applicationSEPTIC DISPOSAL PERMIT APPLICATION Office Use Only
742 Bay Road,Queensbury,NY 12804TwedGossip598-761-8256 yoww.queensbury.net Permit ~)25%~2920
Tax Map ID #:309.15-1-48 Permit Fee:SYD ~_;invoice #:29,
Project Location:46 CAROLINE STREET Septic Variance?__Yes No
Primary Owner(s)[RANDY MCCANE _-
Mailing Address 46 CAROLINE STREET QUEENSBURY,NY 12804
Phone &Email
Installer/Builder|1BS SEPTIC aMailingAddressWARRENSTREET,QUEENSBURY NY iPhone&Email 518-361-2465 AN
Engineer CENTER PROJECT SERVICES ye
Mailing Address __|73 SHERIDAN STREET,GLENS FALLS,NY
Phone &Email 518-796-2515 TCENTER36@YAHOO.COM \——__
Contact Person for Building &Code Compliance:CHRIS BELL Phone:__518-361-2465.
RESIDENCE INFORMATION:
Year Built|Gallons #of bedrooms |X gallons per _|=total daily flow
per day bedroom [Garbage Grinder ves |)1980 or older|150 |installed?(circle one)wera|i309 Spa or Hot Tub Yes |)_installed?(circle one)|
1992-Present |110 3 110 330
PARCELINFORMATION:_Topography ¥_Fiat Rolling Steep Slope %Slope
Soil Nature _Sand Loam Clay Other
Groundwater ‘At what depth?~-
|
Bedrock/Impervious material|At what depth?
7DomesticWaterSupply—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 |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 ft;Each Trench ft
Seepage Pit with #3 stone How many:Size
Alternative System Bed of other type:15x30 pipe-in-stone absorption bed
Holding Tank System Total required capacity?;tank size ;Hof 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.|have read the regulations and agree to abide by these and all requirements of the Town of Queensbury Sanitary Sewage
Disposal Ordinance
C
DATE:b 4-29
Town of Queensbury Bulding &Code En Revised March 2018,
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