SEP-0533-2021 I
SEPTIC DISPOSAL'PERMIT Office use Only
APPLICATION Permit#: _ 150 CFz� ZM1
Town of Que snc bury 8^{7�+
Permit Fee: $
Invoice#: ��
742 Bay Road,Queensbury,NY 12804
P:518-761-8256 www.aueensburv.net Flood Zone? Y Reviewed 4By- '
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Project Location: 73 JOHN STREET
JUL 9
Tax Map #: 301.17-2-17 -- __J
T OVVNt OF QUEENSBURY
BUILDI IG&CODES
RESIDENCE INFORMATION: �_Y
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
1981-1991 130 Spa.or Hot Tub Yes No
1992-Present 110 3 110 330 _ 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: 1-51MIN per minute per,inch (test to be completed by a
licensed engineer/architect)
PROPOSED SYSTEM INFORMATION:
Tank size 1000. , gallons (min. size'1;000 gallons, add 250 gallon_ s for each garbage cylinder or
spa/hot,tub EXISTING loon 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:15 FT X 30 FT
Holding Tank System Total required capacity?' ; tank size ;
# of tanks
Septic Application Revised January 2021
1
CONTACT INFORMATION: PLEASE PRINT LEGIBLY OR TYPE, PLEASE INCLUDE'AN EMAIL
• Applicant:.
Name(s): RON BACON
Mailing Address, C/S/Z: 73 JOHN STREET. QUEENSBURY,NY 12804
Cell Phone: Land'Line:'
Email:
• Primary Owners)
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):SMITHS EXCAVATING
Contractor Trade:
Mailing Address, C/S/Z: QUEENSBURY
Cell Phone: Land Line:518-361-0956
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:
Cell Phone: Land Line:
Email:
NOTES: 1. Alarm system and associated electrical work must be inspected by a Town approved electrical
inspection agency; 2. We will no Ionger 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:FRE IT
SIGNATURE: DATE:
Septic Application Revised January 2021
TOOT OF QUEENSBURY
742 Bay Road, Queensbury, NY. 12804-5902
Septic System Checklist
Plan to scale
Received Deep hole perc test results from engineer/Architect if applicable(Town Approved Engineers and
Architects;June 30 to April 15 Town Engineer for unapproved Engineers and Architects)
1All wells on property and adjacent properties shown M L)0%CyVf--"�
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
N(Septic tank and pump stations 10'from foundation 50'from any well/lake/wetland 10'from any waterline
LSeptic 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)
Septic 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
IJ Seepage pit 150'from well 50'from septic tank
�3 Seepage Pits 3-times diameter apart
Septic tank and pump stations over 30 gallons 50'from watercourse or wetland
distance from bottom of trench or syst 24" o rock 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-- 0P\3Gt3i NOSJ0&
Yprovide Engineer/Architect stamp for bed or design systems
Department of Health Approval for all mobile home park new systems Flood Plain requirements
A2'above established flood elevation to bottom of system V���
N All tanks anchored or 2' above flood elevation
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TOWN 0F QUEENSEURY �
301.17-2-17 SEP-0533-2021 --
Bacon, Ronald t
73 John St �----�
Residential Septic Alteration
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CENTER PROJECT
SERVICES
73 Sheridan Street, Glens Falls,NY 12801
Phone-518-796-2515
June 22, 2021
Project#347
Fred Smith
Smiths Excavating
Queensbury, NY 12804
Re: Proposed Replacement Septic
73 John Street, Queensbury,NY
Dear Fred:
At your request, we have reviewed your proposed replacement septic system design of the
existing 3-bedroom house at 73 John Street 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.
E E
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JUL 9 �7]
TOWN OF QUEENSBURY
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