:or Hot Tub ( Yes- .lVa lristallecfr circl.e;orze 1992-Present. T10 �... .. ) PARCEL`INFgRMITit?N; o .o .ra.. h - ` : . . :P.g. . p...y v"Flat Rolling Steep Slope- lope .. 1 5oil Nature Sand Loam: Cla 0 h..Lr,.:explain: Groundwater At what depth? id Bedrock/Impervious material At what depth? !f Dom" tic:Water.Supply Municipal Well: Iral�e. nro ,�r r� o,v S rF (if well of lake, water supply from any septic system absorp it n is. ft:) Percolation Test Rafe;: per rninute.per inch (test.to:be complet+�tl:by a I licensed.engineer/architect) PROPOSED SYSTEM._INFORMATIO _...._..,._....................:.......__._...,__,........:.........._.... _ Tank size goo gallons (miry:size gallons, add 250:galE:vns for:ea:ch:ga:rbage cylinder or spa/hot tub Sysfem .:- .Akscrption field w/92 stone Total length S® ft .Each.Trerich 5`t� . ft,. - _ . See a e p 'g Pit W #3 stone :How.many: . S• .. ... ........ Alternative S stem y Be or other type: H©Iding Tank System Total required capacity? tank size.. #of tanks: Septic Application Reed December 102o- CONTACT INFORMATION: PLEASE:PRINT LEGIBLY OR:TYPE,.PLEASE:1NCl:l�.DE::AN EMAIL Applicant::: Name(s): : T e.:s 5npyloc f drr.,`n Mailing Address; G/S/Z: e h 7—, le .A Cell Phone:.—(.S� }_ 7`t w"d-CS 6 Lanel Liner ( SP 4 79g �19 y Email: — • Rrimary Qwner.(sl: 1 o rle5s Names �� � Mailing Address; C/5jZ: - CeII Phone:_l cq ) . lO 93�_ '752,5' Land Line:: �( } Email• I A' l . C'o.1vl 0:Check Wall work will be"performed by property:owner:onlu' • Contractor: Cc)ntact Namels): Contractor Trade: ho 7 Maili,ng Address; +G . S'r '7 4lr��D�S (� Land i:irie: CeII Plone�.—�_.. _) Email: . eSA�Q/'P., ........ .... .... ' ' Workers' Comp documentation must:be submitted.v+`rith this.application.* • En ineer s : Name{s): ... Mailing.address, c/S/Z: Cell Phone:_� ) Land_Cine _( } Email:: ... Contact Person:for Campliance;in regards to this project:. Xp CeII.Phane: :°{ } Cane! Line: (. } . ._....... Email: NOTES:J,.:Alarm.system and associated electrical work.must-be inspected by.a:Tow.n::.ap... d::electr.ical irispection.agency; 2..We will po longer allow systems to tie.couered.:u:ntil such.time:`as:ah.as=built plan:is received and,approved. The installed system::must match the septic.layout on.filee .no:.exceptions:3::As- built drav�rings.must tie submitted prior to the.inspection, if there has"been;a-etiange to: h :: tibnittec) plans.4! if,.for any reason,the-buildirig permit application.is withdrawrt.100✓of the fee is'retain:ed by the Town of Queensbury. After 1.yearfrom the initial application date, 1OQ%af'the fee Is retained: Declaration: Any:'permit or approval granted which is.based upon or is granted in:.reliance.upon a.ny material ...... ................ _.. representation or failure too-make:a:rnaterial fact or circumstance known by or on behalf:of an applicant;shall:be: void. I have..react the regulations and:agree to abide by these and ali.requirements:Qf the.Town of abeensbury Sanitary.Sewage Disposal ordinance: PRINT: T NA{1tIE: R 54 i o le:v t — ' SIGNATURE: DATE. . <oy :202Z Septic Application .Revised DecemberJ020 TOWN OF QUEENSBURY 742 Bay Road, Queensbury, NY. 12804-5902 Septic System Checklist Plan to scale Received Deep hole perctest results from engineer/Architect if applicable.(Town Approved Engineers and Architects;June 30 to April 15.Town Engineer for unapproved Engineers and Architects) j All wells on property and adjacent properties shown Water line shown Municipal or well 10'separation to any part of system YSetbackto 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 for 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 Seepage pit 150'from well 50 from septic tank Seepage Pits 3-times diameter apart Septic tank and:pump stations over 30.9allons 50'from watercourse or wetland Distance from bottom of trench or system 24"to bedrock.or mottling 36"within 1000'of Lake George Leech field 100'from watercourse or wetland 1 (N 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 Department of Health Approval for all mobile home park new systems Flood Plain requirements V2'above established flood elevation to-bottom of system ALM tanks anchored or 2' above flood elevation - t —1�fl S I I I __. __ .i._. _�_ I_-. ___�__- .. _-- - ._ v! ._ _ ( _� _ C ► �I rdr, I lay ett I ! TO Y _ ��_._�_.__I__N..____�__i.___. _,_..__.__.___.4_.__I.....__'.__._ i.__ __►.__._,_�-. __ ► u R-Y-- BUI DIN DE PAR IVIE T I I C , ` 4 Rased_o -oour-Iimit d-e rein tiorfi;corn iarrce— __ _� 1 279-17-1-56 SEP-0488-2022 'A"N�our' om gent,, sha! not be crost ued 3s i indi atitl th f-plana p eilf tion re-,irr '' Flores, Dan full compliance w th t e B ildin Codes of —{ _..f... 12 East Rd I'`� •fir eta e —� _ `� _ _ I _ C i _._ _. _l I _I__t _ i� _ _ _�- _.� _ I Residential Septic Alteration r- f ... .... 1 1 �. a _ I -- 1 l f I __ .._� . ......._.. ,. I DUI ® 1 1 I ! ( i ! l l ► I I I Patine , I - _..._( ... :. . , .._�-... (_._..-.. .. 1_ _.J __ J, .. ,► ._._(....-. I . . _l f _..-�------. _ �. � _l _ , _ f I _ - I . _�---1___._i--__1_ i ► � I f_.._ __.... ® � C)c iv r L S8 0 ° 3 2 ' 3 5 " E 1 5 8 . 5 4 ' Residence Shed Shed Overhang Spilt Rail Fence Conc. Walk Deck Steps & Landing Gravel Driveway Spilt Rail Fence Wood Fence Post Edge Of Pavement E d g e O f P a v e m e n t Well Fireplace Conc. Pad 6' Stockade Fence 6' Stockade Fence Stone Retaining Wall Deck Conc. Pad Residence Garage Steps & Landing 6' Stockade Fence Utility Pole & Overhead Wires Guy Wire Guy Wire Garage Conc. P a d Wood Platform Elec. Meter Area = 0.55 ± acres East Road 4' Wire Fence DEED REFERENCE: 1.Conveyance to Serolf Group, LLC, by deed dated November 29, 2021, filed in the Warren County Clerks Office on December 15, 2021, in Book 6519 of Deeds at page 17. MAP REFERENCES: 1.Map entitled "Map of a Survey of Lands for Lee & Kathryn Horning", prepared by D.L. Dickinson, dated July 25, 1984, not filed, Darrah Land Surveying owns the records of D.L. Dickinson. MAP NOTES 1.Boundary information shown hereon was compiled from Map Reference 1, and an actual field survey conducted on December 1, 2022. 2.North orientation and bearing base per Map Reference 1. 3.Warren County tax parcel 279.17-1-56. 4.This survey was prepared without the benefit of an up to date abstract of title. 5.The location of underground improvements or encroachments, if any exist, or as shown hereon, are not certified. There may be other underground utilities, the existence of which are unknown. Size and location of all underground utilities must be verified by the appropriate authorities. The Underground Facilities Protective Organization must be notified prior to conducting test borings, excavation and construction. 6.Reproduction or copying of this document may be a violation of copyright law unless permission of the author and / or copyright holder is obtained. 7.A copy of this document without a proper application of the surveyor's embossed seal should be assumed to be an unauthorized copy. 8.Property corner monuments were not placed as a part of this survey unless otherwise noted. Iron Pipe Found In Concrete Iron Pipe Found Iron Pipe Found Iron Rod Found In Concrete Iron Pipe Found Iron Rod Found 4.7 ' ±2.7' ±4.9' ± 1.8 '± 2.4' 2.6' 13.3' N Map Refere n c e 1 Wood Fence Post D E E D L I N E D E E D L I N E D E E D L I N E N8 0 ° 3 9 ' 4 0 " W 1 2 6 . 0 6 ' N 80°39'40" W 26.60 N09° 33' 42"E 155.43' S11° 43' 51"W 155.39' 105.00' Deed Distance 105.00' Deed Distance Hewitt Road S u n n y s i d e N o r t h 105.03' Field Distance Approx. Site Location Not To Scale "ONLY BOUNDARY SURVEY MAPS WITH THE SURVEYOR'S EMBOSSED SEAL ARE GENUINE TRUE AND CORRECT COPIES OF THE SURVEYOR'S ORIGINAL WORK AND OPINION." UNAUTHORIZED ALTERATION OR ADDITION TO THIS DOCUMENT IS A VIOLATION OF SECTION 7209 SUBDIVISION 2 OF THE NEW YORK STATE EDUCATION LAW. SCALE : PROJ. NO: CHECKED: DRAFTED: DATE : APPROVED: Darrah Land Surveying, PLLC 59 Lake Avenue, Lake Luzerne, New York 12846 Voice: (518) 798-4692 or (518) 654-9416 SHEET: PROJ NO: Map of a Boundary Survey Lands Now or Formerly of Serolf Group, LLC TOWN OF QUEENSBURY WARREN COUNTY, NEW YORK 22341-1 1 OF 1 22341 DCD GCB DCD 22341 1"= 20' 12/14/22 N:\Project Files\2022\22341 Serolf Group_Florez\DWG\22341-1.dwg, 12/15/2022 1:53:53 PM, DWG To PDF.pc3