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1.21.2 SETPH.VAR \Spath Andrew — New On Site Disposal — Leach Bed and Mound to Property Line & Mound Fill Side Slope — 5 -16 -16 RESOLUTION SETTING PUBLIC HEARING ON SEWAGE DISPOSAL VARIANCE APPLICATION OF ANDREW SPATH RESOLUTION NO.: ___92016 INTRODUCED BY: WHO MOVED ITS ADOPTION SECONDED BY: WHEREAS, the Queensbury Town Board serves as the Town's Local Board of Health and is authorized by Town Code Chapter 136 to issue variances from the Town's On -Site Sewage Disposal Ordinance, and WHEREAS, Andrew Spath has applied to the Local Board of Health for variances from Chapter 136 to install a new on site disposal system as follows: 1. Leach Bed to be 7'5" from the property line instead of the required 10' setback; 2. Mound/Basil limit will be 1'2" from the property line instead of the required 10' setback; and 3. Mound/System fill side slope will be 2:1 instead of the required 3:1; on property located at 56 Russell Harris Road, Queensbury, NOW, THEREFORE, BE IT RESOLVED, that the Town of Queensbury's Local Board of Health will hold a public hearing on Monday, June 6r'', 2016 at 7:00 p.m. at the Queensbury Activities Center, 742 Bay Road, Queensbury, to consider Andrew Spath's sewage disposal variance application concerning property located at 56 Russell Harris Road, Queensbury (Tax Map No.: 240.5 -1 -9) and at that time all interested persons will be heard, and BE IT FURTHER, RESOLVED, that the Local Board of Health authorizes and directs the Queensbury Town Clerk to publish the Notice of Public Hearing presented at this meeting and send a copy of the Notice to neighbors located within 500' of the applicant's property as required by law. Duly adopted this 16"' day of May, 2016, by the following vote: AYES NOES ABSENT: Town of Queensbury Building & Codes SEPTIC VARIANCE APP I 12 Submittal: 1 original & 8 copies of the comp pliconcka�e Owner Address Phone I3 Andrew Spath N 56 Russell Harris Office Use Only Received: Tax Map ID: Permit No.: Permit Fee: Approvals: MAY C E; 2016 , QUEENSBURY CLR�" OFFICE Own c `9i Queensbury, NY 12804 (518)361 -2246 Phone Jarrett Engineers, PLLC 12 E. Washington St Glens Falls, NY 12801 (518) 792 -2907 Directions to Site: 56 Russell Harris Road Distance from well on property to septic system (if applicable) SEE PLANS feet Is it possible to install a conforming septic system on this property? Yes x No If YES, please explain and attach diagram: Does proposed system meet setback requirements for distance from wells & septic systems on neighboring properties? x Yes _ No If NO, please explain: Is proposed system to be installed over a parking area? Yes x No Section of the Sanitary Sewage Ordinance from which you are seeking the variance: (example: leaching system will be 89 ft. from well in lieu of required 100 ft. separate distance): 1. Leach bed will be 7'5 "± from property line in lieu of 10' required. 2. Mound /basil limit will be 11211± from property line in lieu of 10' required. 3. Mound /system fill side slope will be 2:1 in lieu of 3:1 required. Town of Queensbury Building & Codes Septic Variance Application 518 - 761 -8256 List the names, parcel addresses, and tax map numbers of all adjoining property owners. You may obtain tax map numbers from the Assessor's Office as well as the names and addresses: North Name Address Tax Map ID South Name: Address Tax Map ID East Name: Address Tax Map ID West Name: Address Tax Map ID Tanis, Barbara 54 Russell Harris Rd 240.5 -1 -8 Spath, Robert 60 Russell Harris Rd 240.5 -1 -10 Bette Qualified Per Trust #1, Lisa K 34 Boathouse Rd 240.5 -1 -2.1 Lake George OWNER STATEMENT t, we do hereby relieve the Town of Queensbury from any liabilities on the plumbing and septic system located at: 56 Russell Harris Road I, we realize that putting the well, septic tank, or leaching system less than the required 10 ' feet from the property line may increase risk of pollution. Owner -Print Name: Owner - Signature: Date: — -2 0 NEIGHBOR OR TENANT RELEASE STATEMENT (if applicable) I, we do hereby relieve the Town of Queensbury from any liabilities on the plumbing and septic system located at: I, we realize that putting the septic tank or leaching system less than the required feet from the may increase risk of pollution. Neighbor or Tenant -Print Name: Neighbor or Tenant - Signature: Date: Town of Queensbury Building & Codes Septic Variance Application 518- 761 -8256 PLEASE ATTACH THE FOLLOWING TO YOUR APPLICATION: Location map showing the site within the Town of Queensbury; 2. Plot plan showing existing and proposed features of the property including: a) Lot dimensions b) North arrow and scale: 1 inch = 40 feet c) Location & dimensions of existing and proposed buildings, showing setback distances and uses d) Parking layout to scale (if applicable) e) Physical features (streets, steep slopes, lakes, wetlands, etc.) f) Location of all wells and septic systems on neighboring properties g) Adjacent ownership h) All properties within 500 feet. A sample plot plan and location are shown below FROM nu / — "�RDFD liulW $.k Sample Location Map I / of Queehslatiry Town Offices Town of Queensbury Building & Codes Septic Variance Application 516- 761 -8256 Short Environmental Assessment Form Part 1 - Project Information Instructions for Completing Part 1 - Project Information. The applicant or project sponsor is responsible for the completion of Part 1. Responses become part of the application for approval or funding, are subject to public review, and may be subject to further verification. Complete Part l based on information currently available. If additional research or investigation would be needed to fully respond to any item, please answer as thoroughly as possible based on current information. Complete all items in Part 1. You may also provide any additional information which you believe will be needed by or useful to the lead agency; attach additional pages as necessary to supplement any item. Part 1 - Project and Sponsor Information Andrew Spath Name of Action or Project: Andrew Spath WW Project Location (describe, and attach a location map): 56 Russell Harris Rd, Queensbury, NY 12804 Brief Description of Proposed Action: Construction of new on site disposal system Name of Applicant or Sponsor: Andrew Spath Address: 56 Russell Harris Rd. City /PO: Queensbury Telephone: 518 - 361 -2246 E -Mail: Andrew_Spath @yahoo.com State: I Zip Code: NY 12804 1. Does the proposed action only involve the legislative adoption of a plan, local law, ordinance, administrative rule, or regulation? If Yes, attach a narrative description of the intent of the proposed action and the environmental resources that may be affected in the municipality and proceed to Part 2. If no, continue to question 2. 2. Does the proposed action require a permit, approval or funding from any other governmental Agency? If Yes, list agency(s) name and permit or approval: 3.a. Total acreage of the site of the proposed action? 0.23 acres b. Total acreage to be physically disturbed? 0.05 acres c. Total acreage (project site and any contiguous properties) owned or controlled by the applicant or project sponsor? 0.23 acres 4. Check all land uses that occur on, adjoining and near the proposed action. ❑ Urban m Rural (non - agriculture) ❑ Industrial ❑ Commercial m Residential (suburban) El Forest ❑Agriculture El Aquatic El Other (specify): ❑ Parkland Page 1 of 3 NO YES ❑✓ ❑ NO YES ✓❑ ❑ 5. Is the proposed action, a. A permitted use under the zoning regulations? b. Consistent with the adopted comprehensive plan? NO YES N/A ❑ ✓❑ ❑ ❑ ❑ ❑ 6. Is the proposed action consistent with the predominant character of the existing built or natural landscape? NO YES ❑ ✓❑ 7. Is the site of the proposed action located in, or does it adjoin, a state listed Critical Environmental Area? If Yes, identify: Namelake George, Reason:Protect the resources of the park, Agencylake George Park Commission, a e: - NO YES ❑ W1 8. a. Will the proposed action result in a substantial increase in traffic above present levels? b. Are public transportation service(s) available at or near the site of the proposed action? c. Are any pedestrian accommodations or bicycle routes available on or near site of the proposed action? NO YES ❑✓ ❑ ❑✓ ❑ ✓❑ ❑ 9. Does the proposed action meet or exceed the state energy code requirements? If the proposed action will exceed requirements, describe design features and technologies: NO YES ❑ ❑ 10. Will the proposed action connect to an existing public /private water supply? If No, describe method for providing potable water: NO YES F71 ❑ 11. Will the proposed action connect to existing wastewater utilities? If No, describe method for providing wastewater treatment: NO YES ❑ 12. a. Does the site contain a structure that is listed on either the State or National Register of Historic Places? b. Is the proposed action located in an archeological sensitive area? NO YES v ❑ ❑ ✓❑ 13. a. Does any portion of the site of the proposed action, or lands adjoining the proposed action, contain wetlands or other waterbodies regulated by a federal, state or local agency? b. Would the proposed action physically alter, or encroach into, any existing wetland or waterbody? If Yes, identify the wetland or waterbody and extent of alterations in square feet or acres: NO YES ❑ ❑✓ ✓❑ ❑ 14. Identify the typical habitat types that occur on, or are likely to be found on the project site. Check all that apply: ❑ Shoreline ❑ Forest ❑ Agricultural/grasslands ❑ Early mid - successional ❑ Wetland ❑ Urban ❑ Suburban 15. Does the site of the proposed action contain any species of animal, or associated habitats, listed by the State or Federal government as threatened or endangered? NO YES ❑ ✓❑ 16. Is the project site located in the 100 year flood plain? NO YES 17. Will the proposed action create storm water discharge, either from point or non -point sources? If Yes, a. Will storm water discharges flow to adjacent properties? ❑ NO ❑YES b. Will storm water discharges be directed to established conveyance systems (runoff and storm drains)? If Yes, briefly describe: ❑ NO DYES NO YES � ❑ Page 2 of 3 18. Does the proposed action include construction or other activities that result in the impoundment of water or other liquids (e.g. retention pond, waste lagoon, dam)? If Yes, explain purpose and size: 19. Has the site of the proposed action or an adjoining property been the location of an active or closed solid waste management facility? If Yes, describe: 20. Has the site of the proposed action or an adjoining property been the subject of remediation (ongoing or completed) for hazardous waste? If Yes, describe: NO YES R NO YES El F] NO YES 21 I AFFIRM THAT THE INFORMATION PROVIDED ABOVE IS TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE Applicant/sponsor name: �v�Jre •-�% L • "�Jx^" "� Date: Signature: "_._ - ----L ��--- PRINT FORM Page 3 of 3 EAF Mapper Summary Report Monday, October 26, 2015 10:55 AM Disclaimer: The EAF Mapper is a screening tool intended to assist � project sponsors and reviewing agencies in preparing an environmental 4 assessment form (EAF). Not all questions asked in the EAF are seT� answered by the EAF Mapper. Additional information on any EAF ' question can be obtained by consulting the EAF Workbooks. Although 2}.5 =1 the EAF Mapper provides the most up -to -date digital data available to z / S DEC, you may also need to contact local or other data sources in order 240.5-1-5 / ' to obtain data not provided by the Mapper. Digital data is not a �w ',. substitute for agency determinations. - • ' n �� : f - 240.5 -1 -2.1 '. 240.5 -1 -61 240 5;�1 =7 gttanra Montreal' % 2.40.5- x P ury lAon 1pe31er 4.t =Stu l X240.5 -1 -10 , 4N iTaonto i 240.5-1-12 ' Rocllester: _ - (-,Concord `"J•. -� �y� ~y 1� Darr oft Buttalo r, Boston 240.5 -1 -11 --� Albanq Prayid. act Cleveland =' cc-s: Esri, #7ERE. D�1 mt-. iJ SGS , ii a rt#n d .� Inter inaemsrt P Carp., taL '�Ty, E;{i � rrr, = T� F�,` �`;�. CF_ Japan, f- ET1, Esri Chfna-146o 9 RftI. ji.'1 2 Cl'' r} Pittsburgh Harristw�g. a n �e� Inter map, Thai land),Jdapm`ylndi�4�.4 ryS a tMa mbus inin fP Crxp., NRCAN, =ntrit4ACA and the GIS Usgr -Gpr }ir�it� 5 Washington.; i -pan, NIETI, Esri China Part 1 / Question 7 [Critical Environmental Area] Part 1 / Question 7 [Critical Environmental Area - Identify] Part 1 / Question 12a [National Register of Historic Places] Part 1 / Question 12b [Archeological Sites] Part 1 / Question 13a [Wetlands or Other Regulated Waterbodies] Part 1 / Question 15 [Threatened or Endangered Animal] Part 1 / Question 16 [100 Year Flood Plain] Yes Name:Lake George, Reason - Protect the resources of the park, Agency:Lake George Park Commission, Date :11 -16 -88 No Yes Yes - Digital mapping information on local and federal wetlands and waterbodies is known to be incomplete. Refer to EAF Workbook. Yes Digital mapping data are not available or are incomplete. Refer to EAF Workbook. Part 1 / Question 20 [Remediation Site] No Short Environmental Assessment Form - EAF Mapper Summary Report Agency Use Only [If applicablcl Project Date: E::�� Short Environmental Assessment Form Part 2 - Impact Assessment Part 2 is to be completed by the Lead Agency. Answer all of the following questions in Part 2 using the information contained in Part 1 and other materials submitted by the project sponsor or otherwise available to the reviewer. When answering the questions the reviewer should be guided by the concept "Have my responses been reasonable considering the scale and context of the proposed action ?" No, or Moderate small to large impact impact may may occur occur 1. Will the proposed action create a material conflict with an adopted land use plan or zoning ❑ ❑ regulations? 2. Will the proposed action result in a change in the use or intensity of use of land? El 1:1 Will the proposed action impair the character or quality of the existing community? El ❑ 4. Will the proposed action have an impact on the environmental characteristics that caused the establishment of a Critical Environmental Area (CEA)? ❑ ❑ 5. Will the proposed action result in an adverse change in the existing level of traffic or affect existing infrastructure for mass transit, biking or walkway? ❑ ❑ 6. Will the proposed action cause an increase in the use of energy and it fails to incorporate reasonably available energy conservation or renewable energy opportunities? 7. Will the proposed action impact existing: a. public / private water supplies? b. public / private wastewater treatment utilities? ❑ ❑ ❑ ❑ ❑ ❑ 8. Will the proposed action impair the character or quality of important historic, archaeological, architectural or aesthetic resources? ❑ ❑ 9. Will the proposed action result in an adverse change to natural resources (e.g., wetlands, waterbodies, groundwater, air quality, flora and fauna)? ❑ ❑ 10. Will the proposed action result in an increase in the potential for erosion, flooding or drainage problems? --F70==0 ❑ ❑ 11. Will the proposed action create a hazard to environmental resources or human health? PRINT FORM Paget oft Agency Use Only [It applicable] Project: Date: Short Environmental Assessment Form Part 3 Determination of Significance For every question in Part 2 that was answered "moderate to large impact may occur ", or if there is a need to explain why a particular element of the proposed action may or will not result in a significant adverse environmental impact, please complete Part 3. Part 3 should, in sufficient detail, identify the impact, including any measures or design elements that have been included by the project sponsor to avoid or reduce impacts. Part 3 should also explain how the lead agency determined that the impact may or will not be significant. Each potential impact should be assessed considering its setting, probability of occurring, duration, irreversibility, geographic scope and magnitude. Also consider the potential for short- term, long -term and cumulative impacts. ❑Check this box if you have determined, based on the information and analysis above, and any supporting documentation, that the proposed action may result in one or more potentially large or significant adverse impacts and an environmental impact statement is required. Check this box if you have determined, based on the information and analysis above, and any supporting documentation, that the proposed action will not result in any significant adverse environmental impacts. Name of Lead Agency Print or Type Name of Responsible Officer in Lead Agency Date Title of Responsible Officer Signature of Responsible Officer in Lead Agency Signature of Preparer (if different from Responsible Officer) PRINT FORM Page 2 of Signature Page This page includes the Authorization to Act as Agent Form, engineering Fee Disclosure, Authorization for Site Visits, Other permit responsibilities and agreement to provide documentation required. Complete the following if the OWNER is using an Agent: Owners Name: Andrew Spath Designates: Jarrett Engineers, PLLC as agent regarding Septic Variance for Tax Map ID: 240.5 -1 -9 OWNER'S SIGNATURE: 'L j Date: Engineering Fee Disclosure: Applications may be referred to the Town consulting engineer for review of septic design, storm drainage, etc, as determined by the Town Board of Health. Fees for engineering review services will be charged directly to the applicant. Authorization for Site Visits: By signing this page and submitting the application materials attached, herein, the Owner, Applicant and his /her /their agent hereby authorize the Town Board of Health, building and code Enforcement Officers and Town Engineer to enter the subject properties for the purpose of reviewing the application submitted. Please Note: Other permits may be required for construction or alteration activity subsequent to approval by the Town Board of Health. It is the applicant's responsibility to obtain any additional permits. Official Meetinq Minutes Disclosure: It is the practice of the Town Board of Health to have a designated stenographer tape record the proceedings of the meetings resulting from application, and that minutes transcribed from those tapes constitute the official record of all proceedings, If there is a discrepancy between such record and the handwritten minutes taken by the designated stenographer, the handwritten minutes shall be deemed the official record. ✓I, the undersigned, have thoroughly read and understand the instructions for submission; agree to the submission requirements and completed the checklist. PRINT NAME OF OWNER: Andrew Spath SIGNATURE OF OWNER: DATE: PRINT NAME OF AGENT: Robert U. Holmess I I, P.E. SIGNATURE OF AGENT: DATE: 9 Town of Queensbury Building & Codes Seplic Variance Application 518 - 761 -8256