SEP-0118-2021 SEPTIC DISPOSAL PERMIT Office Use Only
APPLICATION - Permit#: 102)
Town ofQueensbury
Permit Fee:$ 5
Invoice#: b
742 Bay Road,Queensbury,NY 12804
P:518-761-8256 www.aueensbury.net Flood Zone? Y Reviewed
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Project Location: 5 Fawn Lane071
Tax Map #: 301.17-3-7 TOWN OF QUEENSSUR-I
BUILDING&conFn .;
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)
1981-1991 130 Spa or Hot Tub Yes No
1992-Present 110, 3 110 330 Installed? (choose one)
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 unicipal Well Lake
(if well or lake, water supply from any septic system absorption is
ft.)
Percolation Test Rate: 1:00 per minute per inch (test to be completed by'a
licensed engineer/architect)
PROPOSED SYSTEM INFORMATION: -
Tank size gallons (min. size 1,000 gallons, add 250 gallons for each garbage cylinder or
spa/hot tub existing 1,000 gallon tank
System Absorption field w/#2 stone Total length. . ft.; Each Trench ft.
Seepage Pit w/#3 stone How many: ; Size:
Alternative System - Bed r-other type:15'x27'Absorption bed per original rsubdivision plans
Holding Tank System Total required capacity? ; tank size ;
# of tanks
Septic Application Revised January 2021
CONTACT INFORMATION: PLEASE PRINT LEGIBLY OR TYPE, PLEASE INCLUDE AN EMAIL
• Applicant:
Name(s): Sherman Pines Homeowners Association
Mailing Address, C/S/Z: P.O. Box 332 Saratoga Springs, NY 12866
Cell Phone: Land Line: 518-331-9369 (Kelly Wolfe)
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):Stone Installations
Contractor Trade: Installation,
Mailing Address, C/S/Z:4305'Route 50 Saratoga Springs NY 12866
Cell Phone: Land Line: 518-232-6707(Dean Burdick)
Email:
**Workers' Comp documentation must be submitted with this application**
• Engineer(s)•
Name(s): Hutchins Engineering PLLC
Mailing Address, C/S/Z:169 Haviland Road Queensbury, NY 12804
Cell Phone: Land Line: 518-745-0307
Email:tutchins@hutchinsengineering.com
Contact Person for Compliance in regards to this project:John Safford
Cell Phone: Land Line: 518-331-9369
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 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: Thomas utc ' s (Agent) -
SIGNATURE: DATE:
Septic Application Revised January 2021
'A
169 Haviland Road
Queensbury, NY 12804
Hutchins Engineering Phone: (518)745-0307
Fax: (518)745-0308
June 1, 2021 D E C E 0 V E
Town of Queensbury JUN 0 2 2021
742 Bay Road
Queensbury, NY 12804 TOWN OF QUEENSBURY
S
Re: Sherman Pines Subdivision BUILDING&COD`
5 Fawn Lane
The existing wastewater system serving the above-referenced residence is in failure and
requires replacement. We have been asked by the Homeowners' Association to assist with
procuring permits and overseeing this work. The work will be completed by Stone Installations.
As has been the practice with other properties in this subdivision, it is proposed to replace the
existing absorption bed in accordance with the original subdivision plans. In addition, we
propose installation of an effluent filter and a vent pipe on the absorption field, if necessary.
Attached are a permit application and a mark up plot plan showing ,replacement location.
Please contact me if you have any questions or if you require additional information.
Best Regards, �OP
�
FILE
G. Thomas Hutchins, P.E.
Enclosures
Cc: Ms. Kelly Wolfe, Property Manager, Sherman Pines
Dean Burdick, Stone Installations
I
G.Thomas Hutchins,P.E.