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deep hole perc test see- vox ana g 2319 DEEP HOLE'PERC TEST r Town of Queensbury G •- REQUEST FOR TOWN ENGINEER REVIEW ! EeEEiEP I STE P�. Q Property Owner(s): i IE-N Phone#: SIB ) 366"- 2 161 Mailing Address (c/s/z): S FRA N STEET g Fo t2T EDN AL I) Location of test: 531 Stgtf. PU1t 1441 Tax ID#: 218. I — ✓� *Applicant's Engineer: 12,VANK-J WALL ;��Hi TECTVE Phone#: (61() ) 74 1 ^ 021/0 Applicant's Agent: 4VrlNcI'I fI hW R- - i WeIUt E Phone #: (61V ) 141 026/U Additional Notes: 1. Reason for request? X, New Septic System ❑ Replacement Septic System ❑ Failed Septic System ❑ Subdivision ❑ Site Plan Review 2. Are wetlands present? ❑ YES. NO ❑ UNKNOWN *Applicant is required to engage an engineer for design and testing of the system. The Town Engineer's responsibility is to witness system testing only. PLOT PLAN: plot plan, to scale, must be submitted with application. FEE SCHEDULE: 1. $200 flat fee date paid: { 111-1/ZoJ check#: '3 360 2. OR fee to be determined during to be determined: 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: �� /Q12 DATE: #,Js414 s Original(B&C File) Canary(Planning) Pink(Applicant) Gold(Town Clerk) Deep Hole/Perc Test App Updated August 2017 • itr by .4 Oft „ • � [� 404 ,, . 4 '9 k4 i� • ili\io _, , Id ' * �r, �446 i'.'l' 4'.. ..'.-.9...-N*14:"l'.r„ / y t* \\ / 7� , y et, i ' • \‘24tri ' ,9/ , ' .1Yt ft‘ r . . gat ! l� .:} \ ../ ...- 4 It , -'. . .t*".jet. , .-, . $. , .1t4.4.6, . t /.%. * . . ... . \\__,.. LI f. a -t ! -.;., ,i, -t-• '•- - \ }- t r a ' q"t _ •' � .10,,,..4..*....f:...,r,. . 7:i, ..,.."....., ..' i....:..f„._. . 1:j -Z. . : „'ea'•: ' ''' 111 • ♦ 6 :NN r • ' N4.''' -t,.,„,, f .,0411W_Laifirew_4iiik\ _ , .., 77 TOWN OF QUE=ENSBtJRY BUILDING" f',T;"-`FS ° —‘7)— ©OZ2--2-057 Fr-NEW YORK Department STATE OF Y7 OPPORTUNITY of Health ANDREW M.CUOMO HOWARD A.ZUCKER, M.D.,J.D. SALLY DRESLIN, M.S., R.N. Governor Commissioner Executive Deputy Commissioner February 3,2020 Mr.Thomas Hutchins,PE v I--� C E O E Hutchings Engineering FILE COPY ` i r� 169 Haviland Rd. F�I-E CO "� Queensbury,NY 12804 1 FEB 0 3 2020 p L Re: Onsite Wastewater System Approval TOWN OF QIJEENBBURY Northwest Lodge(West Mtn.)Facility Code 56-BG64 BUILDING&CODES Queensbury(Town),Warren County V6 Dear Mr.Hutchins: We have this day,approved the plans for the above-referenced project.Application for this project was duly made by you and was most recently received by the New York State Department of Health on January 22,2020.This project includes the replacement of Onsite Wastewater Treatment Systems to serve the Northwest Lodge at West Mountain.Approval of these plans is conditioned on the following: 1. That the proposed works to be constructed in complete conformity with the approved plans or amendments thereto; 2. That all components of the proposed works be installed,operated,and maintained as per the manufacturer's specifications; 3. That approval be granted by other agencies or municipalities having jurisdiction; 4. That the design professional inspects the construction and provides certification to this office that construction was completed in accordance with the approved plans.Certification shall also be provided to the Town Office Building and Code Enforcement. The responsibility for the design of the sanitary system lies solely with the design professional and the proper operation of the sanitary system lies solely with the owner.The purpose of the department of health review is for compliance with the New York State Sanitary Code and in no way guarantees proper system operation.A set of approved plans is being retained for our files. Sincerely, R.Dan MacElrath Assistant Engineer Glens Falls District Office Cc: Spencer Montgomery,Owner Anita Gabalski,GFDO Corey Dilorenzo,GFDO David Hattin,Queensbury Code Enforcement Empire State Plaza, Corning Tower,Albany.NY 122371 health.ny.gov