2008-562 ............................... .OFFICE USE ONLY-.........,_.,,...._,_.,_...__.,
TAX MAP N0. PERMIT NO. PERMIT FEE
APPROVALS: ZONING TOWN CLERK 'i sr- i 6 2009
%............................................. -.._,.
APPLICATION FOR SEPTIC DISPOSAL SYSTEM PE = I
A PERMIT MUST BE OBTAINED BEFORE WORK BEGINS.APPLICATION IS SUBJECT TO REVIEW BEFORE ISSUANCE OF A VALID
PERMIT. �
OWNER: tJq
1tt t:L c(�2£ ^GA - INSTALLER:Z),A1l.L� Gd-SI2UC.7 00
ADDRESS: IL4 11fERAr404 LA ADDRESS:
PHONE NOS. -7 4Ll— N00 PHONE NOS. 7 7 3 r 77 A-
LOCATION OF INSTALLATION:
RESIDENCE INFORMATION:
YEAR BUILT NO.OF X COMPUTATION= = TOTAL DAILY FLOW
BEDROOMS GARBAGE GRINDER
1980 or older X 150 gallon per bedroom = INSTALLED? Wp
1981 -1991 X 130 gallon per bedroom = SPA OR HOT TUB
1992-present X 110 gallon per bedroom = INSTALLED? pJD
PARCEL INFORMATION:
✓ TOPOGRAPHY: Flat rolling ✓ Steep slope %Slope
✓ SOIL NATURE: Sand_ Loam Clay Other
✓ GROUNDWATER: At what depth?
✓ BEDROCK/IMPERVIOUS MATERIAL: At what depth?
✓ DOMESTIC WATER SUPLY: Municipal Well (If well: Water supply from any septic
Aystem absorption is ft.)
✓ PERCOLATION TEST: Rate is minutes per inch (MPI)
(Test to be completed by a licensed professional engineer or architect.)
PROPOSED SYSTEM FOR NEW CONSTRUCTION: All individual sewage disposal systems must be designed by
a licensed professional engineer or architect(unless installed in a Planning Board approved subdivision).
TANK SIZE: GALLON (MIN. SIZE IS 1,000 GAL.)Add 250 gallons to the size of the septic tank for
each garbage grinder, spa or whirlpool tub.
SYSTEM TYPE: �S �Q s t-=-� a �S
❑ ABSORPTION FIELD (WITH NO. 2 STONE) Total length ft. Each trench X
❑ SEEPAGE PIT(S)(WITH NO. 3 STONE) How many? Size?
❑ ALTERNATIVE SYSTEM Bed or other type?
❑ HOLDING TANK SYSTEM Total required capacity?
Tank size? Number of tanks?
NOTE: ALARM SYSTEM AND ASSOCIATED ELECTRICAL WORK MUST BE INSPECTED BY A TOWN
APPROVED ELECTRICAL INSPECTION AGENCY. PLEASE REVIEW LIST PROVIDED. s
For your protection, please note that pursuant to Section 136-29 of the Code of the Town of Queensbury, any
permit or approval granted which is based upon or is granted in reliance upon any material misrepresentation 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 with respect to this application and
agree to abide by these and all requirements of the Town of QUESTIONS? CALL T61-8256 OR EMAIL
Queensbury Sanitary Sewage Disposal Ordinance. codertftueensbury.net
VISIT OUR WEBSITE FOR MORE INFORMATION
www.aueensburv.net
Signature of Person Responsible Date
_Y Town of Queensbury - Community Development Office - 742 Bay Road, Queensbury, NY 12804
u c_r nr unc
5 �
` Town of Queensbury■ Bu' ing&Codes Enforcemen Office.742 Bay Road• Queensbury,NY 12804
DEEP HOLE/PERC TEST
Request for Town Engineer Review
Propertye i i C L. A t ?hone:
Property Owner's d 0
Address: ty LtJ i�£41 rI• / J
Location of Test: Atrr,9 ,od P /) Tax ID#: ! tl L [ �
*Applicant's Engineer: TW tv-TA-W1jj-et,-"tj Phone:
Applicant's Agent: Phone:
Additional Notes:
1.Reason for Request? FX—1 New Septic System El Replacement Septic System ❑ Failed Septic System
Subdivision El Site Plan Review
2.Are Wetlands present? YES � NO UNKNOWN
*Note: Applicant is required to engage an engineer for design and testing of the system. The Town
Engineer's responsibility is to witness system testing only.
PLOT PLAN: Plot plan, to scale, to be submitted with application
FE
a. $ 200 Flat Feed Date Paid: 0
0
Check No.:
b. OR Fee to be determined during To Be Determined:
Site Plan /Subdivision review process
SIGNATURE:
In carrying out the provisions of Article IV, the Local Board of Health or the enforcement officer may
engage the services of a qualified professional consultant for expert review and recommendation arising
from the carrying out of the provisions of Art. IV, including but not limited to the review of plans,
specifications and reports, attendance at inspections, dye tests, deep hole test pits, septic related deep
hole and percolation tests, system installations, and any other aspect of any matter contained in this Art.
IV, and any costs incurred in such review shall be paid to the Town by the owner of the property before
any approval can be granted under this Art. IV shall become effective within 30 days of presentment of an
invoice for same, whichever is sooner. Such costs shall not exceed $1,500 without prior written notice to
the party to be charged with same.
My signature below indicates I have thoroughly read and understand the instructions, agree to the
submission requirements and have completed the application. I also fully understand that additional
engineering fees may be necessary per Town of Queensbury Lo I Law 136-14D.
SIGNATURE•1=APPLICAN
T: � Date:
SIGNATURE OF AGENT: Date:
Original (B&C File) Canary (Planning) Pink (Applicant) Gold (Town Clerk)
MANORDRIVE
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Dave Hatin
To: Daniel W. Ryan, P.E.
Cc: Pam Whiting
Subject: Request for Town Engineer Review
DEEP HOLE/PERC TEST
Request for Town Engineer Review
Name: Michael Breda Phone: 744-8400
Address: 14 Veranda Lane
Location of Test: 323 Aviation Rd
Applicant's Engineer: Jarrett Martin Phone: 792-2907
Applicant's Agent: Phone:
Additional Notes: New Commercial Use, has paid $200.00 fee
Reason for Request: = New System = Replacement System Failed System
Are WETLANDS present? = YES FX7 NO UNKNOWN
10/23/2008
flESIGN INFORMATION: GENERAL NOTES:
E AREA- 410003 Sr OF A SURVEY M MAP INFORMATION PROVIDED BY VAN OU$EN R STMS LAND COUNTY.
SURVEYORS; MAP ATEDT EO NAP
OF A SURVEY MADE FOR MICHAfI BREOA TOWN OF QUEENSBURY,WARREN COUNTY. NEW YDRK. DATED'.
1
DECEMBER 10.2008.
OERCIAL DEVELOPMENT MITIGA110N FOR A 50 YEAR$IORM EVENT
ON ACT G-
CTION C
(1?800--967-61T AND RECORD FILE I.O LOCATE EXISTING T`LVERI BUMES UiLONG CONNE TO UC110NS•LOCATION DANDSELEVATION-PRIOR TO NEW YORK 2)
INITIATING CONSTRUCiKW:CONFLICTS OR DISCREPANCIES SHALL BE REPORTED TO THE OWNER OR ENGINEER
IMMEDIATELY. NOIIFY ENGINEER IWEDIATELT IF SITE CONDITIONS ARE NOT AS INDICATED.
MAP REFERENCE,
/ •j M-1 MAP OF A SURVEY MADE FOR VIRGINIA SLEIGHT DATED NOVEMBER 11.2004 BY VAN DUSEN&STEWS
O y,` 19 V DEEP BASIN W/ 1:2 SIDE SLOPES
SILT FENCE 16 y QF D2 MIN VOLUME- 830 CIF
02 /P •C� SUBSURFACERdVESTIGATION:
F DIG RELOCATED EXISTING SIGNPERFORMED BY JME ON 12/11108
`P. ? TEST PIT i1
12'8 PERFORATED HOPE STAND PIPE is \F f� 12'8 PERFOORATEO HOPE STAND PIPE 0 - 10- DARK TOPSOIL
TOP OF STAND PIPE ELEVATION- 473J5 TB TOP OF STAND PPE ELEVATION. 473.75 10 - 23' BROWN MEDIUM SAND & SOME SILT
Z (EXTEND BOTTOM Of STAND PPE 1' BELOW GRADE) / �a^.e! °. + fOc\ D2 (EXTEND SDTTOM OF STAND PIPE 4' BELOW GRADE) 23 - 72" LIGHT BROWN MEDIUM SAND W/ TRACE OF SILT
�`
y / 6p� --�-C' \ +! Cq, 72" BOTTOM OF HOLE
/ 4 8's PERFORATED HDPE CULVERT
\„j (1' MN
T COVER) ROOT TRACES 70 45*
_"`� NO MOTTLINGEVIDENCE OR EVIDENCE OF HIGH GROUND WATER is T2'8 PERFORATEO HOPE STAND WE TEST PR ITOP2
a 75
�ETNTRANCE p I /F� Q�( / /�s��VsssQ y / 7S/ ORU,pry f \ 02 (EX OF STAND PIPE STANDELEVAT P 4'BELOW
0 - 10' DARK TOPSOIL
a ` F rQ (EXTEND BOTTOM OF STAND PPE 4'BELOW GRADE) 10 - 23' BROWN MEDIUM SAND & SOME SILT
'R \f 23 - 76' LIGHT BROWN MEDIUM SAND W/ TRACE OF SILT
,��„ J h �� ~ • ` >\ \ QD 01 WATER SERVICE
25 41 76" BOTTOM OF HOLE
8 8 PERFORATED WS a/ Q 474,1 j C� Cps WATER SERVICE VALVE No MOTTLING OR EVIDENCE OF HIGH GROUND WATER
0'' MIN COVER) 4 a TEST PIT /3
L:2 IN W/A DEEP
P BASIN 1 SIDE SLOPES 0 - ID° DARK TOPSOIL
a A \ Tao p2 MIN VOLUME- 290 CF 10 - 24" BROWN AIEOAJM SAND & SOME SILT
12'9 PERFORATED HOPE STAND PIPE / AI yj� Q Q 24 - 68" LIGHT BROWN MEDIUM SAND W/TRACE OF SILT
TOP OF STAND PIPE ELEVATION- 473.75
(EXTEND BOTTOM OF -�`\ • • C 68" BOTTOM OF HOLE
STAND PPE 4'BELOW CRAOE) D2 � Q M7� �I � jO CD'\ 5•WIDE SLOE WALK CA
MOTTLING OR EVIDENCE OF HIGH GROUND WATER
ei
/ \ 4� 10 (SLOPE AWAY rROM SUILONG
asjj / AJ- ( *"?I(. - _ ,A'i i ��' �, Rk INTO PARKING AREA) TEST PIT I4
a c Dts� \A+ 61 0 - 10' DARK TOPSOIL (SOME TRASH)
{PROVIDE 8'REVEAL/STEP 10 - 22' BROWN MEDIUM SAND & SOME SILT
4 / ! _ Ar \ ALONG PARKING AREA F 24' t S/ \�A; 22 _ 74 LIGHT BROW 74" BOTTOM OIUI.1 SAND W/ TRACE OF SILT
wo,
12 ,
PARKING AREA CONSTRUCTION I 474,1 NO MOTTLING OR EVIDENCE OF HIGH GROUND WATER
b b *rd4t Y I
Allhfly * } i
a � 474. ^4
PERCOLATION TEST It
w DISTURBANCE AREA- 410003 SF ¢$ p yD� �� �T 4 TEST DEPTH. 24'
N� / 1 ham' ti / +''Yr'`.f 4s,3 7'F ♦ 1: TEST ¢: 8'
V 20 SO L: BROWN MEDIUM SAND W/ SOME SILT
SHALLOW SWTALE STABILIZED PERCOLATION RATE OF 0 MINUTES 26 SECONDS-
1 DEEP BASIN IN/ 1:2 SIDE SLOPES 19 \ 4 g� a ,
MIN VOLUME. 525 CF 02 / s f
V PFRCOyl1T10N TEST 02
TEST DEPTH: 12"
a PROVIDE HANDICAP SDEWLk RAMP HANDICAPI 15
W 1:A SLOPE "` 3 F t r" U ♦ �FJ/ TEST 0-, 8'
VI \ \ tR�.1 -, . SOIL' BROWN MEDIUM SAND W/ SOME SILT
k PER ADA REDIRREMEN[S 0$ :/ Dt s; a DAYCARE I: J 1 / STABILIZED PERCOLATION RATE OF 2 MINUTES 17 SECONDS,
'EST
a,v �`
DUMPSFER AREA *, Xti 4�4 ,` I / / 2' WIDE WEAR 0 2.5'i TEST DEPTH: 24"
m W/PRIVACY FENCE AROUND CONTAINER m fy Ij. y +? / / , d/ BELOW SASH TOP SOIL:BROWN MEDIUM SAND W/ SOUE SILT
5'WIDE SCE WALK PT 1 r_1� ,..`• _ .. / W STABILIZED PERCOLATION RATE OF 0 MINUTES 30 SECONDS.
(SLOPE AWAY FROM BUILDING 10
k INTO PARKING AREA) pt o
(PROVIDE 6'REVEAL/STEP �'�"=- :'? $q.T FENCE
ALONG PARKNID AREA z�" -?... ?�" ~ A,h 02
EXISTM RELOCATED SIGN c / 1.
LOCATION IF Is INSTALLED
21 / / 12 (O LET VOLUME- 5YS CF SLOPES NETCONSTRUCTION
IS WSTALLEO v �
h !/ d � (OUTLET ROOF DRAMS INTO BJR91N)
ASPHALT PLAY AREA ` 'G / C1
v WASTEWATER SYSTEM 7 - " \ +. v / 8480 SF SIN SINGLE STORY 'WORLD CLASS KIDS'DAYCARE
C4 %L,\ p `
u° S ��� BUILDING (SEE ARCHITECTURAL PLANS)
PO-1 D `/
o MANHOLE _ I{{ ..)!2 h SO / v
e RIM=471.28 - f� d ,,R SPRNKLEF ONL 0AWINGS STAMPED BY JARRE7"f i+tjleA'e/s.PLLC
RIM--1407L4.224q ` T WITH A RED ISSUED FOR CONSTRUCTION'STAMP ARE TO BE CONSIDEFTED LEGAL.TRUE 8 VALID CONSTRUCTION,OOCJMENTS
O�LF
_ +I� ' SUBMTTED FOR SITE PLAN REVIEW
, 4LANDS t, 0_- o5ro7/09 ® SHEET su
o WHTTEMORE E.A_. ITTED'on
Im v, 4 _ \ 0 / A THIS SHEET aLk tTTE
c f - # ISSUED i REVISIONS
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d� B SITE PAN C1Ps✓
PROPOSED SOMSN t -. m PROPOSED'WORLD
_
CLASS KIDS DAYCARE
MANOR DRIVE B,FARR LANE
u OUEENSBURY,NEW YORK
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2 SITE PLAN JARRETT Engineers, PLLC
o SCALE: SEE GRAPHIC SCALE
moo, GRAPHIC SCALE TT Civil8l Erlalronmenu4l Engineering
u 20 0 10 20 40 g0 7509 12 EAST WASHINGTON STRFFY PHONE:(5181 792.2907
IL COPYRIGHT"..TOOB GLENS FALLS N.Y. FAX:(518)798.1%A
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