SEP-0305-2023 ., 3 SEPTIC DISPOSAL PERMIT APPLICATION Office Use Only
—_ 742 Bay Road,Queensbury,NY 12804
Town of QLeensbuny Permit#: —0�j�5- 2_0-2
P:518-761-8256 www.queensbury.net
Tax Map ID#: 36/i5 8 / —1 —CZ Permit Fee:$ 6 ; Invoice#: b I El
Project Location: Fo/'c.5" p,,,,k. t 5)3✓+ ...toe 1 Septic Variance? Yes A No
Primary Owner(s) ?re fe,r \
Mailing Address /83 r-/-a1,..,, es, 6 ,t,G{.--, 'Ley. JZgpif
Phone & Email 52 _ 7Y-f 777i fiat ,' . --
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Installer/Builder �N s 7 44 Ilia,a"f I�_�J r' it 1 !
Mailing Address �f- /ZS // I 1 1 ' _ - _ /
B� mot• �d (�,rc,�o�C. U� o I� ,I + 1fff4 Fi
Phone& Email f , Z 3Z,�747 y u u /11
-
Engineer i i '�.
�yy•c» G✓ p ' . i
Mailing Address `7Zoc s�`c t 6(.4,--�,�ir Oil /Z�v�6 ..___ '• '_"_:_ , - __,
Phone & Email �a p ipo�
✓, Y> G
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Contact Person for Building&Code Compliance: .[ram ir.rU•ufd i O Phone: � Z7 Z ,0 7
RESIDENCE INFORMATION:
Year Built #of bedrooms X gallons per bedroom =total daily flow Garbage Grinder Ye of
1980 or older Installed? (circle one)
1981-1991 Spa or Hot Tub Yes No
Installed? (circle one)
1992-Present 3 r1 o 33i,
PARCEL INFORMATION:
Topography - ---- — Flat Rolling Steep Slope %Slope
Soil Nature K Sand Loam Clay Other
Groundwater At what depth? �
Bedrock/Impervious material At what depth? .
Domestic Water Supply unicipal _Well(if well,water supply from any septic system absorption is ft.)
Percolation Test ate: f cr per minute per inch (test to be completed by licensed engineer/architect)
PROPOSED SYSTFjM FOR NEW CONSTRUCTION:
Tank size (/14 gallons(min.size 1,000 gallons,add 250 gallons for each garbage cylinder or spa/hot tub f
System Absorption field with#2 stone Total length S/ar ft.; Each Trench 5f ft. /We-z.*'
Seepage Pit with#3 stone How many: ;Size: G/,,u vri f`t,,i.
Alternative System Bed or other type:
Holding Tank System Total required capacity? ;tank size ;#of tanks
NOTES: 1.Alarm system&associated electrical work must be inspected by a Town approved electrical inspection
agency;2.We will no longer allow systems to be covered until such time as an as-built plan is received and approved.
The installed system must match the septic layout on file—no exceptions.
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 reg 'ons and agree bide by these and all requirements of the Town of Queensbury Sanitary Sewage
Disposal Ordinance.
/ 7
PRINT NAME: vied G�/ �� DATE: �j 5L J
1' "L7
SIGNATURE: DATE: J
TOWN OF QUEENSBURY
� 742 Bay Road, Queensbury, NY. 12804-5902
Septic System Checklist
`( Plan to scale
"f 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)
Pp.All wells on property and adjacent properties shown
Water line sho unicipal o ell 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
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)
Septic 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
l)p\Seepage pit 150'from well 50'from septic tank
OI\Seepage Pits 3-times diameter apart
Septic tank and pump stations over 30 gallons 50'from watercourse or wetland
``t 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
pex.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
`(Department of Health Approval for all mobile home park new systems Flood Plain requirements
t)' 2' above established flood elevation to bottom of system
All tanks anchored or 2' above flood elevation
PLOT DATE:
PROJECT #:
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q� `;)ulrf]] [^�� 3, AL I f I h111..T t � F�`dr'�I:,rIY J� I TO Hi 01H 1Ailf,i`(
NO ACTI\E NEIGHBORING 'WELLS NOTED/VI'SIB E WITHIN IDD" y i,
� � I N�� " T�������p
N IRII A'w,R l',fdf) O RlIk L,'I� L . �
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S COMPLETELY REMMGVE DR FILL IN EXISTING SEPTIC 4 � 1.....Mv
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v l!I I 1lM�r OR Mlk I'sE i i, .: 1 I; r
COMPONENTS.
iNI FI IION S O i JNE AH I MIDI(.: C OM C)Psl1.NS S
2 ?r; NO I t R I AI IAA D F'DR a F5 -A.11ON,
LEN_ PURPORTED,
771
ELECTRIC F, 'TRI LINE,
TOTAL� LEN TN...._D �:A_T F AL a — 110'
LOCATE IN
_. _....... FIELD, t�LIC� A,,� HACK AT
PER N"tl'SC}CMHM APM", 75-A(F"E:ET 3, G9Cb); A 25 REDUCTION IN
TRENCH LENGTH IS ALLOWED NTH USE OF GRAVELLESS CHAMBERS NEW 100 GALLON CONCRETE PROJECT
,r-�� _��-�+ � /� 7 � M � PLAN
NTH 1.6SF`/F"T OF BOTTOM AREA & VOLUME OF 7.5GAL/`Pr & OPEN TANK WITH F'ILTLR.SEE PER F"M�C1T T'Y`P. f OJ�_CT O:C� A I IIOI'N � L..AN
SIDEWWAp..LS, TABLE 6C OF NYSt 011 "GREEN" HANDBOOK. DETAIL S.LCICATE AS FEASIBLE
�"""'�i ..... .M;
NOT TO SCALE
`D L a, INF"M" RMATIQ ' 7 r✓� _.
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PT9 STAR9LM2EJ7 r EIMCGLATIUN RATES 155 MN k
__ N..1r TIME F= SEPTIC
NT N ACRES_
PT 02 STABILIZED PERCOLATION RATE° 1:35 MPI IN PECTION
_. _.._
1 LATERALS AT 5' EACH. ..... a
n APPROVAL STAMP / NG'rES
ADS HANCOR ARC 24
CHAMBERS. a WAIF NJ' , 1 N*
...
SIDEWALK--` __.� .�..
PARKING LOCATE WATER LINE AND.... PARKING
_______d___._..� .. .
MAINTAIN 1 ' HORIZONTAL SEPTIC REPLACEMENT DESIGN GRAVELLESS CHAMBER
SEPARATION TO 'SEPTIC„ TYP,
BRIWOOD CIRCLE Y I_ -.
BRIWOUD
1, ),r
183 PITCHER ROAD, QUEENSMURY, NY (TOWN OF QUEENSFMUR"Y)
I
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NV
AS TIE--IN I E.NSI JI'J.:`�...... T_ � 1 , Lt� SITE PLAN
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t CorM EMMi.seLM, _ FILE: NAM SITE .�.....
REF'"fl TANK F XPOS D RI!SERW a
SCALE 1 2MT D.
SEPTIC I�T L � ..r. .....
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/
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... ..... _. __ . .. d I / O
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MOUND TOPSOIL FOR SETTLING, l'RQdL, J
SEED AND COVER WITH STRAW. 'I, S'r,ti-m,DL' I ONED IIT AL OR[ A11J(,',F NlT N'("'DOH Nx 15—�^
�q I. N Y D 0 1'S "A "F N D Y 7'� A, W A A I F R H A I M F N I I A N D A D S,
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..............GRAVELA.-ESS N E ......... , 1 4
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I
CHAMBER EARTH klI COP,[) 13A'�&'Ll I0N ONF. ',dlF 1/151" III`. `I,C ON 01 lf,,�SIAIHU
BACKFILL EXPOSED C(DlAPONENP-S, NO _j1,4lARfl04G
C�)NSIRUCIION SH/dj M A'� "dV11NI'll ON !BC SF DRIAWINU-1 AND
N AC(ORDAW.�,' Wl[J I A[[ N Y`00�i AIND ,YS 11,M VANUI A(,I I Iff
ONE CHAMBER
TO LONGITUDINAL SECTION
PROPOSED GRADE, St OPE
4. All, h0kl< MH`�r GI,; ffi�il 10C)V, SlAfE & FFI)LRAI. 5AF[1,(
DO NOT SMEAR SOILS DURING DRAIN, SEED AND MULCH. R[C I A]I(N_," (N YS0 0�, )SH A, N'T".�f 0 1). 1 1 l0 I I I IN HA::C,,U I I fl M FN I S, AR
EXCAVATION. INS-FALL. LEVEL. REMOVE llil-I OF 1111, OwNl"l,",
______ . ........ DEB�R�,S, RAKE FLOOR & WAL.L.S. 5, f R, E A)I IMI N I l( 8[ K I ll I A WA� I 1::� A4 Tl ff RFA 1 MCN I I 1l I D,
........... N 0 l l�I C(I A WIA) 0 N TR,E A I M UNT r I f[D
Z7/ �Zl/ GROUND WATER, BEDROCK OR
IMPER ALE TRATA
6. Slk Ak't D fl,1,EA1kAllfl AR FA FH LL A DOK�, AND WA '�, Ri 10 HE kAXED
MEA S
PER NYSDOH APP, 75-A FEB 3,,,, 2010 ; A 25%
REDUCTION IN TRENCH, LENGTH IS ALLOWED WTH: USE OF 71 llif,,A IMENF I]l I J) �,HA[[ HE (NACILD fo sii[:i_� I,IAINIAIJ ANL� 10
i GRAVELLESS CHAMBERS wrni i.6SF/FT OF BOTTOM AREA ADS HANCOR ARC 24 CHAMBER MODEL Dl',A N� SUIRI"A(�1 RUkRkl_ I ROM AIDJACFN r ARF W'.
VOLUME OF 7.5GAL/F"f & OPEN SIDEWALLS. G VELLESS CI JAMBER TRENCH TREA"I'MENT SECTION 111L('110lVVLlj1)/n, IONL DOWNSl OP F OR iHAI I OW &ILLS:Sl�OUI[: HAM,
Ov ill-I Cr (,,HlADRINAIH)N AND 1 ll, RAI!( 1,� ',�'YSTFM Nl .IALI `D.
SCALE: NTS NLH WA Ekl (,,UAU1Y 5110lMID HE L`SFED FIF'�NDDICAH,�',
FTROM SEPTIC TANK F -T` T 24" DIA 9. 1:EA1701 Wil 11 ,, Alfl 'SHOWN 01d 11,AN'S A)l All wl [J S IOAY HE
4" DIA. SOLID PVC I I I N I FFN:,flfl 'i I OCATU).
INLET�L III I aJTL.ET
A
10, GAP[5 AGF G+L I NO L l d S AN I� VA I I N 11,4 A T M N I .YS f F M a1141PC; A I-A0 i
ju '.,Lp FIC, NO SUl'IF, 11100P N,LrYfil D MAKING AKING f IX MUL
Sf l:I C I Ep... ......... CAUSF FA[LuRE Ol
...........
INLE T OU TLE L-L I
T PROVIDE EFFLUENT
RLTER. SEE NOTES, APPROVAL STAMP / NOTES
INSTALL RISER EFFLUENT FILTER (J.D 0 L '1..0 K P L 12 2) of N"i"", oducaUon aw tcw anylUr��Qx,,
i �ie is mcling winder diiechon c,f n
LOCKABLE COVER, TYP---- ka uHv, ony diem fr, (my w(iy,
1--V12" PRECAST,----
-LE
CO
CRETE BAFFLE BACKFILL NTH CLEAN- INISHED GRADE
OR EQUAL Top
N�I_IIIIJ,gERINA� T`kMpkF
IN A EFFLUENT FILTER TOP SOIL, SEED MULCH
-REMOVABLE COVER
COVER 'WATERPROOF SEAL
INLET INVERT '--POLY RISER
0 2" ASOVE
0 INLET OUTLET iNvm,r OUTLET
INLET Ill---CAULKED
2
0
NL
U I L I 0 T 11L MIN
",V
AN 4
Z
JOIN"I JOINT
CAULKED-J'A'
OU TLE T z r
SANITARY----1 LEVEL .,t-----SANITARY TEE W1
EFFLUENT FILTER
2" MN. TEE \-aULKHEAD
121, MIN. -----3" MIN
—CLEAN SAND', PEA
GRAVEL OR AGGREGATE
nc-
(3/4 1 1'/2 j�.
If' DEs*NED TO USE Fx%r TING SEPTIC TANK, PUMP OUT AND INSPECT
EXISTING TANK, PROVIDE WRITTEN REPORT TO ENGINEER. SYSTEM COMPONENTS SHAI L BE
MAINTAINED, TANKS SHALL BE PUMPED SEPTIC REPLACEMENT DESIGN GRAVELLESS CHAMBER
.............
1, MINIMUM TANK CAPACITY AS FOLLOWS: OUT AND INSPECTED EVERY 2 YEARS
1. PIP ` ,
K -LAN
E JOINTS TO BE SE ALED LIQUID TIGHT. - FOR 3 BEDROOMS OR LESS TANK S4�IALL BE 1,000 GALLONS, NTH OR LESS FOR OPTIMAL PERFORMANCE'„ 101fl-1ST PA.1 BR I WOOTT
27 S.F. SURFACE AREA. EFFLUENT FILTER (IF INSTALLED) SHALL
2. SPEED LEVELING DE VCES SHALL BE USED ON ALL- - 4 BEDROOMS SHALL. HAVE A 1,250 GALLON TANK WITH 34 S.F.
OUTLET PIPES, SURFACE AREA BE CHECKED AND CLEANED LOT #(3 5
FOR EACH ADDITIONAL BEDROOM ADD 250 GALLONS & 7 S.F. REGULARLY. OTHERWISE PREMATURE
3. SEPTIC TANK TO D--BOX: 4" PVC OR SDR21, LIQUID SURFACE AREA. F A I L U R E C 0 U L 0 0 C C U R 183 PITCHER ROAD, QUEENSRURY, NY (FOAN OF QUFENSBURY)
TIGHT JOINTS, MIN, SLOPE '1/8- PER FOOT. FOR HOT TUB/SPA AND/OR GARBAGE GRINDER ADO 250
GALLONS TO TANK SIZE FOR EACH,
4. THE SLOPE OF OUTLET PIPES BETWEEN THE
A a-
WIN
DISTRIBUTION BOX AND DISTRIBUTION LATERALS 2, BUILDING TO SEPTIC TANK� 4" PVC SCH, 4-0 PIPE, LIQUID TIGHr JOINTS, 0 IIIIIIII11W
IN 1k
SHOULD BE SLOPED AT LEAST 1,/32" PER FOOT MIN. SLOPE 11/4" PER FOOT. mm" KENGINEERING, PLLC DETAU-S
NY
NAtt ��EIA
AND CONSTRUCTED OF 4' PVC SCI+ 40 OR SDR21
225 RUGGLES RD.SARA,ro(��,A SPRINGS,NY
ATM LIaJID TIGHT JOINTS. 3, SEPTIC TANK TO D---BOX OR PUMP TANK: 4" PVC SCH. 40 PIPE OR 518.58�399,3
SD�R21, LIQUID TIGHT JOINTS, MIN, SLOPE 1/8" PER FOOT, 04\1,j FILE NAME DETAILS
5, USE DOUBLE SIDED S'RCKING RUBBER BUTYL FOR gal r6 ..........
�j — _.......... SCALE AS NOTED
DOSED SYSTEMS. 4, SEPTIC TANK TO CONSTRUCTED PER NYSDOH GUIDLIN,ES. N C, WAO�IOP4 Ad'P'l) DAIL
4, . .....................
'SUED FOR REVIEW/APPROVAL RKF 4/20/23
NEW CONCRET'E A �S
DIsrRIBUTION BOX NEW CONCRETE SEPi-IC TANK
RECORD DRAWING RKR 7/13/23
a Q 1
o ...... T
9 SHEE
00
SCALE� NONE'
SCALE: NONE L, _100 2 OF
m CL ss c
2