SEP-0271-2022 SEPTIC DISPOSAL PERMIT office use only
APPLICATION Permit#: *eP— OZ'k an?-.
Km„ofQ=ensburr E C ` E Permit Fee:$ U D,
DInvoice#:
742 Bay Road,Queensbury,NV 2 pp�qq Ay 1 12022
P:518-761-8256 www.aueensb r n t C"! Flood Zone? Y Reviewed By
-rOWN OF OUBENSBURY I J&V-
BUILD1 8:CODES
Project Location: 15 PHEASANT WALK
Tax Map#: 301.14-1-97
RESIDENCE INFORMATION:
Year Built Gallons #of bedrooms: X gallons per =total daily flow►
Garbage Grinder Yes. No
per day bedroom
1980 or older 150 Installed? (choose one) X
1981-1991 130 Spa or Hot Tub Yes No
1992-Present 110 4 110 440
Installed? (choose one) X
PARCEL INFORMATION:
Topography Flat Rolling ,Steep Slope' ' %Slope
Soil Nature Sand V 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
Percolation Test Rate:1-5MIN per minute per inch (test to.be completed by a
licensed engineer/architect)
PROPOSED SYSTEM INFORMATION:
Tank size EX1250 gallons (min. size 1,000 gallons, add 250 gallons for each garbage cylinder or
spa/hot tub EXISTING 1006 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:20 FT X 30 FT
Holding Tank System Total required capacity? ;tank size
#of tanks
Septic Application Rev1sedJanuary 2021
n
CONTACT INFORMATION: PLEASE PRINT LEGIBLY OR TYPE, PLEASE INCLUDE AN EMAIL
• Applicant:
Name(s):PATRICIA SNELL
Mailing Address, C/S/Z: 15 PHEASANT WALK,QUEENSBURY,NY 12804
Cell Phone: Land Line:
Email:
• Primary Owner(s):
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):SANITARY SEWER SERVICES
Contractor Trade:
Mailing Address, C/S/Z:LUZERNE RD,QUEENSBURY
Cell Phone: Land Line:518-796-3760
Email:
"Workers' Comp documentation must be submitted with this application"
• Engineer(s):
Name(s):CENTER PROJECT SERVICES _-
MailingAddress,C/S/Z:73 SHERIDAN STREET,GLENS FALLS NY 12801
Cell Phone: Land Line:
Email:
Contact Person for Compliance in regards to this project:GEORGE DRELLOS
Cell Phone: Land Line:518-796-3760
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.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 factor circumstance known by or on behalf of an applicant,shall.be-
void. I have read the regulations an:greeabide by these and all requirements of the Town of Queensbury
Sanitary Sewage Disposal.Ordin c -
PRINT NAME:GEORGE DRELL S
SIGNATURE: — DATES -�—�- _
Septic Application Revised January 2021
TOWN OF QUEENSBURY
742 Bay Road, Queensbury, NY. 12804-5902
Septic System Checklist
W—Plan to scale
XuReceived 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)
'PSLAll wells on property and adjacent properties shown
f—Water line shown Municipal or well 10'separation to any part of system
L6setbackto property lines show 10' or more for any part of system
V�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
LPLeech Field 20'from foundation 100'from any well 10' from water line
p,/IASeepage pit 150'from well 50'from septic tank
0/Seepage Pits 3-times diameter apart
Septic tank and pump stations over 30 gallons 50' from watercourse or wetland
16istance from bottom of trench or system 24"to bedrock or mottling 36"within 1000' of Lake_George
Y6Leech field 100'from watercourse or wetland
AgToe of mound or bottom of retaining wall 10'from property line 100'from well 20'from
r�Foundation
PProvide Engineer/Architect stamp for bed or design systems
V Department of Health Approval for all mobile home park new systems Flood Plain requirements
VAC/2' above established flood elevation to bottom of system
IU(� All tanks anchored or 2' above flood elevation
RP.,;�Pa aii Si�nv
• s TOWN OF QUEENSBURY
BUILDING DEPARTMENT
Based on our limited examination,compliance
with our comments shall not be construed as
indicating the plans and specifications are in
full compliance with the Building Codes of
New York State.
44. TOWN OF QUEEUSBURY
BUILDING -,; CODES {�
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BUILDING & CODES EPT v
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301.14-1-97 SEP-0271-2022
Snell, Patricia
15 Pheasant Walk t
Residential Septic Alteration }
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73 Sheridan Street, Glens Falls,NY 12801
Phone-518-796-2515
May 8,2022
Project#367
George Drellos
Sanitary Sewer Service
Queensbury,NY 12804
Re: Proposed Replacement Septic
15 Pheasant Walk, Queensbury,NY
Dear George:
At your request, we have reviewed your proposed replacement septic system design of the
existing 4-bedroom house at 15 Pheasant Walk 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 440 GPD and a percolation rate of
1 to 5 minutes, you will need a minimum of 489 sf of absorption area. We recommend using 20
ft wide by 30 ft long absorption bed with 4 —25 ft long laterals. The absorption system can be
constructed with the existing 1,250-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 1I i
Thomas R. Center Jr,P.E.
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