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SEP-0037-2024 SEPTIC DISPOSAL PERMIT Office Use Only 0)\-!11111) APPLICATION Permit#: ''b0'��- 20� Town ofQucensbury Permit Fe 4 Invoice 742 Bay Road,Queensbury,NY 12804 T_ P:518-761-8256 www.queensbury.net Septic Variance' NO Flood Zone? �r Wetlands? '\ • Reviewed B `i Project Location: 7 . moo„ ash Li �'lJ3r� �7 95 w Tax Map #: [ JAN22 -=---=-�-r-- --- --_�-- r I Il 2024 RESIDENCE INFORMATION: f TovvN r_.UEkNSBLIF.-•t Year Built Gallons #of bedrooms: X gallons per =total daily flow t+if l r;OL:1~S per day bedroom Ga?bage Grinder Yes No 1980 or older 150 Installed? (choose one) ❑ gi 1981-1991 130 Spa or Hot Tub Yes No 1992-Present 110 i , Installed? (choose one) ❑ PARCEL INFORMATION: - - Topography LA Flat Rolling ❑ Steep Slope % Slope Soil Nature (Sand ❑ Loam ❑ Clay. ❑ Other, explain: Groundwater At what depth? 7z" A4„c Bedrock/Impervious material At what depth? — 7z'' 4/430 Domestic Water Supply /lunicipal ❑ Well ❑Lake (if well or lake, water supply from any septic system absorption is ft.) Percolation Test Rate: it per minute per inch (test to be completed by a licensed engineer/architect) PROPOSED SYSTEM INFORMATION: Tank size I/0°0 gallons (min. size 1,000 gallons, add 250 gallons for each garbage cylinder or spa/hot tub 6 c,s71%-f System Absorption field w/#2 stone Total length 5 ' ft.; Each Trench/122, ° ft. Seepage Pit w/#3 stone How many: ; Size: Alternative System Bed or other type: A. z,4 Holding Tank System Total required capacity? ; tank size ; # of tanks CONTACT INFORMATION: PLEASE PRINT LEGIBLY OR TYPE, PLEASE INCLUDE AN EMAIL • Applicant: Name(s): 6 ipe.Z 17'4 /2 .-ok7s ' ' Mailing Address, C/S/Z: 5 r•sr-a 'r4; 0,:t•a,/2 iei.e Cell Phonie: 3-- ZyZ'Z7©7 Land Line: 32.29 Email: -ee4„ c) 0oNe.Hc/✓s�r/cs'+ • Primary wner(s): Name(s): !"c Z. ��, ,.,.► l �, / Mailing Address, C/S/Z: �•�o �. ICC 7' cdta r7,1 z jv! Cell Phone: 5 J- 791i9 ' 73Z Land Line: Email: (' , ❑ Check if all work will be performed by property owner only • Contractor: Contact Name(s): VT��� �,, s � I i„ 4;y v .5 Contractor Trade: �,-•%-s Mailing Address, C/S/Z: o . si ' 7 v 4 /2&t' Cell Phone,: Lc - 2—J ,47v7 Land Line: fie -S i Y6,8 Email:Phone,: ,5/ os4c-reic3 .)&irc5 •Oom **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: Ply 1\< 1s.9f1� Cell Phone: Land Line: 1 1 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 he Town of Queensbury Sanitary Sewage Disposal Ordinance. PRINT NAME: '� �r � �1( SIGNATURE: 'C�� DATE: -Z6- • • OS* �—�4" TOWN c� QUEENSB1RY . f,o' • 742 Bay Road, Queensbury,NY. 12804-5902 • • Septic System Checklist • • Plan to scale • .NQeceived Deep hole perc test results from engineer/Architect if applicable(Town proved Engineers and • • Architects;June 30 to April 15 Town Engineer for unapproved Engineers and Architects) `III wells on property and adjacent properties shown . eater line shown Municipal or well 10'separation to any part of system • . IASetback to property lines show 10'or more for any part of system • 1 Septic tank and pump stations 10'from foundation•50'from any well/lake/wetland 10'from anywate ' e AA ,, rlm • Jveptic tank to foundation crawl space/slab on grade,grade in crawl space must be above top for 0',Separation required(field verification required) P of septic tank A' eptic •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 IN) Seepage pit 150'from.well 50'from septic tank • i` eepage Pits 3-times diameter apart : N-(4 l Septic tank and pump stations over.30 gallons 50'from watercourse or wetland • '16 distance from bottom of trench or system 24"to bedrock or mottling 36"within 1000'of Lake George • _leech field 100'from watercourse or wetland 15r1— Toe of mound or bottom of retaining wa11.10'from property line 100'from well 20'from • Foundation A ' " Provide•Engineer/Architect stampfor bed or design . • ��ll sign systems • M4 epartment of Health Approval for all mobile home park new systems Flood Plain requirements • 2'above established flood elevation to bottom of system /""All tanks anchored or 2'above flood elevation —t — -- —, gli,41200/4 . r ✓ 0 • 1 7,1,4-7 /die 0 v , Z3,1 eCrA .17-..5 e y(d r 1 17-. P,b, i9, v .Vt- iii-e, -e /Up i'. , I lit/ II ri" •I b 'gib, ' ' CD F+ ", R I At.,.....: �Lc'" — I l 1 I, N 7 2 I.:r���; I i ' 40 ' ). ,ic c.�Aile lei is-vje t.1 a 8 o o pp t rn;n �y"�•�a�7'c'' 0 eY.S7.-* / D.70 y_. 1.- , CO CD N — - /� tea P''�S� rn a'a Ca N TO •N OF QUEENSSURY — 2 FT. D — II tUI DING & CO -�� rt r, 14. __ 11; 0 o w ' -U V rdA . "..0 t , Ow TO N OF QUEENSBURY . ] •� BU I DING DEPARTMENT ,, ,//- — Based on our'imited examination,complian• ;/i 0/1 9 e. .. ::-•ants shall not be construed .s • indicating th. plans and specifications are n full complia ce with the Building Codes of New York C ...Le. ii _ t‘.0.7 170/25-,„,,, i (1/Yei/-00,,,, pe, • i, 7 V Z ,Ne 7��aal.+ "6c'J f clvJr,e7G.I CC.,-- / 1,..N.„..1cti ,, 'd n3t4/� 1ItC /„� ....Pi—. r III. . 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