SEP-0743-2022 SEPTIC DISPOSAL PERMIT Office Use Only
APPLICATION Permit#:ow,
Town ofQucensbury T
Permit Fee:$
Invoice#:
742 Bay Road,Queensbury,NY 12804
P:518 761-8256 www.aueensburv.net F\IpOd Zone? Y R wed By: ��
Project Location: 23 CONNECTICUT AVE p C E 0 V E
Tax Map #: 309.13-1-55 DEC 2 7 2022
RESIDENCE INFORMATION: TOWN OF QUEENSBURY
Year Built Gallons #of bedrooms: X gallons per =total daily flow BUILDING& CODES
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 2 110 220 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: 1-51VIIN per minute per inch (test to be completed by a
licensed engineer/architect)
PROPOSED SYSTEM INFORMATION:
Tank size l000 gallons (min. size 1,000 gallons, add 250 gallons for each garbage cylinder or
spa/hot tub NEW 1000 GAL PRECAST CONCRETE TANK
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:10 FT X 35 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): BRIAN CASSANT
Mailing Address, C/S/Z: 23 CONNECTICUT AVE, 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: . i
Check if..all.wo,rk will be performed by property owner only
• Contractor:
Contact Name(s):SANITARY SEWER SERVICES
Contractor Trade:
Mailing Address, C/S/Z:LUZERNE RD, QUEENSBURY
Cell Phone: Land Line:518-796-3760
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. GEORGE DRELLOS
Cell Phone: Land Line: 518-796-3760
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 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 Ordina
PRINT NAME:GEORGE DREL S
SIGNATURE: 7DATE:
Septic Application Revised January 2021
TOWN OF QUEEVSBURY
742 Bay Road, Queensbury, NY. 12804-5902
Septic System Checklist
['1 Plan to scale
' Deep hole perc test results from engineer/Architect if applicable(Town Approved Engineers and
ec ived
Architects;June 30 to April 15 Town Engineer for unapproved Engineers and Architects)
KaAII wells on property and adjacent properties shown
water line shown Municipal or well 10'separation to any part of system
Setback 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
y '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' Septic'tank sized for number of bedrooms and add 250 gals for Jacuzzi tubs/garbage grinder each
'JLY_
Leech Field 20'from foundation 100'from any well 10'from water line
�eepage pit 150'from well 50'from septic tank
61- Seepage Pits 3-times diameter apart
f�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
I
Leech field 100'from watercourse or wetland
OkToe of mound or bottom of retainingwall 10'from property line 100'from well 20'from
Foundation
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Provide Engineer/Architect stamp for bed or design systems
��iDepartment of Health Approval for all mobile home park new systems Flood Plain requirements
2'above established flood elevation to bottom of system
P&AII tanks anchored or 2' above flood elevation
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BUILDING DEPARTMENT
Based on our limited examination,compliance
r with our comments shall not be construed as
indicating the pla! s and specifications are in
full compliance v�ith the Building Codes of
----�i Ne*York State.
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309.13"1"55 SEP-0743-2022
Cassant. Brian
23 Connecticut Ave
Residential Septic Alteration
tea,' ^ it'
SERVICES
73 Sheridan Street, Glens Falls,NY 12801
Phone-518-796-2515
December 20, 2022
Project# 387
George Drellos
Sanitary Sewer Service
Queensbury,NY 12804 EM
Re: Proposed Replacement Septic 23 Connecticut Avenue, Queensbury,NY
Dear George:
At your request, we have reviewed your proposed replacement septic system design of the
existing 2-bedroom house at 23 Connecticut Avenue 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 220 GPD and a percolation rate of
1 to 5 minutes, you will need a minimum of 245 sf of absorption area. We recommend using 10
ft wide by 35 ft long absorption bed with 3 — 30 ft long laterals. The absorption system can be
constructed with a new 1,000-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.
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