Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
application
Office Use Only Permit SEP-0198-2020 Permit Fee:$$75.00;Invoice #:259SepticVariance?___Yes No SEPTIC DISPOSAL PERMIT APPLICATION Tow |742 Bay Road,Queensbury,NY 12804 P:518-761-8256 www.queensbury.net Koad @ Onenobrey rol ‘Tax Map ID #:239.8-1-53 Project Location:8 Onondaga Drive,Cleverdale,NY 12820 ©Applicant: Name(s):William and Lynne Mason Mailing Address,C/S/Z:PO Box 85,Cleverdale,NY 12820 Cell Phone:518-726-6093 Land Line:518-656-9573 Email:bill@takundewide.com DEcEive=fl MAY 15 2020 =) TOWNOF BUILDIN B ©Primary Owner(s): Name(s):SAME Mailing Address,C/S/Z:Click or tap here to enter text Cell Phone:()Land Line:() Email:Click or tap here to enter text. O Check if all work will be performed by homeowner only *Contractor:Workers’Comp documentation must be submitted with this application Contact Name(s):Takundewide Mgmt.Grp.,Inc./Crandall Excavating Contractor Trade:Property Management Mailing Address,C/S/Z:PO Box 85,Cleverdale,NY 12820 Cell Phone:518-726-6093 Land Line:518-656-9573 Email:bill@takundewide.com ©Engineer(s) Name(s):Click or Mailing Address,C/S/Z:Click or tap here to enter tex Cell Phone:()Land Line:() Email:Click or tap here to enter text. here to enter text. Contact Person for Building &Code Compliance:William Mason Cell Phone:518-726-6093 Land Line:518-656-9573 Email:bill@takundewide.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|Clickortaphere |Click or tap_|Gick or tap here to toentertext.|here to enter|enter text. text 7 Garbage Grinder Yes|No1981-1991|130|Clickortaphere|Click ortap|Clickortap hereto Installed?(check one)|2|O to enter text:enter|enter toxt ‘Spa or Hot Tub Yes |NoLtaeereresent|ai0|+440 Installed?(check one)|&|Ol |PARCEL INFORMATION:**Addition of 1000 gal.septic tank to existing 1000 gal.septic tank (2000 gal,total)to meet inspection requirements.Member of Takundewide Homeowners ‘Sewage Works System.(All effluent flows to thecommunitysystem)|Topography OO Flat Rolling CO Steep Slope %Slope Soil Nature CiSand Otoam Oclay 0 Other (explain:)|Groundwater ‘At what depth?Click or tap here to enter text Bedrock/Impervious material|At what depth?Click or tap here to enter textDomesticWaterSupplyCiMunicipalC)Well (if well,water supply from any septic system absorption is___ft.)Percolation Test Rate:per minute per inch (test to be completed by licensed engineer/architect) PROPOSED SYSTEM FOR NEW CONSTRUCTION:| Tank size -2000_gallons (min.size 1,000 gallons,add 250 gallons for each garbage cylinder or spa/hot tubSystem‘Absorption field with #2 stone_|Total length ft.;Each Trench ft -‘Seepage Pit with #3 stone How many:5Size: Alternative System __|Bed or other type: Holding Tank System Total required capacity?j tank size ;#of tanks NOTES:1.Alarm system and associated electrical work must be inspected by a Town approved electrical inspectionagency;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 besubmittedpriortotheinspection,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 bevoid.|have read the regulations and agree to abide by these and all requirements of the Town of QueensburySanitarySewageDisposalOrdinance. PRINT NAME:William Mason AM. Hane DATE:May 14,2020SIGNATURE: Septie Application Revised February 2019