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applicationSEP-0026 -202» Office Use Only SEPTIC DISPOSAL PERMIT APPLICATION PeteeeSepticVariance?Yes No 742 Bay Road,Queensbury,NY 12804 P:518-761-8256 www.queensbury.net Tax Map ID #:_240.6-1-37 Li)E ¢| Project Location:2440 Ridge Road ©Applicant:1 |S Name(s):John and Tammy Aust Mailing Address,C/S/Z:2440 Ridge Road Queensbury,NY 12804 Cell Phone:_(518 _)744-1963 Land Line:_() Email: «Primary Owner(s): Name(s):_same as applicants Mailing Address,C/S/Z: Cell Phone:_()Land Line:_() Email: O Check if all work will be performed by homeowner only *Contractor:Workers’Comp documentation must be submitted with this application Contact Name(s):Crandall Excavating Contractor Trade:_Installation Mailing Address,C/S/Z:_63 Woodchuck Hill Road Lake George,NY 12845 CellPhone:(518 _)470-4694 Land Line:_() Email: e Engineer(s): Name(s):Hutchins Engineering PLLC Mailing Address,C/S/Z:169 Haviland Road Queensbury,NY_12804 Cell Phone:_()Land Line:(518 __)745-0307 Email:thutchins @ hutchinsnegineering.com Contact Person for Building &Code Compliance:Chris Crandall Tom Hutchins Cell Phone:_()Land Line:_() Email: Septic Application Revised February 2019, RESIDENCE INFORMATION: Year Built Gallons|#of bedrooms:|X gallons per|=total daily flow ehperday._| bedroom Garbage Grinder Yes (No) 1980 or older|150 installed?(circle one)|=Spa or Hot Tub Yeseyel=.Installed?(circle one)© 1992-Present|110 13 110 330 | PARCEL INFORMATION: ‘Topography ~_¥_Filat Rolling Steep Slope %Slope Soil Nature __Sand Yitoam Clay ___Other (explain:) Groundwater ‘At what depth?41° Bedrock/Impervious material|Atwhat depth?45°Domestic Water Supply __Municipal_¥Well (if well,water supply from any septic system absorption is >100 ft.)_| Percolation Test Rate:25:00 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 ‘Absorption field with #2 stone_|Total length 275 ft.;Each Trench 55 ft. Seepage Pit with #3 stone How many:>Size:| Alternative System Bed or other type:raised | Holding Tank System ___ [Total required capacity?tank size j Hof tanks J NOTE:absorption field is in Fort Ann to be permitted and inspected by Washington County 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 NAMEC Ss ALC Mpc LA CEN i”DATE: SIGNATURE ‘=DATE:2[2y zoeh Septic Application Revised Febuary 2019,