SEP-0239-2022 SEPTIC DISPOSAL PERMIT office Use only
APPLICATION Permit#: 'aZ?41 '.ZD 22a
Tu"ofQucaasbury Permit Fee:s"
Invoice#:
742 Bay Road,Queensbury,NY 12804
P:518-761-8256 www.ciueensbury.net Flood Zone? Y Reviewed By: .
Project Location: 12 JUNE DRIVE
Tax Map#: 302.5-1-24
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) X
1981-1991 130 Spa or Hot Tub Yes No
1992-Present 1110 3 110 330
Installed? (choose one) X
PARCEL INFORMATION:
Topography �/ Flat Rolling Steep Slope., %Slope.
Soil Nature Sand 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 it Municipal Well Lake
(if well or lake,water supply from any septic system absorption is
Percolation Test Rate:1-SHIN per.minute per,inch (test to be completed by a
licensed engineer/architect) .. .
PROPOSED SYSTEM'INFORMATION:
Tank size EX1000 gallons (min. size'1;000 gallons, add 250-gallons for each garbage cylinder or
spa/hot tub EXISTING'1000 GAL CONCRETE
System Absorption field W/#2 stone Total length' ft.; Each Trench ft.
Seepage Pit w/#9 stone How many: Size:
Alternative System Bed or other type:15 FT X 35 FT
Holding Tank S s Total required capacity? ; tank size ;
#of tanks
XV 0=22029
-septic Application TOWN OF QUEENISBURY
BUILDING &CODES Revised Januaryzozl
CONTACT INFORMATION: PLEASE PRINT LEGIBLY OR TYPE, PLEASE INCLUDE AN EMAIL
• Applicant:
Name(s):JON PELLINO.
Mailing Address,C/S/Z: 12 JUNE DRIVE,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"
• Eneineer(s)•
Name(s):CENTER PROJECT SERVICES
Mailing Address, 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 orris 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 i nce.
PRINT NAME:GEORG R
SIGNATURE: DATE:
Septic Application Revised January 2021
TOWN OF QUEENSBU RY
742 Bay Road, Queensbury, NY. 12804-5902
Septic System Checklist
A 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 MU1)I C, c/�
�
Water line shown MnicT�a or well 10'separation to any part of system
setback to property lines show 10'or more for any part of system
J��eptic tank and pump stations 10'from foundation 50'from any well/lake/wetland 10'from any waterline
G �eptic tank to foundation crawl space/slab on grade,grade in crawl space must be above top of septic tank
for0',Separation required (field verification required)
Septic tank sized for number of bedrooms and add 250 gals for Jacuzzi tubs/garbage grinder each
qVLeech Field 20'from foundation 100'from any well 10'from water line
W✓kSeepage pit 150'from well 50'from septic tank
R4Seepage Pits 3-times diameter apart
40 Septic tank and pump stations over 30 gallons 50'from watercourse or wetland
distance from bottom of trench or system 24" to bedrock or mo tling 36"within 1000' of Lake George
, I'CNall �V !/ldc1 vG Z
Leech field 100'from watercourse or wetland
N . Toe of mound or-bottom of retaining wall 10'from property line 100'from well 20'from
Foundation
^� Provide Engineer/Architect stamp for bed or design systems
rNb Department of Health Approval for all mobile home park new systems Flood Plain requirements
r 2' above established flood elevation to bottom of system
Ap
All tanks anchored or 2' above flood elevation
Revised 4/15/202, ,
Jo A; Pel
,1 r Jon SEP-p239+20
WED P �2 J'Jne Dr 22
Residential Se
ENE51 GY C AMP LANCE TOWN OF QUEENSBURY - _ Sep Alter
BUILDING DEPARTMENT aeon
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.
0
TOWN OF QUEENSBURY
BUILDING & CODES DEFT.
Reviewed By: S
Date: 5- fA
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CENTER PROJECT
SERVICES
73 Sheridan Street, Glens Falls,NY 12801
Phone-518-796-2515
April 29, 2022
Project 4 365
George Drellos
Sanitary Sewer Service
Queensbury,NY 12804
Re: Proposed Replacement Septic
12 June Drive, Queensbury,NY
Dear George:
At your request, we have reviewed your proposed replacement septic system design of the
existing 3-bedroom house at 12 June Drive 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 330 GPD and a percolation rate of
1 to 5 minutes, you will need a minimum of 367 sf of absorption area. We recommend using 15
ft wide by 35 ft long absorption bed with 3 — 30 ft long laterals.. The absorption system can be
constructed with the existing 1,000-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.
DECQ � �
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TOWA!OF QUGENSBURY
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