SEP-0706-2022 SEPTIC DISPOSAL PERMIT Office Use Only
LL APPLICATION
Permit#: 81'Ob 29fL'�
Town ofQuecnsbury Permit Fee:$ 1^r-D—
Invoice#: �a (1-
742 Bay Road,Queensbury,NY 12804
P:518-761-8256 www.queensbury.net Septic Variance? Y
Flood Zone? Y
Wetlands? Y 3 Reviewed By: c
Project Location: 163 Haviland Road -5ECEEDVIE --1
Tax Map #: 289.20-1-5
NOV 2 3 2022
RESIDENCE INFORMATION: TOWN OF QUEENSBURY
Year Built Gallons #of bedrooms: X gallons per =total daily flow BUILDING&CODES
per day bedroom varbage Gr lridei Yes No
1980 or older 150 Installed? (choose one) ❑ x❑
1981-1991 130 Spa or Hot Tub Yes No
1992-Present 110 300 GPD Installed? (choose one) ❑ 0
see plans for office design basis
PARCEL INFORMATION:
Topography El Flat Rolling ❑ Steep Slope - % Slope
Soil Nature ❑ Sand ❑■ Loam ❑ Clay ❑ Other, explain:
Groundwater At what depth? 42"
Bedrock/Impervious material At what depth? >42"
Domestic Water Supply ❑■ Municipal ❑ Well ❑Lake
(if well or lake, water supply from any septic system absorption is
ft.)
Percolation Test Rate: 14:30 per minute per inch (test to be completed by a
licensed engineer/architect)
PROPOSED SYSTEM INFORMATION: existing 1,000 gallon tank
Tank size 1,00o 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: 15' x 40' bed
Holding Tank System Total required capacity? ; tank size •
# of tanks
Septic Application Revised July 2022
1 .
I
1
CONTACT INFORMATION: PLEASE PRINT LEGIBLY OR TYPE, PLEASE INCLUDE AN EMAIL. .
• Applicant:
Name(s): Bay West Associates,LLC(contacts:Tom Hutchins&Matt Steves)
Mailing Address, C/S/Z: 169 Haviland Road
Cell Phone: 518-260-7499 Land Line: 518-745-0307
Email: thutchins@hutchinsengineering.com
• Primary Owner(s):
Names) Bay West Associates, LLC.
Mailing Address,C/S/Z: 169 Haviland Road
Cell Phone: ` Land Line: 518-745-0307
Email: •thutchins@hutchinsengineering.com
❑ Check if-all work will be performed by property owner only
• Contractor: * ... --
Contact Name(s): Sanitary Sewer Services
Contractor Trade: Septic Installation
Mailing Address, C/S/Z: 144 Luzerne Road Queensbury,NY 12804
Cell Phone: (518)796-3760 , Land Line:
Email: gdrellos@gmail.com
**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: 518-260-7499 Land Line: 518-745-0307
Email: thutchins@hutchinsengineering.com
Contact Person for Compliance in regards to this project: Tom Hutchins, P.E.
Cell Phone: 518-260-7499 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: Wici1/4/ 7. N VT 4PJ
y
SIGNATURE: •
ite- DATE: l(IZ 2-12-2--
Septic Application Revised July 2022
Q��� TOWN OF UEENSBLIRY
742 Bay Road, Queensbury, NY. 12804-5902
Septic System Checklist
I//,,Plan to scale
S 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)
All wells on property and adjacent properties shown P,UhlC1 ,.L '✓—t-r
C,.e,NNater line shown Municipal or well 10'separation to any part of system
-CA Setback to property lines show 10' or more for any part of system
9
9-rf Septic tank and pump stations 10'from foundation 50'from any well/lake/wetland 10'from any waterline
lfSeptic 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)
'k': Septic tank sized for number of bedrooms and add 250 gals for Jacuzzi tubs/garbage grinder each eikli'l
ir-0 �--
,gLeech Field 20'from foundation 100'from any well 10'from water line
'`iSeepage pit 150'from well 50'from septic tank
1i Seepage Pits 3-times diameter apart
Septic tank and pump stations over 30 gallons 50'from watercourse or wetland
ti distance from bottom of trench or system 24"to bedrock or mottling 36"within 1000' of Lake George
ti`{id Leech field 100'from watercourse or wetland
Toe of mound or bottom of retaining wall 10'from property line 100'from well 20'from
Foundation
Provide Engineer/Architect stamp for bed or design systems
P.1i Department of Health Approval for all mobile home park new systems Flood Plain requirements
ap 2' above established flood elevation to bottom of system
Ivy All tanks anchored or 2' above flood elevation •
06 1Y' a, 461 276).-4-am
LOCATION MAP 1 "=800'
Date: FEBRUARY 23, 2000
DusvNAONGRlgn ALTERATION OR ADDITION TO A SURVEY ",
YAP BEARING A LICENSED LAND SURVEYORS SEAL IS A Ma of a Survey made for Scale 1 =50
`n VUxATION OF SECTION 72D9. SUB -DIVISION R OF TIE
NEw ram sTATE EDuCAnoN LAW 5 11-16—
n 'ONLY COPIES FROM THE ORIGINAL of THIS suRVEY LOCATE FLAGGED UTILITIES
BARKED WITH AN ORIGINAL OF THE LAND SURVEIORS v 4 - 11-26-18 PROPOSED ADJUSTMENT �)teves SEAL SHALL BE CM90ERED TO BE VALID TRUE COPES T ASSOCIATES, LLC TMENT S 1
CERI1FlCAlIONS INDICATED HEREON SIGNIFY THAT3 9-06-07 APPROVAL NOTES
Land BAY WEB
THIS SURVEY WAS PREPARED IN ACCORDANCE NTH THE I
EXISTING CODE OF PRACTICE FOR LAND SURVEYORS ADOPTED 2 7-10-07 PROPOSED ADDITI
169 Haviland Road BY THE NEW PORK STATE ASSOCIA OF PROFESSIONALNN �ensbury, Warren County, New York 1 12-8-00 PROPOSED SIGN SHEET 1 OF 1
veyors
UND SURVEYORS SAID CERIIFlCATIONS SHALL RU BAY.WEST
Su i TO THE PERSON FOR WHOM THE SURVEY IS PREPARED AND Town 0f QueE NO. DATE DESCRIPTto DWG. IN 86672—BW
792-8474
G 8 ON HIS BEHALF TO THE tlllE COMPANY GOVERNMENTAL
J � AGENCY AND LENDING INSIITUI110N LISTED
HEREON, AND
New _York
12804
TO THE ASSIGNEES OF THE LENDING NISTITUTION
Queensbury,
New York Lic. No. 50135