2015-470 9 WE
't'owie of Queensbury• Building&Codes Enforcement Office■742 Bay Road+ Q ry,W2$6) 1 2015
DEEP HOLEJPERC TEST TOWN OF QUEENSBURY
Request for Town Engineer Review BUILDING &CODES
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Property Owner: 1 T�� C.�f- t�j�, pT Phone:
Property Owner's _ ' l
Address: P �IVB
Location of fest: Tax ID#:
"Applicant's Engineer: ] AU- & Phone: t
Applicant's Agent: LA, Phone: Yj f 1 y7
Additional Notes:
i. Reason for Request? ❑ New Septic System Replacement Septic System ❑ Failed Septic Syster p
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❑ Subdivision ❑ Site Pian Review
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2.Are Wetlands present? ❑ YES NO ❑ UNKNOWN
*Note: ARI21icant is r wired to engage an engineer for design-and testin_q of the system. The Tor 0-
Engineer's responsibility is to witness system testing only. 00
PLOT PLAN: Plot plan, to scale, to be submitted with application
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FEE SCHEDULE:
a. $ 200 Flat Fee Date Paid: d d! 0 O
Check No.: 7S � _
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b. OR Fee to be determined during To Be Determined: CL a)
Site Plan 1 Subdivision review process coco
SIGNATURE:
In carrying out the provisions of Article IV, the Local Board of Health or the enforcement officer may
engage the services of a qualified professional consultant for expert review and recommendation arising
from the carrying out of the provisions of Art. IV, including but not limited to the review of plans,
specifications and reports, attendance at inspections, dye tests, deep hole test pits, septic related deep
hole and percolation tests, system installations, and any other aspect of any matter contained in this Art.
IV, and any costs incurred in such review shall be paid to the Town by the owner of the property before
any approval can be granted under this Art. IV shall become effective within 30 days of presentment of an
invoice for same, whichever is sooner. Such costs shall not exceed $1,500 without prior written notice to
the party to be charged with same.
My signature below indicates I have thoroughly read and understand the instructions, agree to the
submission requirements and have completed the application. I also fully understand that additional
engineering fees may be necessary per Town of Queensbury Local Law 136-14D.
SIGNATURE OF APPLICANT Date:
00.1
SIGNATURE OF AGENT: Date:
Original (B&C File) Canary (Planning) Pink(Applicant) Gold (Town Clerk)
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THE North Country Office
Cba375 gQBay Road, Queensbury, NY 12804
— P: (518) 812-0513 F: (518) 812-2205
COMPANIES www.chazencompanies.com
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Engineers Hudson Valley Office (845)454-3980
Environmental Professionals Capital District Office (518) 273-0055
Land Surveyors
Landscape Architects
Planners
October 8, 2015
Dave Hatin, Director, Building and Codes
Town of Queensbury
742 Bay Road
Queensbury, New York 12804
Re: Soil Testing Verification
6 Pinewood Avenue
Queensbury, NY 12804
Dear Mr. Hatin:
As requested, Chazen has witnessed onsite soil testing for the above referenced location on October 7,
2015. The purpose of this testing was to investigate subsurface soils conditions for a proposed septic
system design. The system is proposed as a replacement for an existing system. The testing was
performed by Ethan Hall of Rucinski Hall Architecture.
Only one soil test was performed in the back of the house, near the southwest corner of the property.
The soil profile consists of the following:
0"-15" Topsoil, dark brown.
15"-28" Medium sand, medium brown to reddish
28"-54" Fine sand, light brown
No mottling
No Groundwater
Roots to 38"
If you have any questions or require additional information please do not hesitate to call me at (518)
824-1926.
Sincerely,
Sean M. Doty, P.E., LEED AP ` RECEIVED
Associate
Manager, Municipal Engineering Services
cc: File
Chazen Engineering, Land Surveying 6 Landscape Architecture Co.. P.C.
Chazen Environmental Services. lnc.
The Chazen Companies, Inc.