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SEP-0178-2022 Office CJse Dnly .:.. .... .. , Permit#: She' 0V37B- 2 022 W WW Road,Queensbury,NY 1280 N. 2®22 Permit Fee_:$ �GJ P: Me-Me- 2SO vty�ud.queensbii yVm t WC � Q�� �S Y (11VQICe�.-. �, loi5d Zone? Y Reviewed 8Y: SEPTIC DISPOSAL PER PP1CATtON %bjylf Project Location: Q? _ _ddtm'ry . ..�.,; Tax Map.#: RESIDENCE IN ORMATION.' _ Year.Built Gallons #of bedrddrris: )(gallons per =total dailyflowti per day bedroom Garbage.Grinder Yes 1980or..61der 150 I.nstalled?:.iarcle.one) 1981-199.1 130 v Spa or Hot Tuff Ye:s N Installed:? ;(circle.one) 1992=Present 1`1Q I PARCEL INFORMATION. ! Topography Flat Rolling Sheep Slope !`Slope .: . . .. ........ Soi Nature Sand Loam Clay lJthet`,.explain: i Groundwater _ At.iivhat:depth.? :Bedrock/Im pervious.material. Atwhat depth? Domestic Water Su I _ Lake pp Y Municipal 1Nell (if well or lake, water supply from any septic system absorption:is Perco ation Test Rate:. per minute pet inch (test to be eoinpleted by a Licensed engineerlarchitect) PROPOSEa.SYSTEM INFORMATION. _........................................._....:_.._.__... ......_......_ .. Tank size . gallons (min. size 1,600 gallons, add:250:g4lfons for:.ea'K-- b:''cylinder or spa hoC tub System Absorption field.w/#2 stone Total length`. 1 ft.; Each Trench SeeP ag e Pit w #3 stone Now many:,�� ,• Size: ...... ........ ternative System -Red or other er type, %rr W. H©king Tank System Total required capacity? - tank s ze #oftanks....._.. . Septic application Rev.'Md December Z020 TOWN OF Q UEENSB URY 742 Bay Road, Queensbury, NY. 12804-5902 Septic System Checklist q6PIan 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 I&ater line shown Municipal or well 10'separation to any part of system Vl Setback to property lines show 10'or more for any part of system l Septic tank and pump stations 10'from foundation 50'from any well/lake/wetland 10'from any waterline PJISeptic 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) i6septic tank sized for number of bedrooms and add 250 gals for Jacuzzi tubs/garbage grinder each 1 ILeech Field 20' from foundation 100'from any well 10'from water line N—ASeepage pit 150'from Well 50'from septic tank 4-seepage Pits 3-times diameter apart 16 Septic tank and pump stations over 30 gallons 50'from watercourse or wetland !y distance from bottom of trench or system 24" to bedrock or mottling 36"within 1000' of Lake George %eech field 100'from watercourse or wetland &oe of mound or bottom of.retaining wall 10'from property line 100'from well 20'from Foundation I&Provide Engineer/Architect stamp for bed or design systems N&epartment of Health Approval for all mobile home park new systems Flood-Plain requirements Nb2' above established flood elevation to bottom of system &All tanks anchored or 2' above flood elevation Revised 4/15/2021 M N COCO u (D C-0 tESiD� 5. 0 3 —APR- L :VVN!OF IQ 5-ENS B kRY; T DES LJ __D IL AN M TOMI OF QUEENS UR , —?_ — ..? ! —' +� ! ! n.��� �, —RUILEM&D-EPART�,EN�___ E! Seri on our limitedexaniination,c mplia n ucddqts ha - e-Gostr '� ing the plans -nd s'pedlkatii ns are i %*A i l,cjica Idi pflcei--c-nip i I wit -the 10 Kim M Dw ork §tate.1 ;(IJ Ilk S4 P _J J,)L -,:2-- 0 L-A I t _J i ff 1_4 X I i LY ` i ` � s JL r e � Tw ° Gu�cp� R � gV t,Dl i i i t i �