SEP-0237-2023 ,
-- SEPTIC DISPOSAL PERMIT Office use only
APPLICATION Permit#:�—/y z3 7— 2G 3
Torre ofQueenssbury Permit Fee: $ �w0
—invoice#: ( � 0�
742 Bay Road,Queensbury,NY 12804 � ply
P:518-761-8256 www.gueensburV.net l hood Zone? Y I� ewed By:
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Project Location: 4 BENNE T RO �DN Q si4E1=P1�'
Tax Map #: 295.14-1-27.2
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) X
1981-1991 130 Spa or Hot Tub Yes No
1992-Present 110 3 110 330 Installed? (choose one) X
PARCEL INFORMATION:
Topography ✓ Flat Rolling Steep Slope % Slope
Soil Nature Sand Loam Clay Other, explain:
Groundwater At what depth? GREATER THAN 6 FT
Bedrock/Impervious material At what depth? GREATER THAN 6 FT
Domestic Water Supply Municipal Well Lake
(if well or lake, water supply from any septic system absorption is
ft.)
Percolation Test Rate: 1-5MIN per minute per inch (test to be completed by a
licensed engineer/architect)
PROPOSED SYSTEM INFORMATION:
Tank size EX.1000 gallons (mina size 1,000 gallons, add 250.gallons for each garbage cylinder or
spa/hot tub EX. 1000 GAL CONCRETE
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:20 FT X 30 FT
Holding Tank System Total required capacity? ; tank size ;
# of tanks
Septic Application Revised January 2021
CONTACT INFORMATION: PLEASE PRINT LEGIBLY OR TYPE, PLEASE INCLUDE AN EMAIL
• Applicant:
Name(s): BRANDON STOCKWELL
Mailing Address, C/S/Z: 4 BENNETT RD. QUEENSBURY,NY 12804
Cell Phone: Land Line:
Email:
• Primary Owner(s):
Name(s): SAME AS APPLICANT
Mailing Address, C/S/Z:
Cell Phone: Land Line:
Email:
Check if all work will be performed by property owner only
• Contractor: -
Contact Name(s):SMITHS EXCAVATING
Contractor Trade:
Mailing Address, C/S/Z: QUEENSBURY
Cell Phone: Land Line:518-361-0956
Email:
"Workers' Comp documentation must be submitted with this application"
• Engineer(s):
Name(s): CENTER PROJECT SERVICES
Mailing Address, C/S/Z:73 SHERIDAN STREET, GLENS FALLS NY 12801
Cell Phone: Land Line:
Email:
Contact Person for Compliance in regards to this project: FRED SMITH
Cell Phone: Land Line: 518-361-0956
Email:
(VOTES: 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:FRED S 1I
SIGNATURE: ✓ I DATE:
Septic Application Revised January 2021
(awTOWN OF QUEENSBURY
742 Bay Road, Queensbury, NY. 12804-5902
Septic System Checklist
lly--ISPlan 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) Q-r4,f_ ��,, (l/✓,
All wells on property and adjacent properties shown y%,�I cr P"
Water line shown Municipal or well 10'separation to any part of system
�SSetback 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
.1l.,/ 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)
�i-Cleptic 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 waterline
4seepage pit 150'from well 50'from septic tank
41--seepage Pits 3-times diameter apart
Septic tank and pump stations over 30 gallons 50'from watercourse or wetland
'r- Distance from bottom of trench or system 24"to bedrock or mottlin 36" within 1000'of Lake George
�/Leech field 100'from watercourse or wetland
tAToe 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
,lam Department of Health Approval for all mobile home park new systems Flood Plain requirements
AJ 6 2' above established flood elevation to bottom of system
All tanks anchored or 2' above flood elevation
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Z) 295.14-1-27.2 Sep-0237-2023
Brandon Stockwell
4 Bennett Rd.
Residential Septic Alteration
WATER PROJEdW
SERVICES
73 Sheridan Street, Glens Falls,NY 12801
Phone-518-796-2515 _
D r- C E _ = �� April 18, 2023
Project 4 394
Fred Smith � ��'
Smiths Excavating
Queensbury,NY 12804 TOM-4 OF QiJ;- 3BURY
Re: Proposed Replacement Septic
4 Bennett Road, Queensbury,NY
Dear Fred:
At your request, we have reviewed your proposed replacement septic system design of the
existing 3-bedroom house at 4 Bennett Road in Queensbury. As per our conversation the
residence has an existing failed septic system.
We have reviewed the proposed replacement septic system design and we agree that a standard
absorption bed is acceptable. Based upon a design flow rate of 330 GPD and a percolation rate of
1 to 5 minutes, you will need a minimum of 367 sf of absorption area. We recommend using 20
ft wide by 30 ft long absorption bed with 4 — 25 ft long laterals. The absorption system can be
constructed with the existing 1000-gallon septic tank, new distribution box, and 4-inch diameter
perforated pipe and stone.
Please feel free to contact me at 796-2515 if you have any questions and that you for your
assistance with this request.
Sincerely,
Thomas R. Center Jr, P.E.
295.14-1-27.2 Sep-0237-2023
Brandon Stockwell
4 Bennett Rd.
Residential Septic Alteration
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295.14-1-27.2 Sep-0237 2023
Brandon Stockwell