Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
deep hole perc test
5:EP_ eFDEEP HOLE/I'ERC TEST Town of Queensbury REQUEST FOR TOWN ENGINEER REVIEW Building and Code Enforcement 742 Bay Road,Queensbury,NY 12804 P:518-761-8256 www.queensburv.net ,,QQ Q Q A Property Owner(s): Der N' EL FA U DEL- Phone#: (61 ) 7 V `-4-25 Mailing Address (c/s/z): 11lp 0912Ek al 42N1R- v J CuEi_ au' Ivy f 204- Location of test: ,RP UPPER SH-EIZ M fN AVE- Tax ID#: 30i. 13 - ( -11.D *Applicant's Engineer: RUU IVJm mom. -CHITECTU--E Phone#: (51 S ) 4-I OZW 8 Applicant's Agent: ,UGI Nsici WAL+, TECME Phone#: (51B ) 1 02U18 Additional Notes: 1. Reason for request? ❑ New Septic System Replacement Septic System ❑ Failed SepticSystem ❑ Subdivision ❑ Site Plan Review 2. Are wetlands present? ❑ YES le p(1 NO ❑ UNKNOWN *Applicant is required to engage an engineer for design and testing of the system. The Town Engineer's r s' s . 'tr is to witness system testing only. © ->'''^^ L 1 D VJ PLOT PLAN: plot plan, to scale, must be submitted with application. co N �z 0 FEE SCHEDULE: o o woa 1. $200 flat fee date paid: /6 I to/2—°1 check#: 33dg ,oS$' U O C zIgg 2. OR fee to be determined during to be determined: 0 site plan/subdivision review process ' PLEASE READ BEFORE SIGNING: In carrying out the provisions of Article IV,the Local Board of Health or the enforcement office 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$1500 without proper written notice to the party to be changed the 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 136-14 D. SIGNATURE OF APPLICANT: DATE:SIGNATURE OF AGENT: DATE: 1' ' 00/q Original(B&C File) Canary(Planning) Pink(Applicant) Gold(Town Clerk) Deep Hole/Perc Test App Updated August 2017 111111110 . 4i ,f4---T---------------_.________,______ OIECEOVEL) .. t Lill OCT 102019 { TOWN OF QUEENSBURY BUILDING&CODES , . 1111111111111.1117 • et 1r 1yam,. o .Ac 4 • li'` Idid" *it., ',-- • / 4.3