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application Office Use Only SEPTIC DISPOSAL PERMIT APPLICATION :i: #:Fee: $ JT0. 00; Invoice#: I fJ S Septic Variance? Yes No Town of Queens.ury 742 Bay Road,Queensbury,NY 12804 P:518-761-8256 www.queensbury.net Tax Map ID#: 301.08-1-33 D 2 �r t� nii Project Location: 347 Aviation Rd JUL 19 2019 I ly TOWN OF QUEENSBURY i • Applicant: BUILDING 8 CODES Name(s): Stewart's Shops Corp. (Chris Potter) Mailing Address, C/S/Z: PO Box 435 Saratoga Springs NY 12866 Cell Phone: (518-301-1466 ) Land Line: (518-581-1200 ) Email: cpotter@stewartsshops.com • Primary Owner(s): Name(s): Stewart's Shops Corp. Mailing Address, C/S/Z: PO Box 435 Saratoga Springs NY 12866 Cell Phone: ( 518-301-1466 ) Land Line: ( 518-581-1200 ) Email: cpotter@stewartsshops.com ❑ Check if all work will be performed by homeowner only • Contractor: Workers' Comp documentation must be submitted with this application Contact Name(s): Stewart's Shops Corp. Contractor Trade: Click or tap here to enter text. Mailing Address, C/S/Z: PO Box 435 Saratoga Spring NY 12866 Cell Phone: ( 518-301-1466) Land Line: ( 518-581-1200 ) Email: cpotter@stewartsshops.com • Engineer(s): Name(s): Scott Kitchner Mailing Address, C/S/Z: PO Box 435 Saratoga Springs NY 12866 Cell Phone: ( 518-312-2675 ) Land Line: ( 518-581-1200 ) Email: skitchner@stewartsshops.com Contact Person for Building & Code Compliance: Chris Potter Cell Phone: ( 518-301-1466 ) Land Line: ( 518-581-1200 ) Email: cpotter@stewartsshops.com Septic Application Revised February 2019 RESIDENCE INFORMATION: Year Built Gallons #of bedrooms: X gallons per =total daily flow per day bedroom 1980 or older 150 Click or tap here Click or tap Click or tap here to to enter text. here to enter enter text. text. 1981-1991 130 Click or tap here Click or tap Click or tap here to to enter text. here to enter enter text. Garbage Grinder Yes No text. Installed? (check one) ❑ 1992-Present 110 Click or tap Click or tap Click or tap here to here to enter here to enter enter text. Spa or Hot Tub Yes No text. text. Installed? (check one) ❑ PARCEL INFORMATION: Topography ® Flat Rolling ❑ Steep Slope _0-2_%Slope Soil Nature © Sand ❑ Loam ❑ Clay ❑ Other(explain: Groundwater At what depth?Over 20 ft. Bedrock/Impervious material At what depth?Over 20 ft. Domestic Water Supply ® Municipal ❑ Well (if well,water supply from any septic system absorption is ft.) Percolation Test Rate: 2 minutes per inch (test to be completed by licensed engineer/architect) PROPOSED SYSTEM FOR NEW CONSTRUCTION: Tank size 1,500& 2,000 gallons(min. size 1,000 gallons, add 250 gallons for each garbage cylinder or spa/hot tub System Absorption field with#2 stone Total length ft.; Each Trench ft. Seepage Pit with #3 stone How many: ; Size: Alternative System Bed or other type: 15'x60'Stone Bed Holding Tank System Total required capacity? ; tank size ;#of tanks NOTES: 1. Alarm system and 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. 3. As-built drawings must be submitted prior to the inspection, if there has been a change to the submitted plans. 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: Chris Potter SIGNATURE: 40 DATE: 07/11/2019 Septic Application Revised February 2019