2024-0293 SEPTIC DISPOSAL PERMIT. Office Use Only
3 APPLICATION Permit#: 2O2Ar 0 9
Town of Qucensbury
. '
�. Wit — Permit Fee:$ 65
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Inv: ri :o
ice#:
742 Bay Road,Queensbury,NY 12804 WIPP
P:518-761-8256 www.queensbury.net J N 1 ),'i 2b21i Sepic
r�EN
SBU�Y
TO Flood Zone? No
TOWN
OF OOl�,�3��0� ODES Wetlands? No Reviewed By: �_10AA-t\---)
Project Location: 316 Glen La.e •.e
Tax Map #: 289.9-1-83
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 4 110 440 Installed? (choose one) El
PARCEL INFORMATION:
Topography 111 Flat Rolling ❑ Steep Slope 5-10 % Slope
Soil Nature ❑■ Sand ❑ Loam ❑ Clay ❑ Other, explain:
SEE PLAN FOR SOIL DESCRIPTION
Groundwater At what depth? >62"
Bedrock/Impervious material At what depth? >62"
Domestic Water Supply ❑ Municipal ❑ Well ❑■ Lake
(if well or lake, water supply from any septic system absorption is
>100' ft.)
Percolation Test Rate: 3:10 per minute per inch (test to be completed by a
licensed engineer/architect)
PROPOSED SYSTEM INFORMATION:
Tank size 1250 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 ft.; Each Trench ft.
Seepage Pit w/#3 stone How many: ; Size:
Alternative System Bed or other type:20'x 25'ABSORPTION BED
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): Lynne Rutnick&Brian Backus
Mailing Address, C/S/Z: 2250 Grand Boulevard Niskayuna, NY 12309
Cell Phone: (518)461-8240 Land Line:
Email:
• Primary Owner(s):
Name(s): same as applicants
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): T.B.D.
Contractor Trade:
Mailing Address, C/S/Z:
Cell Phone: Land Line:
Email:
**Workers' Comp documentation must be submitted with this application**
• Engineer(s):
Name(s): Hutchins Engineering PLLC
Mailing Address; C/S/Z: 169 Haviland Road Queensbury, NY 12804
Cell Phone: Land Line: 518-745-0307
Email: thutchins@hutchinsengineering.com
Contact Person for Compliance in regards to this project: Tom Hutchins
Cell Phone: Land Line: 518-745-0307
Email: thutchins@hutchinsengineering.com
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 Or 'nance.
•
PRINT NAME: �s � t� tiV-i7C-Rtf\) .
SIGNATURE: DATE: ., I3 2-.
Septic Application Revised July 2022
•
•
•
•
glekiki
+�0,
TOWN ( ' QUEENSBU.RY . .
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 •
Arc itects;June 30 to April 15 Town Engineer for unapproved Engineers and Architects)
. All wells on property and adjacent properties shown .
. 1 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
• A 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) .
• l Septic tank sized for number of bedrooms and add 250 gals for Jacuzzi tubs/garbage grinder each •
yLeech Field 20'from foundation 100'from any well 10'from water line
iYASeepage pit 150'from•weil 50'from septic tank •
VA-Seepage Pits 3-times diameter apart
---- Septic tank and pump stations over 30 gallons 50'from Watercourse or wetland •
L( distance from bottom of trench or syst 24" bedrock or mottling 36"within 1000'of Lake George •
Leech field 100'from watercourse or wetland
. iJ Aloe of mound or bottom of retaining wall.10'from property line 100'from well 20'from •
'`'� Foundation
•
Provide'Engineer/Architect stampfor bed or .
yy,,,, design systems • . .
•
NP&Department of Health Approval for all mobile home park new systems Flood Plain requirements
• X92'above established flood elevation to bottom of system •
MO Ail tanks anchored or 2'above flood elevation
2024--D2C1�
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JUL 0 3 20n
TOWN 0F _OUEENsBU RY `'' raN
ei:, FILE COPY
BUILDING&CODES off''
c�IAND SG4FEMA
NATIONAL FLOOD INSURANCE PROGRAM
ELEVATION CERTIFICATE
AND
INSTRUCTIONS
2019 EDITION
•
OMB No. 1660-0008
Expiration Date: November 30, 2022
U.S. DEPARTMENT OF HOMELAND SECURITY
Federal Emergency Management Agency
National Flood Insurance Program
ELEVATION CERTIFICATE AND INSTRUCTIONS
Paperwork Reduction Act Notice
Public reporting burden for this data collection is estimated to average 3.75 hours per response.The burden estimate includes the
time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and
submitting this form. You are not required to respond to this collection of information unless a valid OMB control number is
displayed on this form. Send comments regarding the accuracy of the burden estimate and any suggestions for reducing the
burden to: Information Collections Management, Department of Homeland Security, Federal Emergency Management Agency,
500 C Street SW, Washington, DC 20742, Paperwork Reduction Project(1660-0008). NOTE: Do not send your completed form
to this address.
Privacy Act Statement
Authority:Title 44 CFR§61.7 and 61.8.
Principal Purpose(s): This information is being collected for the primary purpose of estimating the risk premium rates necessary
to provide flood insurance for new or substantially improved structures in designated Special Flood Hazard Areas.
Routine Use(s):The information on this form may be disclosed as generally permitted under 5 U.S.C. §552a(b)of the Privacy Act
of 1974, as amended. This includes using this information as necessary and authorized by the routine uses published in DHS/
FEMA-003—National Flood Insurance Program Files System or Records Notice 73 Fed. Reg. 77747 (December 19, 2008); DHS/
FEMA/NFIP/LOMA-1 —National Flood Insurance Program (NFIP) Letter of Map Amendment(LOMA)System of Records Notice 71
Fed. Reg.7990(February 15,2006); and upon written request,written consent, by agreement, or as required by law.
Disclosure: The disclosure of information on this form is voluntary; however, failure to provide the information requested may
result in the inability to obtain flood insurance through the National Flood Insurance Program or the applicant may be subject to
higher premium rates for flood insurance. Information will only be released as permitted by law.
Purpose of the Elevation Certificate
The Elevation Certificate is an important administrative tool of the National Flood Insurance Program (NFIP). It is to be used to
provide elevation information necessary to ensure compliance with community floodplain management ordinances, to determine
the proper insurance premium rate, and to support a request for a Letter of Map Amendment (LOMA) or Letter of Map Revision
based on fill(LOMR-F).
The Elevation Certificate is required in order to properly rate Post-FIRM buildings, which are buildings constructed after publication
of the Flood Insurance Rate Map (FIRM), located in flood insurance Zones A1—A30, AE,AH,A(with BFE), VE, V1—V30, V (with
BFE),AR,AR/A,AR/AE,AR/A1—A30,AR/AH, and AR/AO. The Elevation Oertificate is not required for Pre-FIRM buildings unless
the building is being rated under the optional Post-FIRM flood insurance rules.
As part of the agreement for making flood insurance available in a community,the NFIP requires the community to adopt floodplain
management regulations that specify minimum requirements for reducing flood losses. One such requirement is for the community
to obtain the elevation of the lowest floor (including basement) of all new and substantially improved buildings, and maintain a
record of such information.The Elevation Certificate provides a way for a community to document compliance with the community's
floodplain management ordinance.
Use of this certificate does not provide a waiver of the flood insurance purchase requirement. Only a LOMA or LOMR-F from the
Federal Emergency Management Agency(FEMA) can amend the FIRM and remove the Federal mandate for a lending institution
to require the purchase of flood insurance. However, the lending institution has the option of requiring flood insurance even if a
LOMA/LOMR-F has been issued by FEMA.The Elevation Certificate may be used to support a LOMA or LOMR-F request. Lowest
floor and lowest adjacent grade elevations certified by a surveyor or engineer will be required if the certificate is used to support a
LOMA or LOMR-F request. A LOMA or LOMR-F request must be submitted with either a completed FEMA MT-EZ or MT-1
package,whichever is appropriate.
This certificate is used only to certify building elevations.A separate certificate is required for floodproofing. Under the NFIP, non-
residential buildings can be floodproofed up to or above the Base Flood Elevation (BFE).A floodproofed building is a building that
has been designed and constructed to be watertight (substantially impermeable to floodwaters) below the BFE. Floodproofing of
residential buildings is not permitted under the NFIP unless FEMA has granted the community an exception for residential
floodproofed basements. The community must adopt standards for design and construction of floodproofed basements before
FEMA will grant a basement exception. For both floodproofed non-residential buildings and residential floodproofed basements in
communities that have been granted an exception by FEMA, a floodproofing certificate is required.
Additional guidance can be found in FEMA Publication 467-1, Floodplain Management Bulletin: Elevation Certificate, available on
FEMA's website at https://www.fema.gov/media-library/assets/documents/3539?id=1727.
FEMA Form 086-0-33(12/19) Replaces all previous editions. F-053
U.S. DEPARTMENT OF HOMELAND SECURITY OMB No. 1660-0008
Federal Emergency Management Agency Expiration Date: November 30,2022
National Flood Insurance Program
ELEVATION CERTIFICATE
Important: Follow the instructions on pages 1-9.
Copy all pages of this Elevation Certificate and all attachments for(1)community official, (2)insurance agent/company, and(3)building owner.
SECTION A—PROPERTY INFORMATION FOR INSURANCE COMPANY USE
Al. Building Owner's Name Policy Number:
Brian R. Backus
A2. Budding Street Address(including Apt., Unit, Suite, and/or Bldg. No.)or P.O. Route and Company NAIC Number:
Box No.
316 Glen lake Road
City State ZIP Code
Queensbury New York 12804
A3. Property Description(Lot and Block Numbers,Tax Parcel Number, Legal Description, etc.)
289.9-1-83
A4. Building Use(e.g., Residential, Non-Residential,Addition,Accessory,etc.) Residential
A5. Latitude/Longitude: Lat.43-21-58 Long.73-40-40 Horizontal Datum: ❑ NAD 1927 ❑x NAD 1983
A6. Attach at least 2 photographs of the building if the Certificate is being used to obtain flood insurance.
A7. Building Diagram Number 2A
A8. For a building with a crawlspace or enclosure(s):
a) Square footage of crawlspace or enclosure(s) 1042.00 sq ft
b) Number of permanent flood openings in the crawlspace or enclosure(s)within 1.0 foot above adjacent grade 0
c) Total net area of flood openings in A8.b 0.00 sq in
d) Engineered flood openings? ❑Yes ❑x No
A9. For a building with an attached garage:
a) Square footage of attached garage 0.00 sq ft
b) Number of permanent flood openings in the attached garage within 1.0 foot above adjacent grade 0
c) Total net area of flood openings in A9.b 0.00 sq in
d) Engineered flood openings? ❑Yes No
SECTION B—FLOOD INSURANCE RATE MAP(FIRM) INFORMATION
B1. NFIP Community Name&Community Number B2. County Name B3. State
Town of Queensbury 360879 Warren New York
B4. Map/Panel B5. Suffix B6. FIRM Index B7. FIRM Panel B8. Flood B9. Base Flood Elevation(s)
Number Date Effective/ Zone(s) (Zone AO, use Base Flood Depth)
Revised Date
0020 C 08-16-1996 08-16-1996 AE 404
B10. Indicate the source of the Base Flood Elevation(BFE)data or base flood depth entered in Item B9:
❑ FIS Profile FIRM ❑ Community Determined ❑ Other/Source:
B11. Indicate elevation datum used for BFE in Item B9: ❑x NGVD 1929 ❑ NAVD 1988 ❑ Other/Source:
B12. Is the building located in a Coastal Barrier Resources System(CBRS)area or Otherwise Protected Area(OPA)? ❑ Yes ❑x No
Designation Date: ❑ CBRS ❑ OPA
FEMA Form 086-0-33(12/19) Replaces all previous editions. Form Page 1 of 6
ELEVATION CERTIFICATE OMB No. 166
Expiration Date:e: November 30,2022
IMPORTANT: In these spaces,copy the corresponding information from Section A. FOR INSURANCE COMPANY USE
Building Street Address(including Apt., Unit, Suite, and/or Bldg. No.)or P.O. Route and Box No. Policy Number:
316 Glen lake Road
City State ZIP Code Company NAIC Number
Queensbury New York 12804
SECTION C—BUILDING ELEVATION INFORMATION (SURVEY REQUIRED)
Cl. Building elevations are based on: ❑x Construction Drawings* ❑ Building Under Construction* ❑ Finished Construction
*A new Elevation Certificate will be required when construction of the building is complete.
C2. Elevations—Zones A1—A30,AE,AH,A(with BFE),VE,V1—V30,V(with BFE),AR,AR/A,AR/AE,AR/A1—A30,AR/AH,AR/AO.
Complete Items C2.a—h below according to the building diagram specified in Item A7. In Puerto Rico only, enter meters.
Benchmark Utilized: Lake Spillway Vertical Datum:NGVD 29
Indicate elevation datum used for the elevations in items a)through h)below.
❑x NGVD 1929 ❑ NAVD 1988 ❑ Other/Source:
Datum used for building elevations must be the same as that used for the BFE.
Check the measurement used.
a) Top of bottom floor(including basement,crawlspace, or enclosure floor) 407.7 ❑x feet ❑ meters
b) Top of the next higher floor 415.0 ❑x feet ❑ meters
c) Bottom of the lowest horizontal structural member(V Zones only) ❑ feet ❑ meters
d) Attached garage(top of slab) ❑ feet ❑ meters
e) Lowest elevation of machinery or equipment servicing the building 407.7 ❑x feet ❑ meters
(Describe type of equipment and location in Comments)
f) Lowest adjacent(finished)grade next to building(LAG) 407.2 ❑x feet ❑ meters
g) Highest adjacent(finished)grade next to building(HAG) 414.9 ❑x feet ❑ meters
h) Lowest adjacent grade at lowest elevation of deck or stairs, including
structural support 407.8 ❑x feet ❑ meters
SECTION D—SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION
This certification is to be signed and sealed by a land surveyor,engineer, or architect authorized by law to certify elevation information.
l certify that the information on this Certificate represents my best efforts to interpret the data available. I understand that any false
statement maybe punishable by fine or imprisonment under 18 U.S. Code, Section 1001.
Were latitude and longitude in Section A provided by a licensed land surveyor? ❑x Yes ❑No ❑Check here if attachments.
Certifier's Name License Number "
Matthewew C.Steves 050135
Title Co "'f-
President ��
Company Name d '`u•� :r�=�: '
Van Dusen&Steves Land Surveyors .
Address �3 ,,=Ey
169 Haviland Road �;r�
City State ZIP Code
Queensbury New York 12804 N
Signature Date Telephone Ext.
03-07-24 (518)792-8474 11
y all pa his Elevation Certificate and all attachments for(1)community official, (2)insurance agent/company,and(3)building owner.
Comments(including type of equipment and location, per C2(e), if applicable)
C2 E. Machinery in basement.The ground elevation at the proposed septic tank=413 and thhe ground elevation at the proposed
pump station=415.
FEMA Form 086-0-33(12/19) Replaces all previous editions. Form Page 2 of 6
OMB No. 1660-0008
ELEVATION CERTIFICATE Expiration Date: November 30, 2022
IMPORTANT:In these spaces,copy the corresponding information from Section A. FOR INSURANCE COMPANY USE
Building Street Address(including Apt., Unit, Suite, and/or Bldg. No.)or P.O. Route and Box No. Policy Number:
316 Glen lake Road
City State ZIP Code Company NAIC Number
Queensbury New York 12804
SECTION E—BUILDING ELEVATION INFORMATION (SURVEY NOT REQUIRED)
FOR ZONE AO AND ZONE A(WITHOUT BFE)
For Zones AO and A(without BFE), complete Items El—E5. If the Certificate is intended to support a LOMA or LOMR-F request,
complete Sections A, B,and C. For Items El—E4, use natural grade, if available.Check the measurement used. In Puerto Rico only,
enter meters.
El. Provide elevation information for the following and check the appropriate boxes to show whether the elevation is above or below
the highest adjacent grade(HAG)and the lowest adjacent grade(LAG).
a) Top of bottom floor(including basement,
crawlspace, or enclosure)is ❑feet ❑meters ❑above or ❑below the HAG.
b) Top of bottom floor(including basement,
crawlspace, or enclosure)is ❑feet ❑meters above or❑ below the LAG.
E2. For Building Diagrams 6-9 with permanent flood openings provided in Section A Items 8 and/or 9(see pages 1-2 of Instructions),
the next higher floor(elevation C2.b in
the diagrams)of the building is ❑feet ❑meters ❑above or ❑below the HAG.
E3. Attached garage(top of slab)is
❑feet meters El above or El below the HAG.
E4. Top of platform of machinery and/or equipment
servicing the building is ❑feet ❑meters ❑above or ❑below the HAG.
E5. Zone AO only: If no flood depth number is available, is the top of the bottom floor elevated in accordance with the community's
floodplain management ordinance? ❑ Yes ❑ No ❑ Unknown. The local official must certify this information in Section G.
SECTION F—PROPERTY OWNER(OR OWNER'S REPRESENTATIVE)CERTIFICATION
The'property owner or owner's authorized representative who completes Sections A, B, and E for Zone A(without a FEMA-issued or
community-issued BFE)or Zone AO must sign here.The statements in Sections A, B,and E are correct to the best of my knowledge.
Property Owner or Owner's Authorized Representative's Name
Address City State ZIP Code
Signature Date Telephone
Comments
❑Check here if attachments.
FEMA Form 086-0-33(12/19) Replaces all previous editions. Form Page 3 of 6
ELEVATION CERTIFICATE OMB No. 166
Expiration Date:e: o8
November 30, 2022
IMPORTANT: In these spaces, copy the corresponding information from Section A. FOR INSURANCE COMPANY USE
Building Street Address(including Apt., Unit, Suite, and/or Bldg. No.)or P.O. Route and Box No. Policy Number:
316 Glen lake Road
City State ZIP Code Company NAIC Number
Queensbury New York 12804
SECTION G—COMMUNITY INFORMATION(OPTIONAL)
The local official who is authorized by law or ordinance to administer the community's floodplain management ordinance can complete
Sections A, B, C(or E), and G of this Elevation Certificate. Complete the applicable item(s)and sign below. Check the measurement
used in Items G8—G10. In Puerto Rico only,enter meters.
G1. VThe information in Section C was taken from other documentation that has been signed and sealed by a licensed surveyor,
engineer, or architect who is authorized by law to certify elevation information. (Indicate the source and date of the elevation
data in the Comments area below.)
G2 ❑ A community official completed Section E for a building located in Zone A(without a FEMA-issued or community-issued BFE)
or Zone AO.
G3. ❑ The following information(Items G4—G10)is provided for community floodplain management purposes.
G4. Permit Number G5. Date Permit Issued G6. Date Certificate of
Compliance/Occupancy Issued
2,07-1 Dz°3 --1V8'24.
' G7. This permit has been issued for: ❑ New Construction ❑ Substantial Improvement
G8. Elevation of as-built lowest floor(including basement)
of the building: 461 o t ❑ feet ❑ meters Datum owc,
G9. BFE or(in Zone AO)depth of flooding at the building site: mby a c^,t, ❑ feet ❑ meters Datum1/4)c)
G10. Community's design flood elevation: ❑ feet ❑ meters Datum
Local Official's Name Title
S d H w3 w cw,k F v<v_a:NOv- o F C273 of e,. 4� GoD fj
Community Name Telephone
&a.)ee_ i3o0 ;.-tS-1(91 -- 7--C35
Signature Date
Comment luding type of e i ent and location, per C2(e), if applicable 13
ib- 8V1=‘ of V c 1--
❑ Check here if attachments.
FEMA Form 086-0-33(12/19) Replaces all previous editions. Form Page 4 of 6
BUILDING PHOTOGRAPHS OMB No. 1660-0008
ELEVATION CE"TIFICATE See Instructions for Item A6. Expiration Date: November 30, 2022
IMPORTANT: In these spaces,copy the corresponding information from Section A. ! FOR INSURANCE COMPANY USE
Building Street Address(including Apt., Unit, Suite, and/or Bldg. No.)or P.O. Route and Box No. Policy Number:
316 Glen lake Road
City State ZIP Code , Company NAIC Number
Queensbury New York 12804
I
If using the Elevation Certificate to obtain NFIP flood insurance, affix at least 2 building photographs below according to the
instructions for Item A6. Identify all photographs with date taken; "Front View"and "Rear View"; and, if required, "Right Side View"and
"Left Side View." When applicable, photographs must show the foundation with representative examples of the flood openings or
vents, as indicated in Section A8. If submitting more photographs than will fit on this page, use the Continuation Page.
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FEMA Form 086-0-33(12/19) Replaces all previous editions. Form Page 5 of 6
•
• BUILDING PHOTOGRAPHS OMB No. 1660-0008
ELEVATION CERTIFICATE Continuation Page Expiration Date: November30,2022
IMPORTANT: In these spaces,copy the corresponding information from Section A. FOR INSURANCE COMPANY USE
Building Street Address(including Apt., Unit, Suite, and/or Bldg. No.)or P.O. Route and Box No. Policy Number:
316 Glen lake Road
City State ZIP Code Company NAIC Number
Queensbury New York 12804
If submitting more photographs than will fit on the preceding page, affix the additional photographs below. Identify all photographs
with: date taken; "Front View" and "Rear View"; and, if required, "Right Side View" and "Left Side View." When applicable,
photographs must show the foundation with representative examples of the flood openings or vents, as indicated in Section A8.
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FEMA Form 086-0-33(12/19) Replaces all previous editions. Form Page 6 of 6
•
ice,. ~_== '--_____ ____^_f_::z insurance agent or call the National Flood Insurance Program at(800)638-6.
ROAD r ' "' l ri ' APPROXIMATE SCALE •
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VACANT LOT
IJG25 ACROSS ROAD S,gn-No Parkng
NO WELLS _
---------------
Lands NIF of /`
Jeffrey Godnick %, _..
a
8:925 p; 84 j � � :� I� Lands N(F of �
289.9-1-84 f .�~
��,.\ / / Y ��.. _ �� i " Susan Popowski �
�l �o s •(r 289.9 -1 81 �� 1
RIF
LAKE WATER
SUPPLY >1
,k
'41
3 f ys Cobblestone \ Access
Pienter �` ° • "r-�- ' ,. t 100' Cover PVC o 'h _ ..- .. o .
— _ SHORELINE r Pve-- °
N� I SETBACK (ABS. FIELD)' ' eanout _ Cleanout
' \ Qi �• h g75 57 " ' �\� 58. C 1 R E O
\ 3 o
O
9� lory
' Iyaa
d y
Two
f
HoUse �� \ Story
m I Wood
`
? \ W/;
�' Patio
Frame
m J
House 1
$ C \ s.4o
Hmarrk � 50SHORELINE®.. ® .
° �• .. — _
ii in Red SETBACK (TAN )' " I
I , k 416.0a K
I ` PROPOSED 1, 000 GAL 2 Z� JGocjpleston * I v
NEIGHBORING xy�3 aTjs 1 t - WELL t �AreaI I PRECAST CONCRETE I
PUMP STATION
i 18'1.12.4± Sqi. Fe t
0.42>_ A res 1250 GAL
I � - PROPOSE ,
PRECAST CONCRETE
3 f Paver RF SEPTIC TANK
3 i Tip Line i I '� PROPOSED 4 HOUSE
, N 88'57'36" .W., l Concrete Pad
SEKERDeck
+I
v Pump 1iou5e
-W d ._ I
steps
-I
IPF (Bent
6.5 ( e
q... ¢ ... —�
.• . _ Stone Masonry `
1°
•
00
— —Do,
116' ± Along SKore Glen U
EXISTING LAKE c
WATER SUPPLY
i
i
Lake
WASTEWATER SYSTEM PLAN GRAPHIC SCALE
SCALE: 1 "=20'
APPROXIMATE POLYETHYLENE EXTENSION TO GRADE
FINISH GRADE WITH TAMPER RESISTANT ACCESS COVER
4" PVC INLET t-1 2"
MIN. SLOPE
1/8" PER FOOT
WATi=R77GHT SLEEVE
AND SEAL (TYP)
1,250 GAL PRECAST
CONCRETE DUAL
COMPARTMENT
SEPTIC TANK
12" MIN.
COVER
LIQUID LEVEL
DUAL COMPARTMENT
16" BAFFLE MINN.
L Z X
q O-
�� M
10 Q 10 20 40
( IN FEET )
BALL VALVE, ONE PER PUMP
INSTALL VALVES AND UNIONS
SUCH THAT EITHER PUMP CAN BE
ISOLATED AND REMOVED WITHOUT
REQUIRING PIT ENTRY
118" PER FOOT
MIN. SLOPE
--- Do -
OUTLET 4" PVC
ALARM 3" ABOVE 'PUMP ON'
& LAG PUMP ON
PUMP ON
_ MINIMUM 2X WIDTH PUMP OFF
MAXIMUM 4X WIDTH
INSTALL FLOAT SWITCHES TO
OPERATE PUMP AND MAINTAIN
LEVELS AS INDICATED
FLOAT SWITCHES
—INSTALL INSIDE
PUMP PIT IN
LOCATION ACCESSIBLE
WITHOUT PIT ENTRY
TirIN.
" ,/f. III II It/ Tn TfCn/i nkl
4" SDR-35 PVC PERFORATED
LATERAL INSTALLED NEAR LEVEL,
IN BED CONFIGURATION
ABSORPTION BED PROFILE
NTS
A nnnn Vl, / A =
FILTER FABRIC, TENCATE
MIRAFI 140N OR EQUIVALENT
APPROXIMATE FILTER FABRIC, TENCATE 4" MINIMUM TOPSOIL ON
EXISTING GRADE MIRAFI 14ON OR EQUIVALENT ENTIRE BACKFILL AREA;
20' BED WIDTH SEED AND ESTABLISH TURF
F—StoPE ROPE--,
BACKFILL MATERIAL AS NEEDED J L-20'x25' CRUSHED STONE 2' MIN. USABLE
TO ESTABLISH GRADES ABSORPTION BED SOIL TO B.C.
ABSORPTION BED SECTION
NTS
4" PERFORATED PVC
LATERALS INSTALLED
NEAR LEVEL IN BED
CONFIGURATION
LIMIT OF 20'x25'
STONE BED
20'
MAIN TO 4" PVC DISTRIBUTION BOX
OUTSIDE OF D—BOX
ABSORPTION BED PLAN
NTS
POLYETHYLENE EXTENSION EXTERIOR WEATHERPROOF JUNCT70N BOX
TO GRADE WITH TAMPER (IF NECESSARY). SEAL CONDUIT GAS TIGHT.
RESISTANT ACCESS COVER INSTALL CONTROL PANEL IN HOUSE. ALL ELECTRICAL
WORK TO BE INSPECTED BY A CERTIFIED ELECTRICAL
INSPECTION AGENCY PRIOR TO START—UP OF PUMP STATION.
12" MIN. COVER
DISTRIBUTION BOX
a s G a a. 4
a
a as
a4
a c'
I
1 O00 GALLON PRECAST CONCRETE PUMP sTAToN
SEP7 TANKS � PUMP STAT PROPOSED
SCALE; NTS
inns nCTAII
2"MIN.
2" TEE JOINS TWO 2"MIN. DROP
PUMP DISCHARGES BETWEEN INVERTS
INTO ONE FORCEMAIN SEPTIC TANK NOTES
ALL UNITS SHALL COMPLY WITH THE REQUIREMENTS OF THE NEW
YORK STATE DEPARTMENT OF HEALTH AND SHALL BE OF PRECAST
CONCRETE AS MANUFACTURED BY UTOPIA ENTERPRISES OR
EQUIVALENT
ALL STRUCTURES SHALL BE PLACED ON FIRM, COMPACT SAND OR
PROVIDE 5' GRAVEL BASE. WHERE EXISTING SOIL CONDITIONS ARE UNSUITABLE,
FROST PROTECTION CRUSHED STONE SHALL BE PLACED AS NECESSARY TO ACHIEVE A
STABLE BASE.
SEP71C TANKS INSTALLED IN TRAFFIC AREAS SHALL BE OF EXTRA
HEAVY CONSTRUCTION DESIGNED FOR H-20 WHEEL LOADING
V_I---- 1-1. LUL,AIIUIV MAP
FILE COPY
TOWN OF QUEENSBURY
BUILDING DEPARTMENT
Based on our limited examination, compliance
with our comments snail not be construed as
indicating the plans and specifications are in
full compliance with the Building Codes of
New Yop State,
SITE SOILS DATA
TOVVN OF QUEENSBURY
TEST PIT'
BUILDING & CODES DEPT.
TP' 1 — 6/4/2024 BY TOM HUTCHINS, P.E.
Reviewed v:
PINE L DUFF
Date; ('x9c)
0-3" — TOPSOIL
3-32" — RED BROWN FINE/MEDIUM SAND,
FEW COBBLES
289.9-1-83 2024-0293
32-62" — COARSE SAND, COBBLES
Rutnick, Lynne
316 Glen Lake Road
ROOTS TO 32"
Residential Septic Alteration
BOUNDARY CONDITION > 62"
NO MOTTLING VISIBLE
PROVIDE 240 VER77CAL SEPARATION TO
BOUNDARY CONDITON
PERCOLATION TEST
PT-1 — 61412024 BY TOM HUTCHINS, P.E.
STABILIZED PERCOLATION RATE= 3:10 MIN/INCH
DESIGN PERCOLA7ION RATE= 1-5 MIN/INCH
WASTEWATER SYSTEM DESIGN
SYSTEM INSTALLATION NOTES
4—BEDROOM RESIDENCE
DESIGN FLOW — 110 GPD/BEDROOM
CONSTRUCTION SHALL BE AS SHOWN ON THIS DRAWING AND IN
SYSTEM DESIGN FLOW — 440 GPD
ACCORDANCE WITH THE N.Y.S. DEPARTMENT OF HEALTH INDIVIDUAL
SEPTIC TANK — PROPOSED 1,250 GAL PRECAST CONCRETE
HOUSEHOLD SYSTEMS AND THE MANUFACTURER ANUA'S INSTRUCTIONS.
SEP71C TANK WITH A 1,000 GAL PUMP
STATION.
AFTER EXCAVATION OF ABSORPTION BED TO THE DEPTHS REQUIRED, THE
DESIGN APPLICA77ON RATE: 0.95 GPD/SF, BASED ON
WALLS AND FLOOR OF EACH TRENCH SHALL BE CLEANED AND RAKED IN
ORDER TO LOOSEN SMEARED SEC77ONS OF TRENCH.
1-5 MIN/IN , PERCOLATION RATE
PLACEMENT OF CRUSHED STONE, PURAFLO UNITS AND FILTER FABRIC
ABSORPTION BED AREA REQ'D = (440 GPD)/(0.95 GPD/SF)
SHALL BE AS SHOWN, AND CARE SHALL BE EXERCISED TO AVOID
= 464 SF
INCLUSION OF FINE GRAINED SOILS AND WASTE MATERIAL IN THE STONE
ABSORP77ON BED.
ABSORPTION BED AREA PROWfDED = 20'x25' = 500 SF
DISPOSAL FIELD SHALL BE GRADED TO SHED RAINFALL AWAY FROM THE
POTABLE WATER SUPPLY IS FROM GLEN LAKE
DISPOSAL FIELD.
MAINTAIN 50' MINIMUM SEPARATION BETWEEN
SEP77C TANK & LAKE SHORELINE
DO NOT USE HEAVY EQUIPMENT WITHIN THE ABSORPTION AREA AFTER
ABSORPTION SYSTEM HAS BEEN INSTALLED.
MAINTAIN 100' MINIMUM SEPARATION BETWEEN
ABSORPTION FIELD & SHORELINE
THIS SYSTEM IS DESIGNED FOR WATER CONSERVING FIXTURES.
PUMP STATION NOTES
ROOF, FOOTING, GARAGE, CELLAR AND SURFACE WATER DRAINAGE MUST
BE EXCLUDED FROM THE WASTEWATER SYSTEM.
SEAL ALL TANK OPENINGS WATERTIGHT
PROVIDE AND INSTALL UL LISTED PACKAGED PUMP
SYSTEM MATERIAL SPECIFICATIONS
CONTROL PANEL WITH VISUAL AND AUDIBLE ALARM.
INSTALL DUPLEX, DEMAND DOSE CONTROL PANEL INSIDE
ABSORPTION BED AGGREGATE
HOUSE IN ACCESSIBLE LOCATION.
STONE IS TO BE 3/4" TO 1-1/2" WASHED CRUSHED STONE.
INSTALL POWER & CONTROL WIRING TO CONTROLLER KITH
EFFLUENT SEWER PIPE
ALARM IN HOUSE IN ACCORDANCE WITH MANUFACTURER'S
PIPING TO BE 4" SDR-35 OR SCHEDULE 40 PVC. INSTALL WITH 118" PER FOOT
INSTRUCTIONS AND NA77ONAL ELECTRIC CODE (N.EC.)
MINIMUM SLOPE.
REQUIREMENTS.
FILTER FABRIC
PUMP CONTROL AND FLOAT LEVELS TO BE INSTALLED TO
FILTER FABRIC TO BE 4.8 OZ/SY NON —WOVEN SEPARATION FABRIC, TENCATE MIRAFI
PROVIDE A 40 GALLON DOSE.
140N OR EQUIVALENT.
FORCEMAIN
EFFLUENT PUMPS TO BE GOULDS PUMPS WE SERIES,
PIPING TO BE 1-1/2" SDR-11 HDPE, PROVIDE POS171VE DRAWBACK TO PUMP
MODEL WE05H SUBMERSIBLE EFFLUENT PUMP .5 HP, 230
STATION.
VOLT, 1PH, OR APPROVED EQUIPMENT.
HOUSE SEWER PIPE
VERIFY EXIS77NG ELECTRICAL SERVICE PRIOR TO
PIPING TO BE 4" SDR-35 OR SCHEDULE 40 PVC. INSTALL WITH 1/4" PER FOOT
PURCHASING PUMP.
MINIMUM SLOPE
SYSTEM FILL
ALL ELECTRICAL WORK TO BE INSPECTED BY A CERTIFIED
AS DESCRIBED IN "FILL MATERIAL NOTES."
ELECTRICAL IINSPEC77ON AGENCY PRIOR TO START—UP OF
PUMP STATION.
TOPSOIL
PLACE 4" MINIMUM TOPSOIL OVER ENTIRE BACKFlLL AREA. SEED, MULCH, AND
ESTABLISH TURF.
REDUCING TEE POINTED DOWNWARE) ALL JOINTS MUST BE SEALED WITH BUTYL SEALANT. JOINTS BELOW
WITH 1" BALL VALVE THROTTLED T. THE LIQUID LEVEL MUST BE TESTED BEFORE BACKFILLING, MAP REFERENCE:
ALLOW TRICKLE DRAIN BACK INTO
1. BASE MAP INFORMATION FROM
WETWELL SURVEY FOR BRIAN R. SAC 'MAP OF A TOPOGRAPHIC
QUEENSBURY, WARREN COUNTY,;.KUS " IN THE TOWN OF
7, 2024. PREPARED BY VAN, NEW YORK. DATED MARCH
SURVEYORS. DUSEN & STEWS LAND
Dig ® Safely.
New work
Call Before You Dig
IM Wait The Required Time
13 Confirm Utility Response
Respect The Marks
Dig With Care
800.962.7962
www.digsafelynewyork.com
O N
4
O
d
in
ALTERATION OF THIS DOCUMENT EXCEPT BY
A LICENSED PROFESSIONAL ENGINEER IS A
VIOLATION OF NYS EDUCATION LAW.
Hutchins
Engineering
PLLC
169 Haviland Road
Queensbury, NY 12804
(518) 745—OJ07 Phone
(518) 745-0308 Fax
WASTEWATER
SYSTEM PLAN
& DETAILS
prepared for:
Lynne Rutnik &
Brian Backus
316 Glen Lake Rd
Town Of QUeensbur)/,
County of Warren,
State of New York
WASTEWATER SYSTEM SETBACK REQUIREMENTS Drawn: AVAIHKs lChecked. GTW
STREAM, LAKE, scale., NOTED Date: 0311812024
PROPERTY LINE HOUSE WATERCOURSE, WELL
WETLAND
SEPTIC TANK 10' 10' 50' 50' 292296-01 ®S 1
ABSORP71ON FIELD 10' 20' 100' 100'