SEP-0445-2021 SEPTIC DISPOSAL PERMIT office Use Only
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APPLICATION Permit#: �z-&- QZA4 5-&21
Town ofQoeensbury Permit Fee:$ �rD
Invoice#:
742 Bay Road,Queensbury,NY 12804 P:518-761-8256 vrtvvr.queensbury.net Flood Zone? Y N Reviewed By.
Project Location: 11 LUPINE LANE
Tax Map M 302.17-1-16
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? (choose one) X
1991-1991 130 Spa or Not Tub Yes No
1992-Present 110 4 110 440
Installed? (choose one) X
PARCEL INFORMATION:
Topography ✓ Flat Rolling Steep Slope % Slope
Soil Nature Sand 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 Rate: 1-sMIN per minute per inch (test to be completed by a
licensed engineer/architect)
PROPOSED SYSTEM INFORMATION:
Tank size 1250 gallons (min. size 1,000 gallons, add 250.gallons.fo.r 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 30 FT
Holding Tank System Total required capacity? ; tank size ;
#of tanks
Septic Application Revised January.2021
CONTACT INFORMATION: PLEASE PRINT LEGIBLY OR TYPE, PLEASE INCLUDE AN ENTAIL
• Applicant:
Name(s): HANK BROWN
Mailing Address, C/S/Z: 11 LUPINE LANE. QUEENSBURY,NY 12804
Cell Phone: Land Line:
Email:
• Primary Owner(s):
Name(s): SAME AS APPLICANT
Mailing Address, C/S/Z:
Cell Phone: Land 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*
• Eneineer(s):
Name(s): CENTER PROJECT SERVICES
Mailing Address, C/S/Z:73 SHERIDAN STREET, GLENS FALLS NY 12801 D l, C E 0 V E
Cell Phone: Land Line:
Email: JUN 0 9 2021
Contact Person for Compliance in regards to this project:GEORGE DRELL S TOWN OF QUEENSBURY
Cell Phone: Land Line: 518-796-3760 BUILDING &CODES
Email:
!VOTES: 1. Alarm system and associated electrical work roust 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 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 Dispo*00rdii e.
PRINT NAME:GEORGE SIGNATURE: DATE:
Septic Application Revised January 2021
e
TOWN OF QUEENSBURY �
BUILDING DEPARTMENT
Based on our limited examination,compliance
with our comments shall not be conshf4 as o
indicating the plans and specifications a„0
full compliance with the Building Codes of
New York State.
TTOWN OF .
QUEENSBU�y
.BUILDING & CODES_
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FILE cop y CD
73 Sheridan Street, Glens Falls,NY 12801
Phone-518-796-2515
June 8,2021
Project#343
George Drellos
Sanitary Sewer Service ITOWN
C EpEQueensbury,NY 12804Re: Proposed Replacement Septic JUN 0 9 2021
11 Lupine Lane, Queensbury,NY
OF QUEENSBURYLDING&CODES
Dear George:
At your request, we have reviewed your proposed replacement septic system design of the
existing 4-bedroom house at 11 Lupine Lane 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 440 GPD and a percolation rate.of
1 to 5 minutes,you will need a minimum of 489 sf of absorption area. We recommend using 20
ft wide by 30 ft long absorption bed with 4 —25 ft long laterals. The absorption system can be
constructed with the new 1,250-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.
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