SEP-0784-2020 Office Use Only
- �C-'P-d
Liibi-q
SEPTIC DISPOSAL PERMIT APPLICATION Permit#: t'�,'ZpZA
Permit Fee:$ 5 ; Invoice#: Z-33Town afQ.-m Septic Variance? Yes No
742 Bay Road,Queensbury,NY 12804
P:518-761-8256 www.oueensbury.net
Tax Map ID M 301.15-1-59
Project Location: 35 ELK RIDGE DRIVE
• Applicant: EF LE GO P`
Name(s): FOOTHILLS BUILDERS
Mailing Address, C/S/Z: MOUNTAIN VIEW DRIVE,QUEENSBURY, N Y 12804
Cell Phone:_( 518, ) 796-791-1933 Land Line: _( )
Email:
• Primary Owner(s):
Name(s): MICHAEL TONKS
Mailing Address, C/S/Z: 35 ELK RIDGE DRIVE
Cell Phone: _( ) Land Line: _( )
Email:
❑ Check if all work will be performed by homeowner only
• Contractor: Workers' Comp documentation must be submitted with this application
Contact Name(s): NATE DILLY
Contractor Trade: SUPERIOR EXTERIOR
Mailing Address, C/S/Z: CORINTH NY
Cell Phone:_( 518 ) 926-9099 Land Line: _( )
Email:
• Engineer(s):
Name(s): CENTER PROJECT SERVICES,TOM CENTER
Mailing Address, C/S/Z: 73 SHERIDAN STREET, GLENS FALLS,NY 12801
Cell Phone:_(518 ) 796-2515 Land Line: _( )
Email: TCENTER36@YAHOO.COM
Contact Person for Building & Code Compliance: NATE DILLY
Cell Phone: _( 518 ) 926-9099 Land Line: _( )
Email:
Septic Application Revised February 2019
f ?
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? (circle one) X
1981-1991 130 Spa or Hot Tub Yes No
Installed? (circle one) X
1992-Present 110 3 110 330
PARCEL INFORMATION:
Topography ✓ Flat Rolling Steep Slope %Slope
Soil Nature ✓ Sand Loam _Clay _Other(explain: )
Groundwater At what depth? 6FT+
Bedrock/Impervious material At what depth? NA
Domestic Water Supply ✓ Municipal _Well (if well,water supply from any septic system absorption is ft.)
Percolation Test Rate: 1-5 per minute per inch (test to be completed by licensed engineer/architect)
PROPOSED SYSTEM FOR NEW CONSTRUCTION:
Tank size 1000 gallons(min.size 1,000 gallons, add 250 gallons for each garbage cylinder or spa/hot tub
System Absorption field with#2 stone Total length 144 ft.; Each Trench 48 ft.
Seepage Pit with#3 stone How many: ; Size:
Alternative System Bed or other type:
Holding Tank System Total required capacity? ;tank size ;#of tanks
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.
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:
Joseph G. Leuci DATE: 12/14/2020
uSigned by:
SIGNATURE: DATE: 12/14/2020
Doc
924A238604D54D9...
Septic Application Revised February 2019
TOWN OF OUEENSBRY
742 Bay Road, Queensbury, STY. 12804-5902
Septic System Checklist
Plan to scale
,Received Deep hole pert test results from engineer/Architect if applicable(Town Approved
7 En ineers and Aechottects)(Ju ne 30 to April 35 Town Engi eer foir unapproved Engineers and Architects)
ll wells on property and adjacent properties shown
rAW3%C,\Qf,V
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
_LSe.ptic 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 waterline
Seepage pit 150'from well 50'from septic.tank
`r Seepage Pits 3-times diameter apart
'( Septic tank and pump stations over 30 gallons 50'from watercourse or-wetland
-4distance from bottom of trench or system 24"to bedrock or mottling 36"within 1000'of lake
george
-Z—Leech field 100'from watercourse or wetland
Toe of mound or bottom of retaining wall 10'from propert line 100'from well 20'from
Found ation
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
__L) Au tanks anchored or 2' above flood elevation
" Home of Natural Beauty ... A Good Place to Live "