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SEP-0005-2021 Office Use Only ' 4FL SEPTIC DISPOSAL PERMIT APPLICATION Permit#: SE=P— 0005, 202-1 Permit Fee:$ 15' Invoice#: 3500 Town otQeensbury Septic Variance? Yes V No 742 Bay Road,Queensbury,NY 12804 P:518-761-8256 www.gueensbury.net Tax Map ID#: 239.12-2-31 Project Location: 95 Assembly Point Road • Applicant: Name(s): Robert &Joan Anderson Mailing Address, C/S/Z: 95 Assembly Point Road Lake George, NY 12845 Cell Phone: ( ) Land Line: ( ) Email:joanandbobanderson@gmail.com • Primary Owner(s): Name(s): same as applicant Mailing Address, C/S/Z: Click or tap here to enter text. Cell Phone: ( ) Land Line: ( ) Email: Click or tap here to enter text. ❑ Check if all work will be performed by homeowner only • Contractor: Workers' Comp documentation must be submitted with this application Contact Name(s):IBS Septic &Drain Contractor Trade: Click or tap here to enter text. Mailing Address, C/S/Z: Click or tap here to enter text. Cell Phone: ( ) Land Line: ( ) Email: Click or tap here to enter text. • Engineer(s): Name(s): Dennis MacElroy � •; ``�- ` '� Mailing Address: 112 Sunset Trail QueensburV, NY 12804JAN Cell Phone: (518 376-4485 ) Land Line: (518 792-8200 Email: dmacelroy@edpllp.com Contact Person for Building&Code Compliance: Dennis MacElroy Cell Phone: (518 376-4485 ) Land Line: ( ) Email: dmacelroy@edpllp.com Septic Application Revised February 2019 RESIDENCE INFORMATION: Year Built Gallons #of bedrooms: X gallons per =total daily flow per day bedroom Garbage Grinder Yes No 1980 or older 150 Installed? (check one) ❑ 1981-1991 130 e Spa or Hot Tub Yes No 1992-Present 110 2 110 220 Installed? (check one) ❑ PARCEL I NFOF MATION: Topography © Flat Rolling ❑ Steep Slope %Slope Soil Nature ❑ Sand © Loam ❑ Clay ; ❑ Other(explain: ) Groundwater At what depth?Click or tap here to enter text.54"+ Bedrock/Impervious material At what depth?Click or tap here to enter text. >6' Domestic Water Supply ❑ Municipal ❑ Well (if well,water supply from any septic system absorption is ft.) Percolation Test Rate:6-7 per_minute per inch (test to be completed by licensed engineer/architect) PROPOSED SYSTEM FOR NEW CONSTRUCTION: Tank size 1000 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 or other type: Eljen GSF- 2—20 LF trenches w/pressure distribution Holding Tank System Total required capacity? ;tank size ;#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. I have read the regulations and agree to abide by these and all requirements of the Town of Queensbury Sanitary Sewage Disposal Ordinance. PRINT NAME: Dennis MacElroy—Agent for Robert&Joan Anderson SIGNATURE:�—NPl1���•G yr2a� DATE: December3l, 2020 ..i-tr Septic Application Revised February 2019 ENVIRONMENTAL DESIGN PARTNERSHIP, LLP. 900 Route 146 Clifton Park,NY 12065 (P)518.371.7621 (F)518.371.9540 edpllp.com Shaping the physical environment March 31,2021 Town of Queensbury Building &Codes ✓ D�0� �Z 742 Bay Road Queensbury, NY 12804 D Attn: Dave Hatin, Director APR U a 2021 Re: Anderson—95 Assembly Point Rd. TOWN OF QUEENSBURY BUILDING&CODES Dear Dave: In compliance with application approvals granted by the Town of Queensbury I offer the following regarding the referenced project. The design plans, prepared by this office, reviewed and approved by the Town as associated with the wastewater system application,are as follows: Proposed Wastewater Improvements For 95 Assembly Point Road Applicant: Robert Anderson 95 Assembly Point Road Town of Queensbury December 28,2020 EAS=LUJI • Sheet S-1 Existing Conditions Sheet S-2 Wastewater Plan • Sheet S-3 Wastewater Details During the course of construction I was on the job site to observe key components of the system installation. The field location of the septic tank, pump tank and Eljen GSF absorption field are the same as the approved design plan. I have provided an 'as-built' plan which indicates those locations and a change in the force main piping size of 2"from the 1-1/2" diameter originally specified. All other aspects of the work were constructed as designed and using the materials as specified. The pump system was set up for operation and tested/inspected on March 29t". Based on my inspection of the system installation it is my opinion that the wastewater system is in compliance with the intent of the approved design plan and is ready for operation. Sincerely, Dennis MacElroy, PE Environmental Design Partnership Attachment Cc: Robert Anderson