SEP-0498-2022 SEPTIC DISPOSAL PERMIT Office Use Only
APPLICATION Permit#: 'Z)eR 04,qfS -25Z7-,
Town oFQ_uccnsbuq Permit Fee:$
Invoice#: lcaqnr
742 Bay Road,Queensbury,NY 12804
P:518-761-8256 www.gueensbury.net Septic Variance? Y
Flood Zone? Y N
Wetlands? Y N Reviewed By:
Project Location: 05 LuxeeLmQ, Pov"0
FrI�--� _�Tax Map #: 3 —1 - 2--7G 11 2022
RESIDENCE INFORMATION: I I
TOWN 0F TXTj_:-K1scuP-.y
Year Built Gallons #of bedrooms: X gallons per =total daily flow Rl III F)11\lr'- P. e'
per day bedroom ----,-Yes No
1980 or older 150 0 Installed? (choose one) 0 N_
1981-1991 130 Spa or Hot Tub Yes No
1992-Present 110 Installed? (choose one) El
PARCEL INFORMATION:
Topography Flat Rolling ❑ Steep Slope % Slope
Soil Nature Sand F-1 Loam E] Clay 0 Other, explain:
Groundwater At what depth? =t4A-Bedrock/Impervious material At what depth? _ULA
Domestic Water Supply Municipal E] Well E]Lake
(if well or lake, water supply from any septic system absorption is
Percolation Test Rate: per minute per inch (test to be completed by a
licensed engineer/architect)
PROPOSED SYSTEM INFORMATION:
Tank size 10()(7 gallons (min. size 1,000 gallons, add 250 gallons for each garbage cylinder or
spa/hottub
System Absorption field w/#2 stone Total length Ao ft.; Each Trench 7-i!r ft.
Seepage Pit w/#3 stone How many: Size:
Alternative System Bed or other type: =40
Holding Tank System Total required capacity? tank size
# of tanks
Septic Application Revised July 2022
CONTACT INFORMATION: PLEASE PRINT LEGIBLY OR TYPE, PLEASE INCLUDE AN EMAIL
• Applicant:
p li�cant:
Name(s): >,l'/Vi sea-e/Z
Mailing Address, C/S/Z: - 0X ZZ Y �1e_Ns /Z Zvi
Cell Phone: S 1 J - lG 7Wo Land Line: n 72J7
Email:
• Primary Owner(s):
Name(s): D AWE D�-'�
Mailing Address, C/S/Z: 6975
Cell Phone:�5le- 2Z.1- 90R-5' Land Line: N 4
Email: I"A& AaC.44i1ez.� 'r- w►Ai,-. Gvw.
J
❑ Check if all work will be performed by property owner only
• Contractor:
Contact Name(s): t e
Contractor Trade: JI
Mailing Address, C/S/Z: / ol,/ ZZy a
Cell Phone: it Z6—_ G6 Land Line: ��� _Z?Z 17�,
Email:
** orkers' Comp documentation must be submitted with this application**
• Engineer(s):
Name(s):
Mailing Address, C/S/Z:
Cell Phone: Land Line:
Email:
Contact Person for Compliance in regards to this project:
Cell Phone: Land Line:
Email:
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:
SIGNATURE: DATE: ZZ
Septic Application Revised July 2022
TOWN OF QUEENSBURY
742 Bay Road, Queensbury, NY. 12804-5902
Septic System Checklist
•- Plan to scale
y6eceived Deep hole perc test results from engineer/,Architect if applicable Town Ap
proved Engineers and
Architects;June 30 to April 15 Town Engineer for unapproved Engineers and Architects) `�2,C—)&
ND-All �
wells on property and adjacent properties shown
Water line shown Municipal or well 10'separation to any part of system
JASetback to property lines show 10'or more for any part of system
i4iSeptic tank and pump stations 10'from foundation 50'from any well/lake/wetland 10'from any waterline
VLSeptic 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)
16Septic 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 water line
W ra-Seepage pit 150'from well 50'from septic tank
APISeepage Pits 3-times diameter apart
01 Septic tank and pump stations over 30 gallons 50'from watercourse or wetland
Kdistance from bottom of trench or system 24"to bedrock or mottling 36"within 1000'of Lake George
XLeech field 100'from watercourse or wetland
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
64—Department of Health Approval for all mobile home park new systems Flood Plain requirements
2' above established flood elevation to bottom of system
All tanks anchored or 2' above flood elevation
Un A—el d/1 IVIIIII
LUZF ROB
SEPTIC 5*TEM TO
I NORTH PROP LINE
•_ — o i
FILE COPY KVU- i 1000 GAL. 6' = ,
q3 p TANK 5ET BA
FROM FOUNDA lON SEPTIC SYSTEM
30'-O" O (NEST PROP LINE
LEECH FIELD 4 INES 5'-O°APART
HOUSE 100, n n p I I
I 675 p
l�RACE +aa-o 'I„ 2O'-01
. EGK �LEEGH FIELD 5ET BACK
TO V IN F Q U E E N S B U R fi FROM FOUNDATION
QUIL DI 0 P CODES ®E o
ReVi.°VUe � � i,
Date= a� 5EPTIG 5Y5TEM 5ET BACK I I N
1 FROM PROP. LINE 17
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-gyp a BUILDING DEPAI Tt ® �° LU0 I 'r O
r* Based on our limited exami ation,co pliance D z
n witi our comments shall n �3(D rn
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MARK LANVON A1.4
675 LUG ROAD
OUM7458URY, W 12604
SCALE: 1 *90'—O" DATE 6110122
George Drellos
Sanitary Sewer Service
Queensbury,NY 12804
RE:Proposed Replacement Septic
675 Luzerne Road,Queensbury NY
Dear George:
At your request,we have reviewed your proposed septic system design for the existing two-bedroom
house at 675 Luzerne Road in Queensbury.As per our conversation,the residence has an existing failed
septic system.
We have reviewed the proposed replacement septic system design and agree that a standard
absorption bed is acceptable. Based upon a design flow rate of 450 GPD(one future bedroom)and a
percolation rate of 1 to 5 minutes,you will need a minimum of 500 square feet of the absorption area.
We recommend using 20 feet wide by 30 feet wide absorption bed (600 sq ft)with 4—25-foot-long
laterals using 4-inch perforated and stone. Based on our observations,a new 1,000-gallon septic tank
should be provided.
Don't hesitate to get in touch with me at 518-221-8095 if you have any questions.
Sincerely,
Mark A.Landon,AIA, NCARB =QUE�ENISBURY
675 Luzerne Road,Queensbury,NY 12804—518-221-8095
LUZERNE ROAfl
1000 GAL. 6 x6'
p TANK 5E7 BACK
FROM FOUNDATION
30'-O
LEECH FIELD 4 INE5 5=0"APART
N HOUSE 10' p" k„ 1
1 0 675 2 y,
ARAGE -
+22'-O°
DECK ZEECH FIELD 5ET BACK
FROM FOUNDATION
S BUILT 1
5EPTIC 5Y57EM 5ET BACK 1
PROM PROP. LINE O
N
10'-p'
POOL
73
3
1 1 rn �O
HED
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70
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1
1
MARK LANDON AIA
675 LUZERNE ROAD
OUEEN5BURY, NY 12804
50ALE: I"=30-O" DATE 8/25/22