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SEPTIC DISPOSAL PERMIT APPLICATION Fin of Qgeensry 742 Bay Road,Queensbury,NY 12804 518-761-8256 www.queensbury.net ‘Tax Map ID #:308.14-1-52 Project Location:Lot #11 &15 Forest Park °Applicant: Name(s):Stone Installations Mailing Address,C/S/Z:4305 Rt.SO Saratoga,NY 12866 Cell Phone:(518)232-6707 Land Line:(518)584-1048 Email:dean@stoneindustries.com ¢Primary Owner(s): Name(s):RHP Properties Mailing Address,C/S/2:183 Pitcher Rd.Queensbu Cell Phone:(NA)Land Line:(518)745-7776 Email:forestpark@rhp-properties.com Permit #:0 DMD:202. Permit Fee:os + __; Invoice #:t:2504SepticVariance?Yes O Check if all work will be performed by homeowner only *Contractor:Workers’Comp documentation must be submitted with this application Contact Name(s):Stone Instal Contractor Trade:Septic Systems Mailing Address,C/S/Z:4305 Rte.50 Saratoga,NY 12866 Cell Phone:(518)232-6707 Land Line:(518)584-1048 Email:dean@stoneindustries.com °Engineer(s) Name(s):Ryan K.Riper P.E. Mailing Address,C/S/Z:225 Ruggles Rd.Saratoga,NY 12866 Cell Phone:(518)817-0099 Land Line:(518)817-0099 Email:ryanriper@rkengineering.us Contact Person for Building &Code Compliance:Dean Burdick Cell Phone:(518)232-6707 Land Line:(518)584-1048 Email:dean@stoneindustries.com Septic Application Revised February 2019 RESIDENCE INFORMATION: Year Built [Gallons|#of bedrooms:|Xgallons per|=total daily flow perday |6 bedroom__|660 1980 orolder|150|Clckortaphere|Click or o enter tex Click or tap here to|enter text. Garbage Grinder Yes|No Installed?(check one)|O |1981-1991 130 phere Click or tap hei enter text ‘Spa or Hot Tub Yes|No1992-Present|110|6 110 660 Installed?(check one)|| PARCEL INFORMATION: Topography i FlatRolling CJ Steep Slope %Slope Soil Nature Sand Gitoam Ciclay ©other (explain:) Groundwater ‘At what depth?None Bedrock/impervious material|At what depth?None Domestic Water Supply Municipal Cl Well (if well,water supply from any septic system absorption is__ft.) Percolation Test Rate:__2__per minute per inch (test to be completed by licensed engineer/architect) PROPOSED SYSTEM FOR NEW CONSTRUCTION: Tank size 1,000___gallons (min.size 1,000 gallons,add 250 gallons for each garbage cylinder or spa/hot tub System Gravelless Chambers ARC-24|Total length_220__ft.;Each Trench_55__ft. ‘Seepage Pit with #3 stone How many:;Size: ‘Alternative System Bed or other type: Holding Tank System Total required capacity?;tank size 7H 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. PRINT NAME:Dean Burdick SIGNATURE:Dean J.Burdick DATE:April 2,2020 Septic Application Revised February 2019,