SEP-0896-2021 g�
Office Use only x
Permit#.
1m;n.erQurcns6u DEC 2 7 2[! ) (1 Permit Fee:S 95.00
'142 Ba,Y.Road,Queensbidr NY 12804
p:518-761=8256 -www:dueensburv.net TOWN OF QUEENSIBURY Invoice#:
BUILDING&GOOES
Flood Zone? Y Reviewed B
:SEPTIC DISPOSAL PERMIT APPLICATION
Project Location: ��
10
Tax Map#•
RESIDENCE:INFORMATION:
Year.Built Gallons #of bedrooms: X gallons per =total daily flow
per day bedroom Garbage Grinder Yes �1Q
1980 or older 150 Installed? (circle one) ]�
No
1981-1991 130 - � � Spa or Hot Tub Yes
Installed? (circle.one)
19927Present lio
PARCEL,INFORMATION:-
Topography Flat Rolling Steep Slope % Slope
Soil Nature Sand Loam Clay Other, explain:
Groundwater At what depth?
Bedrock/Impervious material At What.depth?
Domestic Water Supply Municipal Well _Lake
(if well or lake, water supply from any septic system absorption is
ft.)
Percolation_Test Rate: per minute per inch (-test to be-completed by a
licensed engineer/architect)
PRO POSED-.SYSTEM'.i N FORMATION:
Tank size gallons (min. size 1,000 gallons, add 250 gallons for each garbage-cylinder or
spa/hot_tub
System Absorption field w/92 stone Total length ft.; Each Trench
Seepage.Pit w/#3 stone How many: ; Size:
Alternative System Bed or other type:
Holding Tank System Total required capacity? ; tank size ;
# of tanks
septic Application Revised December 2020
CONTACT .INFORMATION: PLEASE PRINT LEGIBLY OR TYPE, PLEASE INCLUDE AN EMAIL
.• ARpliggnt
Name(s):
.Mailing Address;.C/s/Z: w W ds up �w-'
Cell-Rhone:_( ) Land Line:
Email. ,;�-C� � �t0 �C � i
• Primar-- whets :
Name(s):-
Mailing Address;C/S/Z: 13 ^Z Qve rZEN
.Cell Phone-e._O — Land ine: _( )
Email:
11 Check if4ll.work'will be performed by property owner_only
• Contractor: �\
Contact Nam:e(s):
Contractor Trade:
Mailing Address, C/S/Z:
Cell Phon( :_( ) Land Line: _( S� ) ���,Iq�
Email:. w ;<
**Workers' Comp documentation must be submitted with this application**
• Engineeds):
Name.'(s): .
Mailing Address, C/S/Z:
Cell Phone-_( ) Land Line: _( )
Email:
Contact Person for Compliance.in'regards to this project:
COO 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 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. 4i-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.) have read the regulations and agree to abide by these and all requirements of the Town of Queensbury
Sanitary Sewage Disposal Ordinance.
PRINT NAME:
SIGNATURE: . DATE:.O
Septic Application Revised December 2020
TOWN OF Q UEENSB URY
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)
All wells on property and adjacent properties shown To vJtJ \,Ok—CQ_
waterline shown Municipal or well 10'separation to any part of system
YSetback 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
N 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)
Septic tank sized for number of bedrooms and add 250 gals for Jacuzzi tubs gar age grinder each
(Leech Field 20'from foundation 100'from any well 10'from water line.
Seepage pit 150'from well 80'from septic tank
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 syste 24" bedrock or mottling 36"within 1000' of Lake George
Leech field 100'from watercourse or wetland
-ALToe of mound or bottom of retaining wall 10'from property line 100'from well 20'from
Foundation G� Eta ,p ��tJ� Al,
Provide Engineer/Architect stamp for bed or design systems
Department of Health Approval for all mobile home park new systems Flood Plain requirements
_�_2' above established flood elevation to bottom of system
All.tanks anchored or 2' above flood elevation
Revised 4/15/2021
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SERVICES
73 Sheridan Street, Glens Falls,NY 12801
Phone-518-796-2515
December 23, 2021
#
Ivan Bell Project 360
� G � � � [� .
• IBS Septic D
Warren Street
Queensbury,NY 12804 DEC 2 8 ZQ�1 .
0 N U ENSBl1RY +
Re:- Proposed Replacement Septic TOWN CQDR�
13 Honey Hollow, Queensbury,NY BUILD
—- - .--- Dear Chr-is:- - ---- -- .-
At your request, we have reviewed your proposed replacement septic system design of the
existing 5-bedroom house with a possible expansion to 6 bedrooms at 13 Honey Hollow 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 660 GPD and a percolation rate of
1 to 5 minutes, you will need a minimum of 734 sf of absorption area. We recommend using 20
ft wide by 45 ft long absorption bed with 4 — 40 ft long laterals. The absorption system can be
constructed with a new 2,000-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. - -