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SEP-0768-2023 IIIL SEPTIC DISPOSAL PERMIT Office Use Only APPLICATION Permit#: Town of Quccnsbury 5ECEBVIE —N Permit Fee:$ '5PD 742 Bay Road,Queensbury,NY 12804 DEC 05 2023 Invoice#: (Q'c 5 P:518-761-8256 www.queensbury.net Septic Variance. TOWN OF OUEENSSURY BUILDING &CODES Flood Zone? Wetlands? INO � ��Reviewed By: ' Project Location: Li 14e le I., tie;vt C` Tax Map #: 30I . (2 — I — `1a 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) ❑ Rv' 1981-1991 130 4 s2 O Spa or Hot Tub Yes No 1992-Present 110 Installed? (choose one) ❑ PARCEL INFORMATION: Topography [flat Rolling ❑ Steep Slope % Slope Soil Nature „r-Sand ❑ Loam ❑ Clay ❑ Other, explain: Groundwater At what depth? 0 Bedrock/Impervious material At what depth? .0 Domestic Water Supply rj,frilunicipal ❑ 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 IZSo gallons (min. size 1,000 gallons, add 250 gallons for each garbage cylinder or spa/hot tub Noe K;h5 To ix:s )(..49 „ 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: /1'c - 2 t( Ih .• Itya fey Holding Tank System Total required capacity? ; tank size # of tanks �1 Rvn 5 !o F# Septic Application A^r 1 ifra ivv5 'Pa C I'jp w Revised July 2022 rh , , CONTACT INFORMATION: PLEASE PRINT LEGIBLY OR TYPE, PLEASE INCLUDE AN EMAIL • Applicant: Name(s): -e5 iepi4c. •t O f4:0 Mailing Address, C/S/Z: 2 Lower Warren CI Cell Phone: Si$- 196-0 '4 Land Line: Sty- 7Q '- V 9 V Email: (25Lr)p/er u7 i bsfelitc .(a,. • Primary Owner(s): Name(s): R,;: leg t C"r f q Mailing Address, C/S/Z: l7 I!ke I.e, Or ivf. Cell Phone: Sil- 44151- S, 7 ict Land Line: Email: rjj512y ! fniti, i •Ccal" ❑ Check if all work will be performed by property owner only • Contractor: Contact Name(s): 1'85 SPPi, 1- Org y Contractor Trade: 5e I-.c 4- Ph 641h.4' Mailing Address, C/S/: Z Lowpbe k/Q► e- I 1- Cell Phone: ft 46- -7 9 6-o etc 6 Land Line: ct .- WI—TM Y Email: 6)54,rier 9 ibScofi r.(e. **Workers' Comp documentation must be submitted with this application** • Engineer(s): Name(s): Mailing Address, C/S/Z: Cell Phone: Land Line: Email: Contact Person for Compliance in regards to this project: ERic. Y. `7 ti,Q/e, Cell Phone: S-r46- 7 tap'O%S-(o Land Line: 'it'S - ?44-48/c1y Email: to5i,'p1ey o1 , bccep i(.c•(c.,.., • 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: E'' Atc a. 'jti,'Q lP y SIGNATURE: V_• e g DATE: 12l1 12 3 �� Septic Application Revised July 2022 • ~ ro I,rE 1�.• 3 • Q E1TSB I,IRY '• 742 Bay Road, Queensbury,NY. 12804-5902 • • • Septic System Checklist • • Plan 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) g • / 3A11 wells on property and adjacent properties shown • 196Water fine show Municip or well 10'separation to any part of system il-.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 anywaterline • • '("-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) '1 4Septic tank sized for number of bedrooms and add 250 gals for Jacuzzi tubs/garbage grinder each • -/g Leech Field 20'from foundation 100'from any well 10:from water line Q", Seepage pit 150'from•well 50'from septic tank • MA Seepage Pits 3-times diameter apart I f Septic tank and pump stations over 30 gallons 50'from watercourse or wetland • 1- distance from bottom of trench or system 24"to bedrock or mottling 36"within 1000'of Lake George it(4 Leech field 100'from watercourse or wetland /", oe of mound or bottom of retaining wa1110'from property line 100'from well 20'from Foundation tAb Provide'Engineer/Architect stamp for bed or design systems • Department of Health Approval for all mobile home park new systems Flood Plain requirements • ND 2'above established flood elevation to bottom of system • 1"V All tanks anchored or 2'above flood elevation i 1 L 1 , i 1 i taDPI : . 1 , , . 1 1 . 1 i i i i 1 1 1 I _1 i I i —I---i .; i_ ' 1---I i__ - _i i----1 ji il :1-11 ----I. — ig --"n 1 ! i 1 ! ! i_ L 1 , REvLs : 11 0 1 1 1 , _. -FILE_QOPY OrliFificil - 01,5 ' i , , li - - = ' -- -. = '; L - i 1 L___ J___ _I _L_ ' 1 1 .__) J II 1 1 nrsi ,,..-. -1 r !I 1 1111 1 1---TOWN-OF-QUE- B _,'St" 1 --I 1-11-111 211,-.9 , „Al 1 , i 1L_, ii _J__ 1 I ' 0110/171"50 Vtliart:01: Av7 _ '‘i 1 I,__ ,...i , ' --, —LI_______J 1 _1 BUILDING-8, D ! - TO\AIN d F,:1-'11.r:ri 1,:S EU NY i 1- _ , 1 1 J i II::!,77.7_,I,•,,,..f ,J7-s,‘7.-:-:-......„- ii—— ----1!- -i—Reviewed,BI 1 1 ____J ' -to F.' . 1 1 1 1 ire.- e I t-P-r.re — i___' — ______ , : ! ! ill ! ____ , _I I J i_ J I I _,.. ____ __,_..,_.L.. 1---- ----j r 1 r 1 I I rl I I I I I ! I —- _ _____J _1 ___JI I I _i Xi abl Fi' dr--e /14,411-ereit-;ihre i 1404,6 e I __ __ iI 1 L_ -Got.It'ari,c i Ir.-Wri-i-P, 14 te.irq I r4141..,e 'S I_ 1 itt 4 fit.-‘5 Liol 4r--, — - J 1 ' 1 1 1 1 ' r I I , ,,, • ii-.4. , ,.., , I J I 1 V 1 _L___ __I ifik IA, rice .ffl 1 i 1 I __J L__ tr_ v _Iii_dro___i C7i.6 s.. Irt ill kS tie:4C_ Pi 1 1 1 T 4, /iVi i- IIJi I , I .L__J i 0 ____I i____I_____i J 1 ', 4. _1 VI,f 1 1 1 IL____, J ,, , , -— , , , . i . _ _ i , : , FT I L 1 i I i -t 1_,_ I i 301.12-1-49 SEP-0768-2023 1 1 tv i I Currie, Rujirat i , , ; I 1 , e i - _J I V 1 17 Helen Dr ----- , -,--1 Residential Septic Alteration _i___ , ! i . , _ } , . --, --- -- , - ' . , 1 1 1 I , , , , , a—M. ----a- 1-9-- -111,-- MMISM-.maa•Ma + I ' -sav- a Alarril Ili Arc 24 TM by INFILTRATOR THE ARC 24 CHAMBER BY INFILTRATOR spy'a Leaching chambers are rapidly becoming the product of choice for leachfield ,;_-• ,...,,,..... ,. ` = applications over conventional pipe and gravel systems.Their lightweight construction '�. offers lower installed costs and less intrusive installations. �.4 • ,.,,., :-.Qverlocking Ends t t + \ 1 1 V r` a v',3.\ :A 't\ 1.\ ,1 ,.\ ‘,; k 11 Zr ENGINEERED FOR OPTIMAL PERFORMANCE (, :IV f , r. The Arc 24 septic leaching chamber is a sturdy, lightweight plastic unit #" that combines maximized infiltrative surface area and storage capacity 1 '14 with an improved structural design to handle most any conventional leachfield system challenge without sacrificing performance. - Side Port Coupler FEATURES & BENEFITS: • Injection-molded from High Density Polyolefin for lightweight and sturdy design. ;' ._ _ Diamond ;: ,_ ,, ,,r Plate Texture • 10-degree integral articulating joint that is ideal for either straight or ,,,,, contoured septic leachfield applications. • Corrugated chamber design provides increased load bearing capability in the trench , • Designed to accommodate both gravity-fed and pressure-dosed , • systems. = i • "Post and Dome"joint provides a more positive connection during 4�r installation and backfill. I SI,�_ 1E-r:::a • A universal inlet/outlet end cap. • Inspection vent ports on every unit with easy-to-remove knockouts for \ 1 \ ' ' %'� maximum job site flexibility. ' = • Convenient five-foot lengths are easy to handle. ',vim,+'♦ • Quickly installed by one person into two-foot wide trench or bed 1 sios.� applications. '' ; // • Increased plumbing option with Side Port Coupler component which snaps in ° / place to allow side entry at any joint throughout trench line. - • --- • Diamond plate texture increases slip resistance and enhances ease of installation. Louvers and Feet Call Infiltrator at(800)221-4436 or visit www.infiltratorwater.com for more information. a CeSITM by INFILTRATOR Arc 24 Chamber and Endcap (EFFECTIVEF-"1- 60" LENGTH) I ; — I \ (0 22" Arc 24 CHAMBER CHAMBER REQUIREMENTS Length 67"(1,702 mm) Chamber shall meet the load rating of H-10(16,000 lb per axle)with a minimum of Effective Length 60"(1,524 mm) 12 inches of cover when tested in accordance with IAPMO PS 63 and installed in accordance with manufacturers installation procedures. Sidewall Height 8.5"(216 mm) Overall Height 12"(305 mm) CHAMBER CONNECTION Overall Width 22"(559 mm) Each chamber shall interlock with an integral articulating joint.Articulating joints Weight 13 lbs shall have a free range of horizontal rotation of 20 degrees,with a maximum of 10 degrees in either direction.Articulating joint shall be constructed by placing the Total Bottom Area 7.96 sq ft dome with previously—installed chamber,with final engagement occurring when the Capacity 5 cu ft(37.5 gal) lower base flanges of the incoming chamber under-lap the raised base flanges of the previously-installed chamber. INFILTRATOR WATER TECHNOLOGIES STANDARD LIMITED WARRANTY (a)The structural integrity of each chamber,endcap and other accessory manufactured Warranty coverage are damage to the Units due to ordinary wear and tear,alteration, by Infiltrator(collectively referred to as"Units"),when installed and operated in a leach- accident,misuse,abuse or neglect of the Units; the Units being subjected to vehicle field of an onsite septic system in accordance with Infiltrator's installation instructions, traffic or other conditions which are not permitted by the installation instructions;failure is warranted to the original purchaser("Holder")against defective materials and work- to maintain the minimum ground covers set forth in the installation instructions;the manship for one year from the date upon which a septic permit is issued for the septic placement of improper materials into the system containing the Units;failure of the system containing the Units;provided,however,that if a septic permit is not required for Units or the septic system due to improper siting or improper sizing,excessive water the septic system by applicable law,the one(1)year warranty period will begin upon the usage,improper,grease disposal,or improper operation;or any other event not caused date that installation of the septic system commences.In order to exercise its warranty by Infiltrator.This Limited Warranty shall be void if the Holder fails to comply with all of rights,Holder must notify Infiltrator in writing at its corporate headquarters in Old Say- the terms set forth in this Limited Warranty. brook,Connecticut within fifteen(15)days of the alleged defect.Infiltrator will supply replacement Units for those Units determined by Infiltrator to be defective and covered Further,in no event shall Infiltrator be responsible for any loss or damage to the Holder, by this Limited Warranty.Infiltrator's liability specifically excludes the cost of removal the Units,or any third party resulting from installation or shipment,or from any product and/or installation of the Units. liability claims of Holder or any third party.For this Limited Warranty to apply,the Units must be installed in accordance with all site conditions required by state and local (b)THE LIMITED WARRANTY AND REMEDIES IN SUBPARAGRAPH(a)ARE EX- codes;all other applicable laws;and Infiltrator's installation instructions. CLUSIVE.THERE ARE NO OTHER WARRANTIES WITH RESPECT TO THE UNITS, INCLUDING NO IMPLIED WARRANTIES OF MERCHANTABILITY OR FITNESS FOR A (d)No representative of Infiltrator has the authority to change this Limited Warranty in PARTICULAR PURPOSE. any manner whatsoever,or to extend this Limited Warranty.No warranty applies to any party other than the original Holder. (c)This Limited Warranty shall be void if any part of the chamber system(chamber, endcap or other accessory)is manufactured by anyone other than Infiltrator.The The above represents the standard Limited Warranty offered by Infiltrator.A limited Limited Warranty does not extend to incidental,consequential,special or indirect number of states and counties have different warranty requirements.Any purchaser of damages.Infiltrator shall not be liable for penalties or liquidated damages,including Units should contact Infiltrator's corporate headquarters in Old Saybrook,Connecticut, loss of production and profits,labor and materials,overhead costs,or other losses or prior to such purchase,to obtain a copy of the applicable warranty,and should carefully expenses incurred by the Holder or any third party.Specifically excluded from Limited read that warranty prior to the purchase of Units. 4 Business Park Road P.O.Box 768 Old Saybrook,CT 06475 860-577-7000•Fax 860-577-7001 INFILTRATOR 1-800-221-4436 water technologies www.infiltratorwater.com•info@infiltratorwater.com U.S.Patents:8322948;8337119;8297880;7914230;7008138.Other patents pending.Infiltrator,Quick4 and¢flow are registered trademarks of Infiltrator Water Technologies.Infiltrator Water Technologies is a wholly-owned subsidiary of Advanced Drainage Systems,Inc.(ADS). ©2022 Infiltrator Water Technologies,LLC.Not responsible for any typographic errors.Printed in U.SA. ARC24 0522 Contact Infiltrator Water Technologies' Technical Services Department for assistance at (800) 221-4436 v—, v 01 y1 1� ��L 11 I ��G ���a�-1 I �J � I 1 � t-1- '� . 1 I I l _ I I n• � — —1 I 1 —C _l I ! -%, ,7a,„___LH lE. '" I 1 1 I S2i � ?D 1 L PT\ J TN � — r _, L f d 1 J l_ 4 1 ininers II 1 .,) t.„ ,,, , „5,0fi . .) I -- 1 1---- _Li-- ' H A ' IT) H____ 11 ' L I 7 f--2Y)-tir.-1,11 - - �4-jigz _ boy 4 -31„17 )y Dip s, t O I i �— i `�n � L—H'--k 1 _ I ' ITr.' b4-051-17—)) 1 -,D-A-1;_ft_,H_ p — I I Icy I l --� �_ �. I i All A" ,, J iJ �� _�' r 1 _+" 1 l L o ,' - � I h L_ ____,_____Li______4--- 1-1 ' .9 r - 'I � ==+ 1I J.HLIHo