SEP-0420-2022 SEPTIC DISPOSAL PERMIT office•useOnllyy��p.
_ APPLICATION Permit#:
Town of ouc s ry Q
Permit Fee:$ g5
Invoice#: I y
742 Bay Road,Queensbury,NY 12804
P:518-761-8256 www.gueensbury.net Septic Variance? Y G
�Flood Zone? Y
Wetlands? Y Reviewed By:
Project Location: 51 Mason Road
IF
Tax Map #: 226.16-1-19
9 JUL 0 5 2022
RESIDENCE INFORMATION: . I ` N
Year Built Gallons #of bedrooms: X gallons per =total dailyl'floWd A'i, s Cai 11__F=n.PPi ll V i
per day bedroom s �i�l 66i?6age*Uff,d'er Yes No-
1980 or older 150 Installed? (choose one) ❑ [�
1981-1991 130 - Spa or Hot Tub Yes No
1992-Present 110 3 110 330 Installed? (choose one) ❑ [�
PARCEL INFORMATION:
Topography Flat Rolling ❑ Steep Slope % Slope
Soil Nature ❑ Sand [0 Loam ❑ Clay ❑ Other, explain:
Groundwater At what depth? .
Bedrock/Impervious material At what depth?
Domestic Water Supply ❑.Municipal V Well ❑Lake
(if well or lake, water supply from any septic system absorption is
ft.)
Percolation Test Rate: per minute per inch (test to be completed by a
licensed engineer/architect)
'PROPOSED SYSTEM INFORMATION: - Existing septic tank & field to remain
Tank size 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:
Holding Tank System Total required capacity? ; tank size ;
# of tanks
Existing Septic Tank and Field to remain - Pump Station replacement ONLY
Septic Application Revised April 2021
CONTACT INFORMATION: PLEASE PRINT LEGIBLY OR TYPE, PLEASE INCLUDE AN EMAIL
• Applicant:
Name(s): William Wetherbee
Mailing Address, C/S/Z: P.O. Qdy253 Cleverdale. NY 12820
Cell Phone: = Land Line:
Email:
• Primary Owner(s):
Name(s): William B. Wetherbee Trust
Mailing Address, C/S/Z: P.O. Box 253 Cleverdale, NY 12820
Cell Phone: Land Line:
Email:
0 Check if all work will be performed by property owner only
• Contractor:
Contact Name(s): Crandall Excavating
Contractor Trade: Installation
Mailing Address, C/S/Z: 63 Woodchuck Hill.Road Lake George, NY 12845
Cell Phone: 518-470-4694 Land Line:
Email:
"Workers' Comp documentation must be submitted with this application"
• Engineer(s):
Name(s): Hutchins Engineering PLLC
Mailing Address, C/S/Z: 169 Haviland Road QueensbUW, NY 12804
Cell Phone: Land Line: 518-745-0307
Email: tutchins@hutchinsengineerinq.corn
Contact Person for Compliance in regards to this project:
Cell Phone: Land Line:
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'.ekceptiom. 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: G. Thomas Hutchins, .E. AGENT)
SIGNATURE: ( b DATE: 7/5/22
Septic Application Revised April 2021
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
4�:' Water line shown Municipal or well 10'separation to any part of system
CW`Aetback to property lines show 10'or more for any part of system
e"ptic tank and pump stations 10'from foundation 50'from any well/lake/wetland 10'from any waterline
f✓.
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)
44 Septic tank sized for number of bedrooms and add 250 gals for Jacuzzi tubs/garbage grinder each
i✓ Leech Field 20'from foundation 100'from any well 10'from water line /I
-h4eepage pit 150'from well 50'from septic tank
Oseepage Pits 3-times diameter apart
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
r/�ALeech field 100' from watercourse or wetland
N Toe of mound or bottom of retaining wall 10'from property line 100'from well 20'from
Foundation
Provide Engineer/Architect stamp f ems
1- '' Department of Health Approval for all mobile home park new systems Flood Plain requirements
d4b 2' above established flood elevation to bottom of system
1-J6 All tanks anchored or 2' above flood elevation
12—A—A A/1 ;/7n71
LAKE ! i
GEORGE
///� — — �•.� — — `_ LANDS N/F OF
—1_ — — M DREAM, LLC
183 7.0'
'�- :. 1V81
LANDS NIP OF
WMIAM B WE'TEERBEE TRUST
LAKE WATER SUPPLY
LANDS N/F OF
ROBERT EVANS
LAKE HATER SUPPLY
�P sE�ACK
PUMP STATION REPLACEMENT PLAN
SCALE. 1"--10'
GRAPHIC SCALE
5 0 2.5 5 10 20
( IN FEET )
CONTRACTOR TO FIELD VERIFY LOCATIONS AND DISTANCES
THIS IS NOT A FIELD SURVEY.
SETBACK7
UAW ATI EXIS71 G WASTEWATER l /
ABSORPTION FIELD /
a /
0
10' P.L- SET, 9ACK '•/
--
—
EXTENSION TO
WPER RESISTANT
(NON —TRAFFIC
-.AS)
LIFTING CABLE OR CHAIN
118" PER FOOT
MIN. SLOPE
"
EFFLUENT SEWER
ALARM 3" ABOVE
'PUMP ON'
PUMP ON
PUMP OFF
VOLUME OF DOSE TO
BE 40-50f GALLONS
FLOAT SWITCHES —
INSTALL INSIDE PUMP PIT
IN LOCATION ACCESSIBLE
WITHOUT PIT ENTRY
MAP REFERENCE:
1. BASE MAP INFORMATION FROM WARREN COUNTY CIS, AERIAL
PHOTOGRAPHY, AND FIELD MEASUREMENTS. THIS IS NOT A FIELD
SURVEY. ALL LOCATIONS ARE APPROXIMATE CONTRACTOR TO
FIELD VERIFY ALL SETBACKS PRIOR TO BEGINNING INSTALLATION.
2. NORTHERN NEIGHBORING PROPERTY INFORMATION FROM "MAP OF
LANDS OF ANGELA M. AND ROBERT P. KLADIS, SHOWING THE
LOCATION OF THE RESIDENCE, LOCATED ON AUGUST 7, 1997," IN
THE TOWN OF QUEENSBURY, WARREN COUNTY, NEW YORK. DATED
AUGUST 7, 1997. PREPARED BY COULTER & MCCORMACK
LICENSED LAND SURVEYORS.
3. SOUTHERN NEIGHBORING PROPERTY INFORMATION FROM "MAP OF
LANDS BELONGING TO ROBERT L. EVANS, IN THE TOWN OF
QUEENSBURY, WARREN COUNTY, NEW YORK. DATED JUNE 19,
1989. LAST REVISED AUGUST 11, 1993. PREPARED BY COULTER &
MCCORMACK LICENSED LAND SURVEYORS.
WASTEWATER SYSTEM SETBACK REQUIREMENTS
PROPERTY LINE
HOUSE
STREAM, LAKE,
WATERCOURSE,
WETLAND
WELL
SEPTIC TANK
10'
10'
50'
50'
ABSORPTION FIELD
10'
20'
100'
100'
16" MIN.
4'0 PRECAST CONCRETE
MANHOLE USED AS
PUMP STATION
INSTALL FLOAT SWITCHES TO
OPERATE PUMP AND MAINTAIN
LEVELS AS INDICATED
PUMP STATION DETAIL
SCALE. NTS
SITE LOCATION -' LOCATION MAP
1-1/2"
FORCEMAIN
BALL VALVE
EXTERIOR WEATHERPROOF JUNCTION BOX (IF NECESSARY).
SEAL CONDUIT GAS TIGHT. INSTALL CONTROL PANEL IN HOUSE.
ALL ELECTRICAL WORK TO BE INSPECTED BY A CERTIFIED
ELECTRICAL INSPECTION AGENCY PRIOR TO START—UP OF PUMP
STATION.
TRANSITION TO 4"
OUTSIDE OF D—BOX
12" MIN. COVER
DISTRIBUTION BOX
,' CONCRETE BAFFLE
USE SPEED LEVELERS TO
ASSURE ALL OUTLETS ARE AT
EXACTLY THE SAME ELEVATION 2" MIN. DROP
4" PVC SOR-35 SOLID HEADER TO BETWEEN INVERTS
ABSORPTION LATERALS, 1/8" PER
FOOT MIN SLOPE
1-112" SCH-40 PVC PIPING INSIDE WET
PUMP STATION NOTES
WELL THROUGH WALL
SEAL ALL TANK OPENINGS WATERTIGHT.
UNION — LOCATE SUCH THAT UNION
CAN BE DISCONNECTED AND PUMP
PROVIDE AND INSTALL UL LISTED PACKAGED PUMP
REMOVED WITHOUT TANK ENTRY
CONTROL PANEL WITH VISUAL AND AUDIBLE ALARM.
REDUCING TEE POINTED DOWNWARD WITH 1"
INSTALL SIMPLEX, DEMAND DOSE CONTROL PANEL
BALL VALVE THROTTLED TO ALLOW TRICKLE
INSIDE HOUSE IN ACCESSIBLE LOCATION.
DRAIN BACK INTO WET WELL
INSTALL POWER & CONTROL WIRING TO CONTROLLER
BALL CHECK VA*MIN OF QUEENSBURY
DEPARTMENT
WIN ALARM IN HOUSE IN ACCORDANCE WITH
GOULDS WE03L INS comp fiance
MANUFACTURER'S INSTRUCTIONS AND NA1i0NAL
Based on our limited examination,
trued an
not bfica#
ELECTRIC CODE (N.E.C.) REQUIREMENTS.
with our Comments plans and ors are
indicating P Codes 0f
the uilding
PUMP CONTROL AND FLOAT LEVELS TO BE INSTALLED
full compliance with
TO PROVIDE A 40-50 GALLON DOSE.
EFFLUENT PUMP TO BE GOULDS PUMPS WE SERIES,
R TO FIELD
r%WERIFFY
MODEL WE03L SUBMERSIBLE EFFLUENT PUMP 113 HP,
MP STATION
230 VOLT, 1PH
REQUIRED
VERIFY EXISTING ELECTRICAL SERVICE PRIOR TO
PURCHASING PUMP.
ALL ELECTRICAL WORK TO BE INSPECTED BY A
CERTIFIED ELECTRICAL INSPECTION AGENCY PRIOR TO
�� COPY
� P 3
START—UP OF PUMP STATION.
Ll
1' � 4
BURY•
�Lj
226.16-1-19 � 6
Wetherbee, Willia IL 9 CODES DEFT` JUL 0 5 2022 x
51 Mason Rd B. TOip�i r. EUER r Y
Residential Septic AI n `l ��'� rl `' �. ..
TAX MAP # 226.16-1-19
Dig (Safely.
New/.York
■ Call Before You Dig
■ Wait The Required Time
■ Confirm Utility Response
■ Respect The Marks
■ Dig With Care
800.962-7962
www.dirmfeiynewyork.com
2' MIN.
LANDS N/F OF
— M DREAM, LLC
,gip L'�JBACK
\ SHED
PUMP STATION REPLACEMENT PLAN
SCALE. I"--10'
GRAPHIC SCALE
5 0 2.5 5 10 20
( IN FEET )
CONTRACTOR TO FIELD VERIFY LOCATIONS AND DISTANCES
THIS IS NOT A FIELD SURVEY.
RECORD DRAWING DIMENSIONS
TABLE
CORNER "A"
CORNER "B"
PUMP STATION PORT
26'
13.5'
MAP REFERENCE:
1. BASE MAP INFORMATION FROM WARREN COUNTY GIS, AERIAL
PHOTOGRAPHY, AND FIELD MEASUREMENTS. THIS IS NOT A FIELD
SURVEY. ALL LOCATIONS ARE APPROXIMATE. CONTRACTOR TO
FIELD VERIFY ALL SETBACKS PRIOR TO BEGINNING INSTAH AWON.
2. NORTHERN NEIGHBORING PROPERTY INFORMATION FROM "MAP OF
LANDS OF ANGELA M. AND ROBERT P. KLADIS, SHOWING THE
LOCATION OF THE RESIDENCE, LOCATED ON AUGUST 7, 1997," IN
THE TOWN OF QUEENSBURY, WARREN COUNTY, NEW YORK. DATED
AUGUST 7, 1997 PREPARED BY COULTER & MCCORMACK
LICENSED LAND SURVEYORS.
J. SOUTHERN NEIGHBORING PROPERTY INFORMATION FROM "MAP OF
LANDS BELONGING TO ROBERT L. EVANS, IN THE TOWN OF
QUEENSBURY, WARREN COUNTY, NEW YORK. DATED JUNE 19,
1989. LAST REVISED AUGUST 11, 1993. PREPARED BY COULTER &
MCCORMACK LICENSED LAND SURVEYORS.
WASTEWATER SYSTEM SETBACK REQUIREMENTS
PROPERTY LINE
HOUSE
STREAM, LAKE,
WATERCOURSE,
WETLAND
WELL
SEPTIC TANK
10'
10'
50'
50'
ABSORPTION FIELD
10'
20'
100'
100'
SITE LOCATION --I LOCATION MAP
EXTERIOR WEATHERPROOF JUNCTION BOX (IF NECESSARY).
SEAL CONDUIT GAS TIGHT. INSTALL CONTROL PANEL IN HOUSE.
ALL ELECTRICAL WORK TO BE INSPECTED BY A CERTIFIED
ELECTRICAL INSPECTION AGENCY PRIOR TO START-UP OF PUMP
STATION.
TRANSITION TO 4" 12" MIN. COVER
OUTSIDE OF D-BOX DISTRIBUTION BOX
CONCRETE BAFFLE
1-112" USE SPEED LEVELERS TO
L�FORCEMAIN ASSURE ALL OUTLETS ARE AT
EXACTLY THE SAME ELEVATION
BALL VALVE 4" PVC SDR-35 SOLID HEADER TO
ABSORPTION LATERALS, 118" PER
FOOT MIN SLOPE
F
16" MIN.
1. d
4'0 PRECAST CONCRETE
MANHOLE USED AS
PUMP STA71ON
INSTALL FLOAT SWITCHES TO
OPERATE PUMP AND MAINTAIN
LEVELS AS INDICATED
PUMP STATION DETAIL
SCALE. NTS
1-1/2" SCH-40 PVC PIPING INSIDE WET
WELL THROUGH WALL
UNION - LOCATE SUCH THAT UNION
CAN BE DISCONNECTED AND PUMP
REMOVED WITHOUT TANK ENTRY
REDUCING TEE POINTED DOWNWARD WITH 1"
BALL VALVE THROTTLED TO ALLOW TRICKLE
DRAIN BACK INTO WETWELL
BALL CHECK VALVE
GOULDS WE03L PUMP
W
TO FIELDSTATIONUIRED
A REPRESENTATIVE OF OUR OFFICE VISITED THE SITE
DURING CONSTRUCTION AND IT IS MY OPINION THAT
THE SYSTEM IS INSTALLED IN GENERAL CONFORMANCE
WITH THE APPROVED PLAN AND THIS RECORD
DRAWING. FINAL SURFACE FINISHING AND TURF
ESTABLISHMENT IS ONGOING
G. THOMAS HUTCHINS, P.E.
71512023
EM Call Before You Dig
Wait The Required Time
IM Confirm Utility Response
EM Respect The Marks
IM Dig With Care
800-962-7962
www.digsafelynewyork.com
2" MIN.
2" MIN. DROP
BETWEEN INVERTS
PUMP STATION NOTES
SEAL ALL TANK OPENINGS WATERTIGHT.
PROVIDE AND INSTALL UL LISTED PACKAGED PUMP
CONTROL PANEL WITH VISUAL AND AUDIBLE ALARM.
INSTALL SIMPLEX, DEMAND DOSE CONTROL PANEL
INSIDE HOUSE IN ACCESSIBLE LOCATION.
INSTALL POWER & CONTROL WIRING TO CONTROLLER
IMTH ALARM IN HOUSE IN ACCORDANCE WITH
MANUFACTURER'S INSTRUCTIONS AND NA71ONAL
ELECTRIC CODE (N.E.C.) REQUIREMENTS.
PUMP CONTROL AND FLOAT LEVELS TO BE INSTALLED
TO PROVIDE A 40-50 GALLON DOSE.
EFFLUENT PUMP TO BE GOULDS PUMPS WE SERIES,
MODEL WE03L SUBMERSIBLE EFFLUENT PUMP 113 HP,
230 VOLT, 1PH
VERIFY EXISTING ELECTRICAL SERVICE PRIOR TO
PURCHASING PUMP.
ALL ELECTRICAL WORK TO BE INSPECTED BY A
CERTIFIED ELECTRICAL INSPECTION AGENCY PRIOR TO
START-UP OF PUMP STATION.
INSTALLATION DATE: 612912023
INSTALLED BY - CRANDALL EXCAVATING, INC
TAX MAP # 226.16-1-19