SEP-0332-2021 SEPTIC DISPOSAL PERMIT Office Use Only
APPLICATION Permit#: 5> ' ' o3?>2—tN-ZN
Town ofQucensbury
Permit Fee:$
Invoice#: So .
742 Bay Road,Queensbury,NY 12804
P:518-761-8256 www.aueensbury.net Flood Zone? Y N Reviewed By:
CSC MOVE
Project Location: 12 HILLCREST AVENUE
MAY 0 9 2021
Tax Map #: 301.12-3-7
TOWN OF QUEENSBURY
RESIDENCE INFORMATION: ILDING&CODES
Year Built Gallons #of bedrooms: X gallons per =total daily flow
per day bedroom Garbage Grinder Yes No
1980 or older 150 Installed? (choose one)
1981-1991 130 Spa or Hot Tub Yes
1992-Present 110 2 110 220 Installed? (choose one)
PARCEL INFORMATION:
Topography �/ Flat Rolling Steep Slope % Slope
Soil Nature Sande Loam Clay Other, explain:
Groundwater At what depth? GREATER THAN 6 FT
Bedrock/Impervious material At what depth? GREATER THAN 6 FT
Domestic Water Supply Municipal Well Lake
(if well or lake, water supply from any septic system absorption is
ft.)
Percolation Test R ate: 1-5MIN per minute per inch (test to be completed by a
licensed engineer/architect)
PROPOSED SYSTEM INFORMATION:'
Tank size l000 gallons (min. size 1,000 gallons, add 250 gallons for each garbage cylinder or
spa/hot tub EXISTING 1000 GAL CONCRETE
System Absorption field w/#2 stone Total length ' ft.; Each'Trench ft:
Seepage.Pit w/#3 stone How many: ;Size:
Alternative System Bed or other type:20 FT x 20 FT
E
lding Tank System Total required capacity? ; tank size ;
# of tanks
Septic Application Revised January 2021
CONTACT INFORMATION: PLEASE PRINT LEGIBLY OR TYPE, PLEASE INCLUDE AN EMAIL .
• Applicant:
Name(s): MARY&JOHN DUFFY
Mailing Address, C/S/Z: 12 HILLCREST AVE. QUEENSBURY,NY 12804
Cell Phone: Land Line:
Email:
• Primary Owner(s):
Name(s): SAME AS QRPLICANT ;1
i ,
Mailing Address, C/S/Z:
Cell Phone: Lart Line: { �'
Email:
Check if all work�will,be performed by property owner only
• Contractor:
Contact Name(s):SANITARY SEWER SERVICES
Contractor Trade:.
Mailing Address, C/S/Z:LUZERNE RD, QUEENSBURY
Cell Phone: Land Line:518-796-3760
Email:
**Workers' Comp documentation must be submitted with this application**
• Engineer(s):
Name(s): CENTER PROJECT SERVICES
Mailing Address, C/S/Z:73 SHERIDAN STREET, GLENS FALLS NY 12801
Cell Phone: Land Line:
Email:
Contact Person for Compliance in regards to this project: GEORGE DRELLOS
Cell Phone: Land Line: 518-796-3760
Email:
- 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. 4. If,for any reason, the building permit application is withdrawn, 30% of the fee is•retained by the
Town of Queensbury. After 1 year from the initial application date, 100% of the fee is retained.
Declaration: Any permit or approval granted which is based upon or is granted in reliance upon any material
representation orfailure 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:GE9RG�C DRE S
SIGNATURE: DATE: 7-2
Septic Application Revised January 2021
D 1-12-3-7 .
SEP 0332 2021 D "�
�Y, Mary&John
12 Hillcrest AVe
Residential Se MAY 0 9 2021
ptic Alteration
TOWN OF QUEENSSUay
To UEENSBURY SUrLD'NG&CODCS
BUILDING
Based on o r limited examination,comp ian
with our co ments shall not be construed as
indicating I e plans and specifications are in r -
full compli nce with the uilding Codes of
New York ttate.
TOWN OF QU
BUILDING & S
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CENTER PROJECT
SERVICES
73 Sheridan Street, Glens Falls,NY 12801
Phone-518-796-2515
May 1, 2021
Project#336
George Drellos
Sanitary Sewer Service
Queensbury,NY 12804
Re: Proposed Replacement Septic
12 Hillcrest Avenue Queensbury,NY
Dear George:
At your request, we have reviewed your proposed replacement septic system design of the
existing 2-bedroom house at 12 Hillcrest Avenue in Queensbury. As per our conversation the
residence has an existing failed septic system.
We have reviewed the proposed replacement septic system design and we agree that a standard
absorption bed is acceptable. Based upon a design flow rate of 220 GPD and a percolation rate of
1 to 5 minutes, you will need a minimum of 245 sf of absorption area. We recommend using 20
ft wide by 20 ft long absorption bed with 4 — 15 ft long laterals. The absorption system can be
constructed with the existing 1,000-gallon septic tank, new distribution box, and 4-inch diameter
perforated pipe and stone.
Please feel free to contact me at 796-2515 if you have any questions and that you for your
assistance with this request.
Sincerely,
Thomas R. Center Jr, P.E.
pECEodIE
MAY 0 9 2021
TOWN OF QUEENSBURY
BUILDING&CODES
4 •
DEC
.33
TOWN OF QUEENSBURY
BUILDING&CODES
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