IM Inspection Report (07-13-2021) SEPTIC DISPOSAL PERMIT Office Use Only
Permit#: SEP
-. L C EU
Town of 0,yecnsbun
pp�� Permit Fee:$ 85
MAY 2$ 2U21 Invoice#:
742 Bay Road,Queensbury,NY 1 804
P:518-761-8256 www. ueensb r . VVN OF Septic Variance? Y
BUILDING&&�OMESRY
Flood Zone? Y N
Wetlands? Y N Reviewed By:
Project Location: 7 and 9 Ivy loop,.Queensbury, NY
(mobile home and apartment)
Tax Map #: 289.10-1-24
RESIDENCE INFORMATION:
Year Built Gallons #of bedrooms: X gallons per =total daily flow
per day bedroom Garbage Grinder Yes No
1980 or older 150 4 130 520 Installed? (choose one) ❑ ✓❑
1981-1991 130 Spa or Hot Tub Yes No
1992-Present 110 Installed? (choose one) ❑ ❑✓
PARCEL INFORMATION:
Topography ❑✓ Flat Rolling ❑ Steep Slope % Slope
Soil Nature ✓❑ Sand ❑ Loam ❑ Clay ❑✓ Other, explain: cobblestone
Groundwater At what depth? 30 ft.
Bedrock/Impervious material At what depth?
Domestic Water Supply ❑ Municipal ❑✓ Well ❑Lake
(if well or lake, water supply from any septic system absorption is
100 ft.)
Percolation Test Rate:1 min 35secper minute per inch (test to be completed by a
licensed engineer/architect)
PROPOSED SYSTEM INFORMATION:
Tank size 1,250 gallons (min. size 1,000 gallons; add 250 gallons for each garbage cylinder or
(existing) spa/hot tub (existing 1,250 tank and drywell to be cleaned and remain, adding a 2nd drywell)
System Absorption field w/#2 stone Total length ft.; Each Trench ft.
Seepage Pit w/#3 stone How many: 2 ; Size: 8 ft x 4 ft
Alternative System Bed or other type: 4y10 - Buz
Holding Tank System Total required capacity? : tank size ;
# of tanks
3 (S 4
Septic Application Revised April 2021