SEP-0734-2022 f-=- SEPTIC DISPOSAL PERMIT Office Use Only
`; APPLICATION Permit#: P " 20 2-7—
Town ofQuccnsbu y Permit Fee:$ brj
Invoice#: 5(0 5e\--
742 Bay Road,Queensbury,NY 12804
P:518-761-8256 www.queensburv.net Septic Variance? Y
Flood Zone? Y
Wetlands? Y eviewed By:
Project Location: 31 Hicks Road °~ nn �p� En
nu
Tax Map #: 297.7-1-22 :1 -
DEC 6 2022 ti:j
RESIDENCE INFORMATION: TOWN OF QUEENSBURY
Year Built Gallons #of bedrooms: X gallons per =total daily flow BUILDING&CODES
per day bedroom ar age Grinder Yes No
1980 or older 150 Installed? (choose one) x
1981-1991 130 Spa or Hot Tub Yes No
1992-Present 110 3 110 330 Installed? (choose one) 111
PARCEL INFORMATION:
Topography ■ Flat Rolling Steep Slope % Slope
Soil Nature ■ Sand Loam Clay ■ Other, explain:
Some Silt
Groundwater At what depth?
Bedrock/Impervious material At what depth?
Domestic Water Supply ❑ Municipal ■ Well Lake
(if well or lake, water supply from any septic system absorption is
ft.)
Percolation Test Rate: 7:40 per minute per inch (test to be completed by a
licensed engineer/architect)
PROPOSED SYSTEM INFORMATION:
Tank size 1,o00 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 200 ft.; Each Trench 50 ft.
Seepage Pit w/#3 stone How many: ; Size:
Alternative System Bed or other type:
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): Jeanette and Matthew Koskinas
Mailing Address, C/S/Z: 31 Hicks Road Queensbury, NY 12804
Cell Phone: 518.232.9024 Land Line:
Email: ibkoskinas@gmail.com.
• Primary Owner(s)'
Name(s): same as applicants - •
Mailing Address, C/S/Z:
Cell Phone: : Land Line:
Email:
0 Check if all work will be performed by property owner only
• Contractor:
Contact Name(s): IBS Septic
Contractor Trade: 2 Lower Warren St, Queensbury, NY 12804
Mailing Address, C/S/Z:
Cell Phone: Land Line: (518) 798-8194
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 Ordinance.
PRINT NAME: Jeanette Koskinas
SIGNATURE: DATE: 12/15/f
Septic Application Revised July 2022
11Iftiv, TOWN OF UEENSBURY
� � Q
742 Bay Road, Queensbuni, NY. 12804-5902
Septic System Checklist
/I-/ Plan to scale
'JV7 eceived 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)
16 ti All wells on property and adjacent properties shown
f ,Water line shown Municipal or well 10'separation to any part of system
iSetback to property lines show 10'or more for any part of system
leptic
tank and pump stations 10'from foundation 50'from any well/lake/wetland 10'from any waterline
Ju -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)
VSeptic 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
*Seepage pit 150'from well 50'from septic tank
OSeepage Pits 3-times diameter apart
l''Septic tank and pump stations over 30-gallons 50'from watercourse or wetland
'{r4distance from bottom of trench or s s'fem 24"to be rock or mottling 36"within 1000'of Lake George
..]-12/Leech field 100'from watercourse or wetland
MrToe of mound or bottom of retaining wall 10'from property line 100'from well 20'from
Foundation
y
1 Provide Engineer/Architect stamp for bed or design systems
v Department of Health Approval for all mobile home park new systems Flood Plain requirements
/V 2'above established flood elevation to bottom of system
N'
All tanks anchored or 2' above flood elevation
1:0n1rieorl A/1 S/')!1')1
WASTEWATER SYSTEM SETBACK
REQUIREMENTS
PROPERTY LINE
HOUSE
WELL.
SEPTIC TANK
10'
10'
50'
ABSORPTION FIELD
10'
20'
100'
PERCOLATION TEST
POTABLE WATER SUPPLY IS ON -SITE WELL PT-1 - 1211312022 BY TOM HUTCHINS, P.E.
- MAINTAIN 50' MIN. SEPARATION BETWEEN STABILIZED PERCOLATION RATE: 7:40 PER INCH
WELL & SEPTIC TANK copy
297.7-1-22 SEP-0734-2022
MAINTAIN 100 MIN. SEPARATION BETWEEN DESIGN TO 8-10 MINUTES PER INCH G. �- - Koskinas, Jeanette &Matthew TOWN OF QUEENSBURY
_ WELL & ABSORPTTON`AREA
31 Hicks Rd BUILDING &CODES DEPT.
Residential Septic Alteration
Reviewed By:
_ Date,
_TAX MAP # 2 _.7- _
'T
97 1 22 -
REMOVE ORGANICS AND TOPSOIL
1 TO PLACING FILL MATERIAL PRIOR
JM1safely.
-.. _
I oPsal
4 MIN. T
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- Ne /.York _
6 1YP. TRENCH SPACING
SHALLOW TRENCH FILL MATERIAL AS Cali Before You _
■ Dig
Required Time
. .:, ... ... :..: . _, . ..... NECESSARY TO Wait The R ESTABLISH DESIRED GRADE ■ equl
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• ■ Confirm Ufliltg Response
■ Respect The Marks
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MIN. SEPARATION ,
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STEWATER Ei SYSTEM PLAN &DETAIL. .
TO BOUNDARY 4 _ _ _ --- __. CONDITION .
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31
UNDARY CONDI f New York
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PROPOSED 24 IMDE ABSORPTION TRENCH, 4 REQUIRED AT 50 LONG EACH .-.- _ ; ,•, ;...■. ; :; ::_ _ ; --• ;—' I ;— --11�--...I . _- . ' _._ BASE MAP INFORMATION FROM WARREN COUNTY G1S, ry/ / ::I s
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.own' o u
T A FIELD MEASUREMENTS.
I I : _._._._::: I :___; I I • .._ ;:: ;-•--w: , ..:.__: I I— .,,_ AERIAL PHOTOGRAPHY, AND
�.....__, . I ; ,........_..: .._...._.._ ; ,........_ . .. �8 Checked: GTH Scale: NOTED
Date: 12/5/2022
(SEE ABSORPTION TRENCH SECTION AND PROFILE FOR DETAILS) - _ ; :......._.... I THIS IS NOT A FIELD SURVEY. ALL LOCATIONS ARE s Drawn: �Rs
I
•
P 169 HaVllond Road
:-- ::.. _�" I • ; _._.: ' APPROXIMATE CONTRACTOR Ti0 FIELD VERIFY ALL
SETBACKS PRIOR TO BEGINNING INSTALLATION. Queensbury, NY 12804
ALTERATION of THIS 111 ac�T B`r 292091-01
ED PIRIIFE�IONAL ENGINEER IS. A _ _ _ _ ,_ (518) 745=-0307 Phone
A_LlCENS_
woUEI) OF N5 EDII(J►noN LAW. Hutchins Engineering PLLC (518) 745-0308. Fox
TIO:
ABSO'PTIo
FIELD 5ECUON
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�EQLf3F.Q, INSTALL POLYETHYLENE @QUFRED: INSTALL POLYETHYLENE \ \ 3 uz d x
r ' f4 >� v � { ��< v
EXTENSION TO GRADE WITH EXTENSION TO GRADE WITH - � h T
16?'± TO LANDS NIF OF SUGGESTED: INSTALL POLYLOK PL122 FILTER SUCH11
/ TAMPER RESISTANT ACCESS TAMPER RESISTANT ACCESS ,
NEIGHBORING WELL ROE11fER THAT IT IS READILY REMOVABLE THROUGH TANK
t FROM PROPERTY LINE COVER (NON-TRAFFIC AREAS) COVER (NON-TRAFFIC AREAS) ;' '� r� '
ACCESS COVER F
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"F '�' r It
__ .-_ APPARENT P.L. FROM BARREN COUNTY G_I.S.
12" MIN. COVER
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— _ — f"s ' .J � c
1/4" PER FOOT Ta. a
t
LANDS NIF OF t t
MIN. SLOPE ° » 12" MIN. COVER , a � : '�
ROEMER I a ° a 1/8 PER FOOT
DISTRIBUTION BOX
_ 3 F
4„ H ° 3" MIN. SLOPE v T r f �'
HOUSE
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OUSE SEWER ____�_�►- ,, rY j. r 'a. ,�F^ 3, f^ S+ 5 F 2 i Jry Pffl` T -,[
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7
LIQUID LEVEL 4" EFFLUENT SEWER � '� �� � �T £ �111�� av
RECORD DRAWING DIMENSIONS
WATERTIGHT SLEEVE & f`�" �, '� �` : I r ��
BAFFLE v ,
SEAL (TYP.) » » x , r ,
/ ( ITALE 16 18 2 MIN. £ r ;
MIN. USE SPEED LEVELERS TO ASSURE �3 , r; I'l �' "
" » I / ° ALL OUTLETS ARE AT EXACTLY THE 2 MIN. DROP , {�
CORNER A CORNER B I SAME ELEVATION BETWEEN INVERTS }j
._ — — o ,`* _ `�, .r rye�.\JS\�aN-14"' a ,_£ \\�.% v ,,:g,,
- - - TANK OUTLET 47' 38' d " I'llI'll \,"r I ,><
t 4 PVC SDR-35 SOLID HEADER TO �a 1
t ABSORPTION FIELD, 1/8" PER FOOT
v I k
ti D-BOX 69 62 " MIN SCOPEr F"
LIQUID DEPTH11
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tat 30 MIN. { x sv
t END OF TRENCH 77' 87' I 60" MAX. § f
o SEPTIC TANK NOTES h ry � i; ,
a ALL UNITS SHALL COMPLY WITH THE REQUIREMENTS OF THE NEW YORK STATE DEPARTMENT OF x T a � � � :
t ,s., - y I -�..�
. HEALTH AND SHALL BE OF PRECAST CONCRETE AS MANUFACTURED BY UTOPIA ENTERPRISES OR -` u , <:� , _ ,..._.. �� �._� 1
�q I EQUIVALENT. SITE LOCATION LOCATION
/ �/^/�Ti t'1 A/ MAP
i//t/7
LANDS NIF OF t MINIMUM 2X WIDTH Vt.A / .LO l�tf"I!"
BENWAh lo MAXIMUM 4X WIDTH ° ALL STRUCTURES SHALL BE PLACED ON FIRM, COMPACT SAND OR GRAVEL BASE. WHERE
VACANT LOT I t EXISTING SOIL CONDITIONS ARE UNSUITABLE, CRUSHED STONE SHALL BE PLACED AS NECESSARY SYSTEM INSTALLATION NOTES
NO HATER SUPPLY �t TO ACHIEVE A STABLE BASE.
�. CONSTRUCTION SHALL BE AS SHOWN ON THIS DRAWING AND IN ACCORDANCE WITH THE N.Y.S. DEPARTMENT OF
r! I I's ° d a SEP77C TANKS INSTALLED IN TRAFFIC AREAS SHALL BE OF EXTRA HEAVY CONSTRUCTION HEALTH INDIVIDUAL HOUSEHOLD SYSTEMS AND ASTM F481 INSTALLATION OF THERMOPLASTIC PIPE AND
DESIGNED FOR H-20 WHEEL LOADING. CORRUGATED TUBING IN SEP77C TANK LEACH FIELDS.
Q' �t NEW 1,000 GAL. PRECAST CONCRETE SEP71C TANK
4' Ut ALL JOINTS MUST BE SEALED WITH BUTYL SEALANT. JOINTS BELOW THE LIQUID LEVEL MUST BE AFTER EXCAVATION OF TRENCHES TO THE DEPTH REQUIRED, THE WALLS AND FLOOR OF EACH TRENCH SHALL BE
t � TESTED BEFORE BACKFILLING. CLEANED AND RAKED IN ORDER TO LOOSEN SMEARED SECTIONS OF TRENCH.
0 �I SEPTIC TANK DETAIL PLACEMENT OF AGGREGATE SHALL BE AS SHOWN, AND CARE SHALL BE EXERCISED TO AVOID INCLUSION OF FINE
_' GRAINED SOILS AND WASTE MATERIAL IN THE ABSORPTION TRENCHES.
— _ — — ' t SCALE: NTS
t 0 LANDS NIF OF THE PIPING SHALL BE LAID AT THE GRADES INDICATED, MAINTAINING STRAIGHT CONTINUOUS GRADES WITHOUT
I wI MCGARR SAGS, HUMPS, SEPARATED JOINTS, OR OTHER UNSUITABLE CONDITIONS.
t EXISTING at ALL DISPOSAL FIELDS SHALL BE GRADED TO SHED RAINFALL AND DIVERT SURFACE RUNOFF AWAY FROM THE
/ WELL± f 4" MIN TOPSOIL OVER THE DISPOSAL FIELD.
(( r 4" MIN TOPSOIL OVER THE EN77RE ABSORPTION ENTIRE ABSORPTION FIELD,
t W FIELD, SEED AND ESTABLISH TURF SEED & ESTABLISH TURF DO NOT USE HEAVY EQUIPMENT WITHIN THE ABSORP77ON AREA AFTER TRENCHES HAVE BEEN INSTALLED.
I03 0.I OVERFILL TO ALLOW
\ FILTER FABRIC M/RAF! 140N OR EQUIVALENT BACKFILC FREE OF FOR SETTLEMENT
' \I/ Q) � t THIS SYSTEM IS DESIGNED FOR WATER CONSERVING FIXTURES AND IS NOT DESIGNED TO ACCOMMODATE EXTREME
+ -cE ___
cn �IIv, —I T I—III—I __— STONES OVER 3" WATER USE OR EXTREME ORGANIC LOADING DEVICES SUCH AS JACUZZI TYPE SPAS OR GARBAGE GRINDERS.
/ t —III=III=III—III—III—III—III=
t Q f o3 G EXISTIN 12" MAX =1 I I=1 111 I I I=1 I-1 _
' .., � � P TO 4 FERIVC IN — — ROOF, FOOTING, GARAGE, CELLAR AND SURFACE WATER DRAINAGE MUST BE EXCLUDED FROM THE WASTEWATER
t w 4I h� CONCRETE NEIGHBOR 1=1 11=I SYSTEM.
o I RESIDEN — —
N I L } Z � 6" MIN.
' �
t� ��it i+�i1�� f�
LANDS NIF OF \ .� `� M t » �o SYSTEM MATERIAL SPECIFICATIONS
' z I�Q 2 MIN. QCToo SLOPE 012j0� FILTER FABRIC
PREHODA
t �� �- o �o I ® 6
a CEO 0� MIRAFI 14ON
2' TRENCH WIDTH 6-12" ABSORPTION FIELD AGGREGATE
MUNICIPAL WATER I �� s ao- \• T ca EXISTING OR EQUAL » »
SUPPLY zJ V, ��£ �I�., zI a� STONE IS TO BE 3/4 TO 1-1/2 WASHED RUSHED STONE.
,� -s� v ��£ WELL±
' ���a c� r �� EFFLUENT FILTER
�' �'�\ .�, i�' � r` t c7�o 00 6 c�OCR c7�
�u e��� a f� � �� r 6" O o0�a Q EFFLUENT FILTER TO HAVE ? 16-INCH FILTRATION, POLYCOK PL-122 OR EQUIVALENT.
t �, � r� � � � c 0c� 4 PERFORATED PVC LATERAL, 2 MIN. � /
� � o,� 0 » n `��� EFFLUENT SEWER PIPE
�0 0� SLOPE 1/16 - 1/32 PER FT. END CAP
a T 12" MIN. PIPING TO BE 4" SDR-35 OR SCHEDULE 40 PVC. INSTALL WITH 1 8" PER FOOT MINIMUM SLOPE.
a{ tNSTALLED EFFLUENT SEWER � INSTALLED t,0OO GA TE ,� �C�cT /
�1 SEPTIC ANKPRECAST �£RE i CRUSHED STONE ABSORPTION TRENCH PROFILE 6" ���� Q 0o boo FILTER FABRIC
D o �
`'`� O o � o FILTER FABRIC TO BE 4.8 OZ/SY NON—WOVEN SEPARATION FABRIC, TENCA7E MIRAFI 140N OR EQUIVALENT.
4 PERFORATED PVC LATERAL, HOUSE SEWER PIPE
t �� SCALE: NTS ,. » "
t ,v2 INSTALLED DISTRIBUTION BOX 3/4 TO 1-1/2 .SHED SLOPE 1116" - 1/32" PER FT. PIPING TO BE 4" SDR-35 OR SCHEDULE 40 PVC. INSTALL WITH 1/4" PER FOOT MINIMUM SLOPE.
T \� ,' CRUSHED STONE
r a ` t SHALLOW TRENCH FILL MATERIAL
INSTALLED PIPE-IN-STONE
ABSORPTION FIELD, t ABSORPTION TRENCH SECTION MATERIAL TO HAVE SIMILAR PERCOLATION RATE To EXIS77NG IN-SITU SOILS NO PARTICLES GREATER THAN 3".
T — SEE SHALLOW TRENCH FILL MATERIAL NOTES.
t _ _ _ �vvv � `� 4 TRENCHES � 5O LF EACH,,
t — — �v�v�v O SCALE. NTs
1, »
a � 200 ,LF TOTAL � TOPSOIL
JO P.L. SETBACK w,v�,;�
v �
APPARENT P.L. FROM WARREN COUNTY G.I.S.
— — -— —— — - — — — — — — PLACE 4" MINIMUM TOPSOIL OVER ENTIRE BACKFILL AREA. SEED, MULCH, AND ESTABLISH TURF
11
SHALLOW TRENCH FILL MATERIAL NOTES
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M<.: a, _ AREA OF PROPOSED ABSORPTION F
£,<,i" .c<.. >,,. •x: , ,.z:: ,..>.>.. ,x,>, <v. w.. ,e s...,.. zac h.. ',} ,,:\ ..,,. £ ....':,.`�2 .A K3""'... L <Z:;£ ,v
IELD AND TAPER AREA.
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� �.h. \� WASTEWATER SYSTEM DE T = � � > t, £< ��, � a S S M SIGN r � � < , __�� �., < ITS 1 . DATA,t � � S SOILS
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,�._.. LC MATERIAL INCLUDING
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t � � _> z ri,� __ .>_ t „� . �, �_ _ ,, , M.,..,_ ,.,�. ,r .,h�\,.<> .>,5 .,., _ DESIGN FLOW 110 GPD BEDROOM
,: � „a, „�.z..?,.,,. _.w..,.,?,� ._................ ... ......<„�,<.. ,uw z... �,,. .<,.. _ .,....,_� £s, a. \ ass'`x....... >..,x.,,\�,hs�: >r .. �-`�
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LEACH FIELD - PIPE-IN-STONE ABSORP77ON TRENCHES 4-36" - LIGHT BROWN FINE AND VERY
LANDS NIF OF LANDS NIP OF DESIGN PERCOLATION RATE 8-10 MIN/IN FINE SAND, SOME SILT
36-52" - MEDIUM BROWN SILTY FINE SAND,
WEEKS COUNTY OF WARREN APPLICA77ON RATE = 0.9 GPD/SF
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ABSORPTION TRENCH AREA REQUIRED = 367 SF RECORD DRAWING NOTE:
2' WIDE ABSORPTION TRENCH REQUIRED = 184 L.F. RECORD DRA Y Y I N
NO GROUNDWATER TO 52 A REPRESENTATIVE OF OUR OFFICE VISITED THE SIZE
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WASTEWATER SYSTEM PLAN INSTALLED 4 TRENCHES AT 50 L.F = 200 LF DURING CONSTRUCTION AND IT IS MY OPINION THAT
SCALE: 1"--30' PERCOLATION TEST THE SYSTEM IS INSTALLED IN GENERAL CONFORMANCE
WASTEWATER SYSTEM SETBACK POTABLE WAFER SUPPLY IS ON-SITE WELL WITH THE APPROVED PLAN AND THIS RECORD INSTALLATION DATE: 1/19/202
GRAPHIC SCALE — MAINTAIN 50' MIN. SEPARATION BETWEEN PT-1 — 1211312022 BY-TOM HUTCHINS, P.E. DRAWING. FINAL SURFACE FINISHING AND TURF INSTALLED BY - lBS SEPTIC REQUIREMENTS STABILIZED PERCOLATION RATE: 7:40 PER INCH ESTABLISHMENT IS ONGOING
15 0 7.5 15 30 60 WELL & SEP77C TANK
PROPERTY LINE HOUSE WELL — MAINTAIN 100' MIN. SEPARATION BETWEEN DESIGN TO 8-10 MINUTES PER INCH THOMAS CENTER, P.E.
( IN FEET ) WELL & ABSORPTION AREA 112512023
CONTRACTOR TO FIELD VERIFY LOCATIONS AND DISTANCES SEPTIC TANK 10' 10, 50'
THIS IS NOT A FIELD SURVEY. ABSORPTION FIELD 10' 20' 100'
TAX MAP # 297.7-1-22
PRE ROVE TO PACING FILGANICS L MATERIAL " Dig ® Safely.
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MAP REFERS
NEW 24" WIDE ABSORPTION TRENCH, (4) REQUIRED AT 50' LONG EACH - I .
: ---= ,�--.. - .e_ BASE MAP INFORMATION FROM WARREN COUNTY G/S, ��. Cr
(SEE ABSORPTION TRENCH SEC77ON AND PROFILE FOR DETAILS) _�-: - AERIAL PHOTOGRAPHY, AND FIELD MEASUREMENTS. 06 ��g Drawn: JRS/WGC Checked: GIN Scale: NOTED Date: 12/5/2022
ABSORPTION FIELD SECTION a PROXIMATE• CONTRACTOR S IS NOT FIELD SURVETO FIELDALL ?VERIFY ALL ' 169 Havlland Road
SCALE: NTS
SETBACKS PRIOR TO BEGINNING INSTALLATION. ALTERATION I MENT EXCEPT BY Queensbury, NY 12804 292091 -01.
A LICENSED PROF S IONAL ENGINEER IS A (518) 745-0307 Phone ,
VIOLATION OF NYS EDUCATION LAW. Hutchins Engineering PLLC (518) 745-0308 Fax