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applicationseesOM 90 1D—ligSEPTICDISPOSALPERMITAPPLICATION|perm roars TeeSepticVariance?Yes Nomiriam—RE\/T GED —‘a pecerven|(aM hl[ov aS mo |y Project Location:25CleverdaleRoad TOWN OF QUi BUILDING ¢Applicant: Name(s):Raymond &Wendy Kraft Mailing Address,C/S/Z:97 Glenwood Ave.Queensbury,NY 12804 Cell Phone:_(518 _)961-0338 Land Line:_() Email ©Primary Owner(s): Name(s):_same as applicants Mailing Address,C/S/Z: Cell Phone:_()tand Line:_() Email: CO check if all work will be performed by homeowner only ©Contractor:Workers’Comp documentation must be submitted with this application Contact Name(s):_Raymond Kraft Contractor Trade:_Contractor Mailing Address,C/S/Z:97 Glenwood Ave.Queensbury,NY 12804 Cell Phone:(518 _)361-0338 Land Line:_() Email: ©Engineer(s): Name(s):Hutchins Engineering 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 Building &Code Compliance:Ray Kraft Cell Phone:_(518 _)361-0938 land Line:(__)Email: Septic Application Revised February 2019, RESIDENCE INFORMATION: Year Built [Gallons|#of bedrooms:|X gallons per|=total daily flow per day bedroom.Garbage Grinder Yes is1980orolder}150 Installed?(circle one) ponieica tana|Riae ‘Spa or Hot Tub Yes (Wi Installed?(circle one) 1992-Present|110 4 110 440 PARCEL INFORMATION: Topography ¥_Fiat Rolling Steep Slope %Slope Soil Nature _Sand Loam Clay __¥_Other (explain:Sil ) Groundwater ‘At what depth?32"apparent seasonal high groundwater table Bedrock/impervious material|At what depth?greater than 56" Domestic Water Supply Municipal _¥”Well (if well,water supply from any septic system absorption is 101 ft.) Percolation Test Rate:_12:00_per minute per inch (test to be completed by licensed engineer/architect) PROPOSED SYSTEM FOR NEW CONSTRUCTION: Tank size|1.250 gallons (min.size 1,000 gallons,add 250 gallons for each garbage cylinder or spa/hot tub System ‘Absorption field with #2 stone|Totallength a0 ft;Each Trench 60.ft. ‘Seepage Pit with #3 stone How man3Size: ‘Alternative System Bed or other type: Holding Tank System Total required capacity?jtanksize#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.|have read the regulations and agree to abide by these and all requirements of the Town of Queensbury Sanitary Sewage Disposal Ordinance. Septic Application Revised February 2019