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2024-0441
Office Use Only 'SSEPTIC DISPOSAL A PtIOATION -� ° Permit#: o1c�Jo24 —61Y10 Permit Fee: �, Do Town of Quccrtsbury FA-11-6-2-0-21 �324742 Bay Road,Queensbury,NY 12804Invoice# ; P:518-761-8256 www.queensbury.net TOWN OF QUEENBHURY��I Flood Zone? Y TYPE: r BUILDING&CODES Project Location: % PI C C C Liorn LAn C' Wetlands? Y a@ Reviewed By: LA Tax Map #: 30i. 111 '2,- STRUCTURE INFORMATION Garbage Grinder Yes No Year Built Gallons #of X gallons per =total daily flow Installed? Per day Bedrooms Bedroom ��`"' 1980 or 150 Spa or Hot Tub older Installed? El R. " 1981-1992 130 1992-Present 110 PARCEL INFORMATION TOPOGRAPHY JFlat Rolling n Steep Slope fill Slope SOIL NATURE Land L Loam Clay Other, explain: GROUNDWATER At what depth: ar BEDROCK/IMPERVIOUS MATERIAL At what depth: DOMESTIC WATER SUPPLY unicipal Well F Lake (if well or lake, water supply from any septic system absorption is feet) PERCOLATION TEST Rate: per minute per inch (test to be completed by a licensed engineer/architect) PROPOSED SYSTEM INFORMATION TANK SIZE gallons (min. size 1,000 gallons, add 250 gallons for each garbage cylinder or spa/hot tub kli:14'nj ji4o SYSTEM _ Absorption field w/#2 stone Total length 1.oc ft. Each trench SO ft. Seepage pit w/#3 stone How many: ; Size: Alternate system Bed or other type: Holding tank system Total required capacity: ; tank size: ; # oftanks: Septic Alteration Application Revised May 2024 CONTACT INFORMATI ON: PLEASE PRINT LEGIBLY OR TYPE, PLEASE INCLUDE AN EMAIL • Applicant:. Name(s): X85 S ,I,c fr Ora:r. GLC Mailing Address, C/S/Z: 2 L+Wr Warr., St Pei /L} Cell Phone: Slei-7Sr6-bs4-4 Land Line: SIS'7c!$-`$/9'k Email: e5A:+pley 9 i'175''1pi( -Co», • Primary Owner(s): Name(s): ge1•th Ferraro Mailing Address, C/S/Z:, 44. Pic Ecltrdr. Lert,e Cell Phone: 'SIj 7�(�- i365 Land Line: Email: Ke:t k feeta fey 9 y a hoe • ❑Check if all work will be performed by property owner only • Contractor: Contact Name(s): Tel cP,?•C Or+�.•, LC� Contractor Trade: f/c.s s Svp/..c Mailing Address, C/S/Z: 2 Zw.i i tesrerr• J"/ C15 , ,° /Z IPa y Cell Phone: $71,- 7(I6• O SS Land Line: S$-7yq-$/4 P Email: e5'/I:My o7r i•b 97/Cec . C01,-- **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 any questions regarding this project: a/'. C. y 4 e Cell Phone: Si 7N.-O$4"6 Land Line: acp4- -`b(99 Email: 41114y I b cp .c. Cc 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: 4:RI C S• hip 4 y SIGNATURE: it: 1,. gliefet DATE: i f/Qh y Septic Alteration Application Revised May 2024 1 1 1 - - - - . ■■■■■■■ ■ ■■■■ ■ ■■16■ 20 I 301.14-2-8 24-0440 ■ ■■■■■ ®o 1 So , ■ ENEFerraro, Keith &Connie ' ■ ..■■■�.uu■■..■u. IME' 46 McEchron Lane ■■■■■■■ r ja { , 15 0 AO It ■ r■ ■ Residential Septic Alteration ■■�■■■■ ■■�IN■■■■ mouniummummommummonautsimitamo „pie ►+ m■■ ■■■■■■■■■■■ ■■ .. ■nm�■ ■■■■■r■■ ■■■■■■■ ■■■■■■■■■■■■■■■ .■■■■�■■■■■r��■■■■■■■■■■ ■ ,■■■■■■■■■■■■■■ tsium ■ roirmgmEml ■ U ■■■UN■■■■■� N ■■■ ■ ■ TN ' �UEE.SB RY ■■ ■■■■M■■�■■■■ U . fd �' M1t•o'n.0 hmi ed e.amnia!'? ,co pli d as(1 ma's-s•.; r� - ce �M■■■■■■ ■■■11�� cati Ih• pia s a d sp uiidi' icn,iar� �n Y ■■■■■■ ■■ ■■1 ■ :vii c' pliau e-��itb-J �� M_Le Yc St.te. ■■■_■■■■■■ M _ III . 11111.11 ■■..■■�■ ■■■■■■�� MU ■ � r11111111111111111111111r1■■■■■■■■ ■■■■■■ ■ ■ M■■■■■■■■■■ _ M _._UN■■■� ■. u r i ill ■■■■■■■r�r1 ■■■ 20 2 LA , u ■ ■■■■■■■■ ,■ 1i■■� . ■ rinit: ■ . n■■■■■■■ r1■ ■ i B61.1111111111111111` 1 ,,Dtis ■ Pi ■■■■�/■ 114.11111.111.11 ■ n © iNiIrnflIflhIUIL i ■■ ■■■ ■■/ _ I W [�■■■■■■■milmilIt ■■■■� n■ 2 ..', • .. ,• . ■■■■■ ■,��■ • ■ o -, _ _ wil•••■■■ ■■■■ ■ .l■■■■■ - . , _.- _ ■ii■■ •_1a .""r■■■ S■■ ■■/I■■■fi ! ■■■■■■■■■ ■ r■■■■■rr■■ s e �B1ii■ ■■■ ■■■■ ■■■■■ ■ ■c1■■■■■■■■■ iii ii , h 1 MIEN • q d' A r............... Iry ita f G 1[1111111 EN MPIE J E Iiiiimirr, aill . • 1 :III., N.., 11 11 ,....... . 1 II u . • , .r- 1.4111 rt. 4. lir: •Illir pin cf,in) u�' ■