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SEP-0653-2023 SEPTIC DISPOSAL PERMIT Office Use Only "-a APPLICATION `�.;JP -D(c>5 - 2023 Permit#: Timm of0.ueensbury Permit Fee:$ "' Invoice#: (0(o 52-- 742 Bay Road,Queensbury,NY 12804 P:518-761-8256 www.queensbury.net Septic Varianc: No Flood Zone? Wetlands? N. - Reviewed By: (A S Project Location: 2 D 1E C E DV IE Tax Map#: i 0q h cam-- I - L 5 OCT 13 2023 1")) RESIDENCE INFORMATION: TOWN OF QUEENSBURY Year Built Gallons #of bedrooms: X gallons per =total daily flovy _BUILDING &CODES per day bedroom Garbage Grinder Yes No 1980 or older 150 Installed? (choose one) ❑ 1981-1991 130 130 39(2 Spa_or Hot,Tub Yes No 1992-Present 110 Installed? (choose one) ❑ Q" PARCEL INFORMATION: Topography 4Flat Rolling ❑ Steep Slope % Slope Soil Nature Sand ❑ Loam ❑ Clay ❑ Other, explain: Groundwater At what depth? Bedrock/Impervious material At what depth? Domestic Water Supply cl2Municipal ❑ 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: Tank size /r W 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 ZOO ft.; Each Trench ,S-0 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 Septic Application Revised July 2022 CONTACT INFORMATION: PLEASE PRINT LEGIBLY OR TYPE, PLEASE INCLUDE AN EMAIL • Applicant: Name(s): �`��rr�4►.,5 S e 4-art, Mailing Address, C/S/Z: Cell Phone: Land Line: Email: • Primary Owner(s): Name(s): to ��,M,,•;;,�� Mailing Address, C/S/Z: i, te—i f e erg Cell Phone: (9t1 )90 . lc\ Land Line: Email: ❑ Check if all work will be performed by property owner only • Contractor: Contact Name(s): M ro 1, Contractor Trade: Mailing Address, C/S/Z: Cell Phone r ec1 1957-gtel3. Land Line: Email: **Workers' Comp documentation must be submitted with this application** • Engineer(s): Name(s): 1 AL e Mailing Address, C/S/Z: `*' Cell Phone: Land Line: ( S£cy-I3°° Email: Contact Person for Compliance in regards to this project: Luc/ Cell Phone: (cli6 TS-7—ieici 7 Land Line: Email: 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: L✓ e � SIGNATURE: < DATE: hini'L Septic Application Revised July 2022 l� TOWN OF QUEENSBURY � � 742 Bay Road, Queensbury, NY. 12804-5902 Septic System Checklist jce'..Srian to scale Received Deep hole perc test results from engineer/Architect if applicable(Town Approved Engineers and rchitects;June 30 to April 15 Town Engineer for unapproved Engineers and Architects) ill`fAll wells on property and adjacent properties shown (1-dWater line shown Mun_icl or well 10'separation to any part of system r C itS Setback to property lines show 10'or more for any part of system t- Septic tank and pump stations 10'from foundation, 50'from any well/lake/wetland, 10'from any waterline ASeptic 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) teAeptic 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 Nj47Seepage Pits 3-times diameter apart (I Septic tank and pump stations over 30 gallons 50'from watercourse or wetland L£4 'Distance from bottom of trench or system 24"to bedrock or mottling 36"within 1000'of Lake George -tS Leech field 100'from watercourse or wetland q-41-oe 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 61 xJ6 Department of Health Approval for all mobile home park new systems Flood Plain requirements 2'above established flood elevation to bottom of system /L) All tanks anchored or 2' above flood elevation • \\F:rn • '1i\) ‘ef-m � r f- co (_ • D Box _ - A 64-"‘. ''' _ _ . 1� 1 A is " 0 R • - • J GENERAL NOTES: 1 SITE PLAN 40'-0"= 1'-0" rn 50'-011 O -00 DISTRIBUTION n BOX z_ _z o � I CD 0 N I EXISTING 1000 GAL. SEPTIC TANK TO REMAIN. PROPOSED SEWER LINE HOME I „ I � I TOPSOIL FOR SETTLING EARTH BACKFILL UNTREATED BUILDING. PAPER OR STRAW —CRUSHED STONE OR WASHED GRAVEL DISTRIBUTOR PIPE - 6'-0" O.C. 00 BEDROCK, IMPERVIOUS LAYER OR EVIDENCE OF HIGHEST LEVEL OF GROUND WATER. 24' LEACH FIELD SECTION N.T.S. CAP END LATERALS SLOPE TRENCH BOTTOM 1/16" - 1/32" PER FOOT CRUSHED STONE OR WASHED GRAVEL 3/4" TO 1 1 /2" NOTE: TRENCH BOTTOM TO BE LEVEL NOTE: LENGTH AND LAYOUT OF FIELD SHALL BE BASED ON DESIGN PERCOLATION SYSTEM BY QUALIFIED ENGINEER AND CALCULATIONS SHALL BE PROVIDED TO CITY ENGINEER. PROVIDE SPACE FOR SECOND LEACH FIELD AREA EQUAL TO FIRST, LEACH FIELD SECTION N.T.S. SOIL PROFILE: 0"-2" TOPSOIL, 2"-60" OAKVILLE FINE SAND GROUND WATER: NO SEASONAL HIGH GROUND BEDROCK: NONE ENCOUNTER ENCOUNTERED PERCOLATION HOLE: 24" DEEP, 12" DIA TEST DATA: #1 RUN # Time PERK TEST DATA: 1 6 MIN 2 6 MIN SOIL TEST AND PERCOLATION TEST WAS PERFORM ON SITE TAAII! KI/ITCC• 1. EXISTING TANK TO REMAIN 1000 GAL. SEPTIC TANK 2. INLET AND OUTLET TEES SUPPLIED BY CONTRACTOR AND TO BE SEALED WITH A NON -SHRINK MORTAR. 3. ALL INVERT ELEVATIONS AND GRADES ARE REFERENCED FROM T.B.M. 4. 4" DIA. HIGH DENSITY POLYETHYLENE PIPE SEALS PROVIDED AT ALL PIPE CONNECTIONS SHOWN 5. THERE ARE INLET KNOCKOUTS ON THREE SIDES FOR 4" DIA. PIPE. SEPTIC NOTES 1. SANITARY FACILITIES MAY BE CONSTRUCTED ONLY AFTER TOWN OF QUEENSBURY "PERMIT TO CONSTRUCT" HAS BEEN ISSUED. THESE FACILITIES SHALL NOT BE PLACED IN OPERATION UNTIL HARLAN-MCGEE OF NORTH AMERICA INSPECTS THE SYSTEM AND PROVIDES CERTIFICATION THAT THE SYSTEM HAS BEEN INSTALLED IN CONFORMANCE WITH THE APPROVED PLANS. 1. NO ROOF, FLOOR FOOTING, COOLING WATER, BACKWASH DRAINS, ETC. SHALL BE CONNECT TO THE SEWAGE TREATMENT SYSTEM AND ALL DISCHARGES SHALL BE DIRECTED AWAY FROM TREATMENT AREA. 2. NO VEHICULAR PARKING OR TRAFFIC SHALL BE ALLOWED ON ANY PORTION OF THE SEWAGE TREATMENT SYSTEM. TANK WEIGHT, LBS. TOP BOTTOM TOTAL SIZE LIQUID INLET OUTLET OUTSIDE SECTION SECTION WEIGHT GALLONS LEVEL HEIGHT HEIGHT TANK HEIGHT 1000 5-0" 1 5'-10" 5'-7" 6-10" 1 6120 5600 11,720 SEPTIC SYSTEM DESIGN CRITERIA BEDROOMS -3 DESIGN FLOW -390 GPD. PERCOLATION RATE - 6 MIN. REQUIRED TRENCH -195 LF 4 LINE OF 4" PERFORATED PVC PIPE @ 50-LINE -200 LF PROVIDED SEWER CONSTRUCTION, INCLUDING MATERIALS SHALL COMPLY WITH THE APPLICABLE SECTIONS OF THE NEW YORK STATE UNIFORM FIRE PROTECTION AND BUILDING CODE CONTAINED IN NYCRR, PARTS 903 THROUGH 907, INCLUSIVE, AND PART 1250. REQUIRED RETENTION TIME I SET AT TWO DAYS. DAILY FLOW MULTIPLIED BY 2 EQUALS THE DESIRED SEPTIC TANK SIZE. 330 gpd. X 2 DAYS = 660 GALLONS. A 1000 GALLON TANK IS REQUIRED. DO NOT REMOVE ANY MATERIAL FROM THE AREA OF THE LEACHFIELD. DO NOT EXCAVATE ANY MATERIAL FROM THE LEACHFIELD BASAL AREA. MAINTAIN REQUIRED SEPARATION FROM GROUNDWATER INTERFACE. HARLAN-MCGEE OF NORTH AMERICA, THE DESIGN ENGINEER, MUST INSPECT, APPROVE, AND CERTIFY THIS INSTALLATION. ALL STRUCTURES SPECIFIED TO BE MANUFACTURED BY THE FORT MILLER COMPANY OR EQUAL. INLET 10-0 12" CRUSHED STONE OR PEA GRAVEL BED SECTION - DISTRIBUTION BOX N.T.S. 1. CONTRACTOR SHALL CHECK AND VERIFY ALL CONDITIONS AT THE SITE PRIOR TO STARTING OF THE WORK AND HE SHALL FAMILIARIZE HIMSELF WITH THE INTENT OF THOSE PLANS AND MAKE WORK AGREE WITH THE SAME. 2. CONTRACTOR SHALL OBTAIN ALL REQUIRED APPROVALS, PERMITS, INSPECTION APPROVALS, ETC. FOR WORK PERFORMED FROM AGENCIES HAVING JURISDICTION THEREOF. 3. SEWER CONSTRUCTION, INCLUDING MATERIALS, SHALL COMPLY WITH THE APPLICABLE SECTIONS OF THE FIRE PROTECTION AND BUILDING CODES AND DEPARTMENT OF HEALTH REGULATIONS. 4. IF IN THE COURSE OF CONSTRUCTION A CONDITION EXISTS WHICH DISAGREES WITH THAT AS INDICATED ON THESE PLANS, THE CONTRACTOR SHALL STOP WORK AND NOTIFY THE ARCHITECT. SHOULD HE FAIL TO FOLLOW THIS PROCEDURE AND CONTINUE WITH THE WORK, HE SHALL ASSUME ALL RESPONSIBILITY AND LIABILITY ARISING THEREFROM. 5. THE CONTRACTOR SHALL_ TAKE ALL NECESSARY PRECAUTIONS TO PROTECT AND PRESERVE EXISTING UTILITIES. 6. SIZE AND LOCATION OF ALL UNDERGROUND UTILITIES ARE SUBJECT TO VERIFICATION BY THE CONTRACTOR BEFORE CONSTRUCTION BEGINS. 7. THE CONTRACTOR SHALL NOTIFY RESPECTIVE UTILITY COMPANIES AT LEAST 72 HOURS PRIOR TO THE START OF EXCAVATION FOR VERIFICATION OF THE LOCATION OF UNDERGROUND UTILITIES. 8. IT SHALL BE THE CONTRACTOR'S RESPONSIBILITY TO MAINTAIN EXISTING UTILITY SERVICES ENCOUNTERED AND RESTORE ANY SERVICES DAMAGED OR INTERRUPTED BY NEW WORK. IT IS RECOMMENDED THAT THE CONTRACTOR CAREFULLY EXCAVATE TO LOCATE EXISTING UTILITIES AND VERIFY LOCATION PRIOR TO PERFORMING NEW WORK WHICH MAY CONFLICT. 9. NO ATTEMPT HAS BEEN MADE TO SHOW ANY BURIED TELEPHONE AND CABLE TV OR SIMILAR FACILITIES WHICH MAY BE PRESENT ON THE SITE. CONTRACTOR SHALL VERIFY CONDITIONS WITH ALL UTILITY COMPANIES. 10. WHERE WORK IN PUBLIC ROADS OR ACCESS ROADS MAY INTERFERE WITH NORMAL TRAFFIC FLOW, CONTRACTOR SHALL PROVIDE AND MAINTAIN TRAFFIC CONTROL. 11. CONTRACTOR SHALL RESTORE ALL AREAS DAMAGED OR DISTURBED BY CONSTRUCTION TO THEIR ORIGINAL CONDITIONS. 12. THE CONTRACTOR SHALL NOTIFY U.F.P.O., INC. (1-800-962-7962) FOR VERIFICATION OF THE LOCATION OF UNDERGROUND UTILITIES AT LEAST 72 HOURS PRIOR TO THE START OF EXCAVATION. 13. CONTRACTOR SHALL COMPLY WITH CONSTRUCTION INSPECTION REQUIREMENTS AND PHASE WORK ACCORDINGLY. 14. HARLAN-MCGEE OF NORTH AMERICA (HMNA) AND/OR THE DESIGN ENGINEER HAS BEEN RETAINED TO PERFORM OR PROVIDE ANY PROJECT INSPECTIONS, APPROVALS, CERTIFICATIONS, OR CONSTRUCTION OBSERVATION SERVICES, AS RELATED TO THE CONSTRUCTION OF THIS PROJECT. 15. ALL WELLS LOCATED WITHIN 200' OF THIS PLAN TABLE 2 SEPARATION DISTANCES FROM WASTEWATER SYSTEM COMPONENTS TO STREAM,LAKE, SYSTEM WELL OR DWELLING PROPERTY COMPONENTS SUCTION LINE WATERCOURSE LINE OR WETLAND HOUSE SEWEEIR 25' IF CAST IRON 25' 10, 10, (WATERTIGHT JOINTS) 50' OTHERWISE SEPTIC TANK 50' 50' 10, 10, EFFLUENT LINE TO 50, 50' 10, 10, DISTRIBUTION BOX DISTRIBUTION BOX 150' 150' 20' 10, ABSORPTION `=1ELD 150, 150' 20' 10, NYS DEPARTMENT OF HEALTH NOTES 1. THERE SHALL BE NO DEVIATION FROM THESE PANS DURING CONSTRUCTION WITHOUT PRIOR APPROVAL OF HARLAN-MCGEE OF NORTH AMERICA (HMNA) AND THE NYS DEPARTMENT OF HEALTH (NYSDOH). 2. THE MATERIALS AND SPECIFICATIONS NOTED ON THE PLANS MUST BE UTILIZED UNLESS ALTERNATES ARE ACCEPTED AND APPROVED IN WRITING BY A LICENSED DESIGN PROFESSION AND NYSDOH REPRESENTATIVE. 3. PRIOR TO EXCAVATING, CONSULT THE UNDERGROUND FACILITIES PROTECTIVE ORGANIZATIONS. 4. THE ELECTRICAL EQUIPMENT INSTALLED ACCORDING TO THIS PLAN MUST BE NEVV YORK STATE BOARD OF FIRE UNDERWRITERS CERTIFIED x 309.5-1-25 SEP-0653-2023 Cummings, Beth 8 Wintergreen Rd Residential Septic Alteration iGVJN OF a`rP�RTMENT BEJII.DtNG G'- inatiorl, compi'' vpents sha,i noare based on our I�m'Ited cxam t be canstru With our c�the plans and s gui dm codes lr,:'.;Icata�9liancethe tuii GOrr1p State. NeW York TOWN OF QUEENS: BUILDING & CODES UtH I - R.evlewcrr� Y.a t FILE� FORT MILLER �s��Y CONCRETE PRODUCT DISTRIBUTION BOX DETAIL DISTRIBUTION BOX N.T.S. Cz 07 W z CV W CV d U 7- r 07 � 4 t� O � >- 00 L0 ® U) z - ot� L0 LJJ I- x LU N cu z 2E O z CO W 0 r 4 co U cU N ^ CO m L N N a U iT5 o z W� r—•1 w 0 cit [1E U E OCT 13 2023 TOWN OF QUEENSBURY BUILDING & CODES M~� � o � w W P� ~ NOTE: HARLAN-MCGEE of NORTH AMERICA HAS NOT BEEN RETAINED TO PERFORM OR PROVIDE ANY PROJECT INSPECTIONS, APPROVALS, CERTIFICATIONS, OR CONSTRUCTION OBSERVATION SERVICES, AS RELATED TO THE CONSTRUCTION OF THIS PROJECT. IF IN THE COURSE OF CONSTRUCTION A CONDITION EXISTS WHICH DISAGREES WITH THAT AS INDICATED ON THIS PLAN, THE CONTRACTOR SHALL STOP WORK AND NOTIFY THE ARCHITECT 8 ENGINEER OR ASSUME ALL RESPONSIBILITY AND LIABILITY ARISING THEREFROM. COPYRIGHT © 2020 BY HARLAN-MCGEE of NORTH AMERICA ALL RIGHTS RESERVED. THIS DOCUMENT AND ALL ATTACHMENTS ARE THE PROPERTY OF HARLAN-MCGEE of NORTH AMERICA. ANY UNAUTHORIZED WITHOUT THE PERMISSION OF HARLAN-MCGEE IS STRICTLY PROHIBITED AND THE REPRODUCTION, TRANSLATION OR COPYING OF ANY PART OF THIS WORK BEYOND THAT PERMITTED BY SECTION 107 OR 108 OF 1976 UNITED STATES COPYRIGHT ACT WITHOUT THE PERMISSION OF THE COPYRIGHT OWNER, HARLAN-MCGEE, 15 UNLAWFUL. ALL REQUESTS FOR PERMISSION OR FURTHER INFORMATION SHOULD DE ADDRESSED TO: HARLAN-MCGEE of NORTH AMERICA 4000 SILVER BEACH RD., MALTA, NY 12020 DRAWING: WATER WANE DESIGN SCALE: AS NOTED DRAWN BY: E G DATE: 10.01.2023 PROJECT NO. HMNA23-10 DRAWING NO. rz ERNES`T J fa11 C5F2, P.E. PAGE 1 OF 1 HM Forensic Engineers • Scientists Harlan-McGee of North America Malta Ridge Professional Building 4000 Silver Beach Road • Malta,New York 12020 TOWN OF QUEENSBURY CERTIFICATE OF CONSTRUCTION COMPLIANCE To: Town Engineer This will certify that the approved wastewater disposal system for the building located at 8 Wintergreen Road, Queensbury,New York, was installed in accordance with the terms and conditions of the Permit to Construct, Certificate of Approval and approved plans, and amendments thereto. The system was successfully dye tested and is operational. q15 1- Si rely, � or, . . 2�' P.E. #059460 n [ C E q V NO .�.,�� � U cto�ier 2023 OCT 2 7 2023 TOWN OF QUEENSBURY BUILDING-&CODES Phone: (518)584-1300 Fax: (518)584-1374 Email:info@harlan-mcgee.com :--. --„__ f rsli ill - — I z — J - _ - J - - 1 - _[3. _ - - --- ---- -- ::. _____:A...6eci_i _ . .. _ , r _ 13 / _ - -- _ . - • IECEUVE As Built Sketch I-R:11 ' OCT 272023 TOWN OF QUEENSBURY BUILDING&CODES