SEP-0403-2021 CONTACT INFORMATION: PLEASE PRINT LEGIBLY OR TYPE, PLEASE INCLUDE AN EMAIL
• Applicant:
Name(s): Doug Miller
Mailing Address, C/S/Z: 4 Stone Pine Lane, Queensbury, NY 12804
Cell Phone:_(518) 232-4199 Land Line:
Email: doug(cD_adksc.com
• Primary Owner(s):
Name(s): Doug and Teresa Miller
Mailing Address, C/S/Z: 4 Stone Pine Lane, Queensbury, NY 12804
Cell Phone: (518) 232-4199 Land Line:
Email: doug(_)adksc.com
❑ Check if all work will be performed by property owner only
• Contractor:
Contact Name(s): Chris Bell
Contractor Trade: IBS Septic & Drain Service
Mailing Address;C/S/Z: 2 Lower Warren St, Queensbury, NY 128,
Cell Phone: (518) 361-2465 Land Line: (518) 7987-8194
Email:- mbeckwith@ibsseptic.com
"Workers" Comp documentation must be-submitted With this application"
• Engineer(s):
Name(s): Ethan Hall, Rucinski Hall Architecture
Mailing Address; C/S/Z: 134 Dix Ave., Glens Falls, NY 12801
Cell Phone: Land Line: (518) 741-0268
Email: ephall(aD_nycap.rr.com
Contact Person for Compliance in regards to this project: Doug Miller
Cell Phone:_(518) 232-4199 Land Line:
Email: doug(cD_adksc.com
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 If, for any reason, the building permit application is withdrawn, 30%of the fee is retained by the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 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: Doug P4iker
SIGNATURE: DATE: 5/26/21
Septic Application Revised April 2021
. _
RUCINSKI HALL ARCHITECTURE
Ronald Richard Rucinski
Ethan Peter Hall
G�
134 Dix Avenue
Glens Falls NY 12801
Voice 518 741 0268
Fax 518-741 0274
Email ephall@nycap.rrcom
11 Ivy Loop
Garage/Trailer seepage pit system
13 July 2021
Town of Queensbury Building Department
742 Bay Road
Queensbury 'NY 12804
Re: Revision to Proposed Plans .
At the above referenced project location this office observed the installation of the new 8' diameter
seepage pits.prior to backfill. The attached drawing.reflects the location of each pit. The seepage pit.
installed in the place of the existing collapsed seepage pit is shown on the drawing with the
following new seepage pit at.24' (3 times the diameter) away from pit#1. The existing tank was
Verified to be in working order as needed. This installation is acceptable to this office. If there are
any questions please contact our office to discuss:
Regards,
Ethan Peter Hall
Architect
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RUCINSKI HALL ARCHITECTURE J'
Ronald Richard Rucinski ``�� •
Ethan Peter Hallg'�
G�
134 Dix Avenue:
Glens Falls NY 12801
Voice 518 741 0268
Fax 518 741 0274
Email ephall@nycap.rr.com
11 Ivy Loop.
Camp system
19 July 2021
Town of Queensbury Building Department.
742 Bay Road
Queensbury :NY 12804
Re: .Installation.of Replacement sewage disposal.system
At the above referenced project location this office observed the installation of the new septic tank,
effluent pump chamber, distribution box, and gravity infiltration laterals (rated-H-20 for traffic area)
prior to backfill. This installation is acceptable to this office. If there are any questions please .
contact our office to dis us
Regards,
r:'/`J JAY n' •,J���^ .t �`'� .. '
Ethan er Hall.a..d
Architect
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AS BUILT
DECRYED
TOWN OF QUEENSBURY
JUL 19 ���
BUILDING ODD EPTa Towle®F o�,EE" 31311.,
BUILDING& Conc,
Reviewed B�:
Date: /� ��