BOTH-000092-2016 bn,)+r `' i LL �l�
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Town of Queensbury■ Building&Codes Enforcement Office■742 Bay Road• Queensbury,NY 12804
DEEP HOLEJPERC TEST
Request for Town Engineer Review
Property Owner. E191 w1�14k I 0 bC Phone: 115v--1q2
Property owners (l y+a0 ,lfa Vcg!. I0 t►0 {-� 625--
Address:
Location of Test: (I aotvex �A-40 1'`�7� Tax ID#:
*Applicant's Engineer: � ,AI�I Alt. Phone: fit$ f7kit—02b ,
Applicant's Agent: `''�►�-t ,�-� �. Phone:
Additional Notes:
1.Reason for Request? New Septic System d Replacement Septic System El Failed Septic System
ElSubdivision E-1 Site Plan Review
2.Are Wetlands present? F-1 YES R50"'NO [--] UNKNOWN
*Note: Armlicant is required to engage an engineer for design and testing of the system. The Town
Engineer's responsibil'Ity is to witness system testing only.
PLOT PLAN: Plot plan, to scale, to be submitted with application
FEE SCHEDULE:
a. $200 Flat Fee Date Paid: .-2-12Z 17.0 t b
Check No.:
b. OR Fee to be determined during To Be Determined:
Site Pian/Subdivision review process
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 became 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:
SIGNATURE OF AGENT: Date: r90 00161
Original(B&C File) Canary(Planning) Pink(Applicant) Gold (Town Clerk)
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THE Town of Queensbury 2 - ZZ+ �0
Cha
�A,� 742 Bay Road
— Queensbury, New York 12804
COMPAN I ES
Re: Soil Testing Verification
Engineers North Country Office
Environmental Professionals
Land Surveyors 375 Bay Road, Queensbury, NY 12804
P: (518)812-0513 F: (518) 812-2205
Landscape Architects Planners www.chazencompanies.com
Hudson Valley Office (845)454-3980
February 25, 2016 Capital District Office (518)273-0055
Dave Hatin, Director, Building and Codes
Existing Residence–11 Knolls Road North.
Queensbury, NY 12804
Chozen Project#:91600.15
Dear Mr. Hatin:
As requested, Chazen has witnessed onsite soil testing for the above referenced location on February 25,
2016. The purpose of this testing was to investigate subsurface soils conditions for septic systems
associated with the existing residence. The testing was performed by Ethan Hall of Rucinski Hall
Architecture.
One test pit was attempted at approximately(43.422111°, -73.630740°) 250 feet north of 11 Knolls Road
North in the existing backyard approximately 30 feet to the west of the existing garden. The soil profile
consists of the following:
Test Pit#1:
0"-3" Frozen clay, machine/operator were unable to penetrate frozen soil to perform test pit.
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
Associate
Manager, Municipal Engineering Services
Chazen Engineering,Land Surveying 8 Landscape Architecture Co.,P.C.