application 01/41D
40,4,
SEPTIC DISPOSAL it a LC� i Office Use Only
f 742 Bay Road,f$uen' r NY A28d4y s /q j ((�
{vivra ofC,rrccmburr s' A 2019 ! 1,1 Permit#: l� 02 ( t-- -ci( i P:518-761-8256 SW..+` a'eerRi" ,sie ; _
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Tax Map ID#: 301.15-1-21 _, QUEENSBURY�� Permit Fee:$ 7S 160, Invoice#: / �,,5
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Project Location: 8 FERRIS DRIVE ,_„ k}a =,•y , hD s Septic Variance? Yes No
Primary Owner(s) RICHARD MANELL
Mailing Address 8 FERRIS DRIVE,QUEENBSURY NY
Phone & Email 518-798-0843
Installer/Builder SANITARY SEWER SERVICES
Mailing Address LUZERNE ROAD,QUEENSBURY NY
Phone & Email 5187963760
Engineer TOM CENTER
Mailing Address 73 SHERIDAN STREET,GLENS FALLS,NY 12801
Phone & Email TCENTER36@YAHOO.COM
Contact Person for Building&Code Compliance: GEORGE DRELLOS Phone: 5187963760
RESIDENCE INFORMATION:
Year Built #of bedrooms X gallons per bedroom =total daily flow Garbage Grinder Yes No
1980 or older Installed? (circle one)
1981-1991 Spa or Hot Tub Yes No
Installed? (circle one)
1992-Present 3 110 330
PARCEL INFORMATION:
Topography ✓ Flat Rolling Steep Slope %Slope
Soil Nature Sand Loam Clay Other
Groundwater At what depth? DEEPER THAN 6'
Bedrock/Impervious material At what depth? NONE
Domestic Water Supply / Municipal _Well (if well,water supply from any septic system absorption is ft.)
Percolation Test Rate: 1'-5' per minute per inch (test to be completed by licensed engineer/architect)
PROPOSED SYSTEM FOR NEW CONSTRUCTION:
Tank size 1000 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: 20 X 25 FT BED
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 regulations and agree to abide by these and all requirements of the Town of Queensbury Sanitary Sewage
Disposal Ordinance.
PRINT NAME:657.-,erre—, DATE: /
(7:-..D...
SIGNATURE: --2,1_
Town of Queensbury Building&Code Enforcement Revised February 2017