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SEP-0552-2021 Office Use Oni- f` Permit 1rfiiir�aiii Permit Fee:$. 5 ..:74Z Bay Road;Queenshury;:NY:22804 �d Pi:SI$-761 8256^''www.c{ue6nsauix net InVOICe.# ;. Food-Zone- Y ReviewedBy ..'SEPTIC-DISPOSAL:PERMIT APPLICATION Project location: �U�1 1 2021 TOWN OF QUEENSBURY ..: � BUILDING&CODES RESIQEN:CEINF4 RMATl N Year Built Gallons #of b rooms: X gallons per . =total daily f1GW �. bedroom i Garbage:Grinder Yes; N. 1980 ortiltler -150 Install ed?.:(circle:one) 1981-1991 130 spa;or Hof TUV Yes .--........................_......-_...._....._...__. — _._ 1992�Present lid ane}Installed? �eirele : � PARCEL INFORMATION:. ........ Topography Flat Rolling Steep,:Slope l Stope. .. Sofl'Nature 53fid Loam Cla.Y Other, explain:< .Gra.undwater: At hat-depth? ::ged:ro-.ck/imp6r.v.i*ci.us..mator.i'aI At/What ebth? pom:estic:Water S.u.pply: _ Municipal _W:ell ':Lake {if well or lake, water supply:from any septic system absorption:is ft.l Percolation Test: Rate; per minute'peninch (test to be completed bya ' _. icense . engineer architeck - PROROSED 5Y5TEIN('INF:ORN1ATIQN Tank size 90 gallons 'min.size.1,D00 gallons, add=25Q_gah4ns for each:garbage lindcrYor ANN .. :spa :.ot fub System_- ,Absorption field w#2 stone Total length ft;; Each Trench.. .... . ft,.. Seepage'Pit wf#3 stone How many: _—. Alternat ve:Sy5tem. Bed or other.:type: 5 Holding Tank Systern Total required capacity? tank ize _. #of tanks. Septic Application Revised December.2020 ti E, y.. i CONTACT jNFORMATI.ON .PLEASE PRINT:LEGIBLY OR.TYPE, PLEASE INCLUDE AN EMAIL •: :A licant: Names) 'IE5 QeDN1C l Willin Address; . : : . C/S/Z lr Cell Phone: } — Land Line: Email: .•:..:Prima . Owner(s):. - r1/.. Names Mailing Addre..ss, C/S/Z: Cell.Phone: ( Land'Liner - - Email.: Check if ail work+n►111 be-performed by property:owner.only •' Conte4cta►r: Contact Names}', Contractor Trade: Mailing.:Address; C/S/Z: �/.. _ Cell Phone:_( �`_} Land'Liner _( _) _ _. . Email: *:*:Workers Com documentatoln must:be:submitted:withthis=-appaiiCation •: En ineer Name.(s)';-:- •ems Y� cry c Mailing Address,C Cell.Phone::_( ... ) Land:Line: in ( l ( ff Crinta:ct;Perso for °.o: .plian e:in:r arils to this project:. . !1S I.l . Cell:Phone :. }:... Land Line: f } Emall C. i L5 leALK - -NOTES: 1:;Alarm:°system and associated.electrica!_work must.be.inspected:by:a:Town:a _proved.el:e.ctrica( K� insp.ection:agency;2. We Will no longer allow systems.to be covered until such:time as an as-built plan:is received and.approve.d.The installed system.must match the septic.:lay.out.on::file---no.exceptions.3.;As-' built.`drawings must be submitted_prior to;the.inspection; ii.fthere has been a chapge:to:.the submitted plans 4Jf,for any.reason;the building,,permit application is withdrawn,.30% of the flee is retained:.bv the. Town°of.:Queensbury.:After 1 year from the initial application date, 100%.ofthe feeds retained.. ©eciaration: Anypermit.or approval granted which is based_upon or is granted in reliance;;upon any material .. representation or failure to.make am 8tefial fact or:circumstance khd.Wn.l y or on.behalf of an applicant;shall be void:l have<read the regulations and:agree..to abide by these and,all requirements of the:Town:of Queensbury sanitary 5ewageDisp, sal ord'i arise. " --.PRINT NAME: ... <».SIGNATURE: OATS YT. Septic Application• Revised:December 2W TOWN OF DUEENSBURY 742 Bay Road, Queensbury, NY. 12804-5902 Septic System Checklist Plan to scale Received Deep hole pert test results from engineer/Architect if applicable(Town Approved Engineers and Architects;June 30 to April 15 Town Engineer for unapproved Engineers and Architects) 0 All wells on property and adjacent properties shown M vt'3%Y water line shown Municipal or well 10'separation to any part of system YSetback to property lines show 10'or more for any part of system YSeptic tank and pump stations 10'from foundation 50'from any well/lake/wetland 10'from any waterline Septic tank to,foundation crawl space/slab on grade,grade in crawl space must be above top of septic tank for 0',Separation required (field verification required) YSeptic tank sized for number of bedrooms and add 250 gals for Jacuzzi tubs/garbage grinder each Leech Field 20'from foundation 100'from any well 10'from water line Seepage pit 150'from well 50'from septic tank 00c Seepage Pits 3-times diameter apart Septic tank and pump stations over 30 gallons 50'from watercourse or wetland Ydistance from bottom of trench or syste 2 " edrock or mottling 36"within 1000'of Lake George Leech field 100'from watercourse or wetland Toe of mound or bottom of retaining wall 10'from property line 100'from well 20'from Foundation C-JD s'�'o C Z) Provide Engineer/Architect stamp for bed or design systems Department of Health Approval for all mobile home park new systems Flood Plain requirements G� .2' above established flood elevation to bottom of system O-All tanks anchored or 2' above flood elevation r Y SERVICESCENTER PROJECT 73 Sheridan Street, Glens Falls,NY 12801 Phone-518-796-2515 July 22, 2021 Pro'ect#349 Chris Bell IBS Septic D Warren Street Queensbury,NY 12804 JUL 2 3 2021 Re: Proposed Replacement Septic TOWN OF QUEENSBURY 644 West Mountain Road, Queensbury,NY I ' BUILDING&CODES Dear Chris: At your request, we have reviewed your proposed replacement septic system design of the existing 3-bedroom house at 644 West Mountain Road 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 330.GPD and a percolation rate of 1 to 5 minutes, you will need a minimum of 367 sf of absorption area. We recommend using 15 ft wide by 30 ft long absorption bed with 3 — 25 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.