SEP-0071-2023 f SEPTIC DISPOSAL PERMIT office Use only
_ APPLICATION
Permit#: 70/2�
Town ot'Qu n ury Permit Fee:$
Invoice#: Z�
742 Bay Road,Queensbury,NY 12804
P:518-761-8256 www.oueensbury.net Septic Variance? r*4b
Flood Zone?
Wetlands? Reviewed By:
Project Location: 3 Knolls Road North
Tax Map #: 253.3-1-24
FEB23 202.
RESIDENCE INFORMATION: TOWN OF OIJEENI3URY
Year Built Gallons #of bedrooms: X gallons per =total daily flow BUILDING& GODES
per day bedroom _ Gar age Grl'n-cTer` - es No
1980 or older 150 Installed? (choose one) ❑ 0
1981-1991 . 130 Spa or Hot Tub Yes No
1992-Present 110 3 110 330 Installed? (choose one) ❑ x❑
PARCEL INFORMATION:
Topography ■❑ Flat Rolling ❑ Steep Slope % Slope
Soil Nature ❑ Sand W Loam X Clay ❑ Other, explain:
Groundwater . At what depth? 24"
Bedrock/Impervious material At what depth?
Domestic Water Supply ❑ Municipal ❑■ Well ❑Lake
(if well or lake, water supply from any septic system absorption is
ft.)
Percolation Test Rate: 28 per minute per inch (test to be completed by a
licensed engineer/architect)
PROPOSED SYSTEM INFORMATION:
Tank size 1250 gallons (min. size 1,000 gallons, add 250 gallons for each garbage cylinder or
spa/hot tub
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:15' x 40' Absorption Bed
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:
Name(s): Daniel and Kathryn McGrath
Mailing Address, C/S/Z: 3 Knolls Road North Queensbury, NY 12804
Cell Phone: Land Line: 818-761-6810
Email: kmcgrath2007@aol.com
• Primary Owner(s):
Name(s): same as applicants
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): IBS Septic& Drain
Contractor Trade: Excavating
Mailing Address, C/S/Z: 2 Lower Warren St. Glens Falls, NY 12801
Cell Phone: ;/'9. 361, Land Line: (518) 798-8194
Email: :Csama Zbss�
"Workers' Comp documentation must be submitted with this application"
• EnRineer(s):
Name(s): Hutchins Engineering PLLC
Mailing Address, C/S/Z: 169 Haviland Rd. Queensbury, NY 12804
Cell Phone: Land Line: 518-745-0307
Email: Iwdobie@hutchinsengineering.com
Contact Person for Compliance in regards to this project: Ivan Bell
Cell Phone: �j�$,3�1, U1�� Land Line: 518-798-8194
Email: S65Sc� �.�orn
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: Daniel or Kathryn McGrath
SIGNATURE: i ; 0,171 C - �(�� f't, DATE. c-
Septic Application Revised July 2022