SEP-0498-2020 SEPTIC DISPOSAL PERMIT Office Use Only
ATION � Permit#: SG—P' 1g •2QZ0
E C g V E Permit Fee:$_Atp
Invoice#:
742 Bay Road,Queensbury,NY 128 OCT 2 0Q �
P:518-761-8256 .www. ueensbu et Septic Variance? Y CN)
TOWN OF OUECNSBURY Flood Zone? Y N
BUILDING&COME-SO
Wetlands? Y N Reviewed By;
Project Location: 145 Eagan Road
Tax Map M 315.8-1-4
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) ❑ 10
1981-1991 130 -- j Spa or Hot Tub Yes No.
1992-Present 110 2 110 Installed? (choose one)' . ❑
220 - - -
PARCEL INFORMATION:
Topography . Flat Rolling ❑ Steep Slope % Slope
Soil Nature Sand ❑ Loam ❑ Clay ❑ Other, explain:
Groundwater ; At what depth? rg eater than 53"
Bedrock/Impervious material At what depth? greater than 53"
Domestic Water Supply ❑ Municipal [�Well ❑Lake
(if well or lake, water supply'from any septic system absorption is
Percolation Test Rate: 1-5 per minute per inch (test to'be completed by a--
licensed engineer/architect)
PROPOSED SYSTEM INFORMATION:
Tank size 1.000 gallons (min. size 11000 gallons, add 250 gallons for each-garbage cylinder or
s a hot tub precastconcrete _
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: Bed: 1o',x 24'=240 SF
Holding Tank System Total required capacity? ; tank size ;
#of tanks
Septic Application Revised April 2021
CONTACT INFORMATION: PLEASE PRINT LEGIBLY OR TYPE, PLEASE INCLUDE AN EMAIL
• Applicant:
Name(s): David Bogue
Mailing Address, C/S/Z:.74.E6aan Road dueensburv. NY 12804
Cell Phone:. Land Line: 818745=0307.
Email: dbogue@roadrunner.com
Primary Owner(Ah.
Name(s): same as applicant:
Mailing Address, C/S/Z:
Cell Phone: _ Land Line:
Email: .
F� Check if all work will be performed by property owner only
Contractor•
Contact Name(s):_ Stevenson:Excavafing-Bruce Stevenson
Contractor Trade:
Mailing Address, C/S/Z:
Cell Phone: 518.401.7659 Land Line:.
Email:
**Workers' Comp documentation must be submitted with this application_**
6. Engineer(s):
Name(s): .Hutchins=Engineermg.PLLC
Mailing Address, C/S/Z: 169 Haviland Road Queensbury NY 12804
Cell Phone: _ Land Line: 518-745-0307
Email: thutithins@hutchinsengineering.com
Contact Person for.Compliance in regards to this project: Tom Hutchins _
Cell Phone: Land Line: 518-745-0307
Email: :thutchih& -hUtchinsenQirieetina.corn
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.
DeclaratioW.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. 1 have read the regulations and agree to abide by these and all requirements of the Town of Queensbury
Sanitary Sewage Disposal Ordinance.
PRINT NAME: Thomtis Hutchins AGENT
�.
SIGNATURE: ` � J DATE: 10/20/21
Septic Application Revised April 2021
I
742 Bay Road, Queensbury, NY. 12804-5902
Septic System Checklist
Plan to scale
YReceived Deep hole perc test results from engineer/Architect if applicable(Town Approved
Engineers and Arehitects)(June 30 to April 15 Town,Engineer for unapproved Engineers aced Architects)
All wells on property and adjacent properties shown
water line shown Municipal or well 10'separation to any part of system
Setback to property lines show 10'or more for any part of system
_Septic.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)
6eptictank sized for number of bedrooms and add 250 gals for Jacuzzi tubs/garbage grinder each
�) Leech Field 20'from fouu7ndation.100'from any well 10'from water line
seepage pit 150'from well 50'from septic tank
-kkseepage-Pits 3-times diameter apart
YSeptic tank and pump stations over 30 gallons 50'from watercourse or wetland
distance-from bottom of trench or system 24"to bedrock or mottling 36"within 1000'of lake
george O-y 1 17� E
�/ J' �Ov�iJ, L��iC � � � 6GG1\t`tJ
Leech field 100'from watercourse or wetland
Toe of mound or bottom of retainingwall 10'from pwpe y line 100'from well 20'from
Foundation `per pV VAbv FJV -VC) L, ) �� CepS'�O P �
tJ C3E- Ct�
Provide Engineer/Architect stamp for bed or design systems p tv-f�i-►\���
—ilDepariment of Health Approval for all mobile,home park new systems
Flood.Plain requirements
2'above established flood elevation to bottom of system
p�� CIF � oSD
All tanks anchored.or 2''above flood elevation
."Home of Natural Beauty ... A Good Place to Live "