Septic variance SEPTIC VARIANCE office Use Only
Received:
'APPLICATION Permit#: 5� �i5_ zo 2
Town .4 r
Permit Fee:
742 Bay Road,Queensbury,NY 12804 O,
P:518-761-8256 www.aueensbury.net Invoice.#:
Approvals:
Submittal: I (one)original&8 copies of the completed application package
Property Owner(s): �0.eQs Pr•e�. Owner's Agent: ®d9'` a.. �
Address: U overoto, Address: 6'3- r-k a le
Phone#: j "" ® Phone#: 426
Site Address: 3 6 0 owtr Uo e- u( Tax ID#: 2 ' ` Z s 3 1
Directions to Site: 9 L t.V'er
Distance from well on property to septic system(if applicable) feet
Is it possible.to install a conforming septic system on this property? Yes No
If YES,please explain and attach a diagram:
Does the proposed Sys meet setback requirements for distance from wells&septic systems on neighboring
properties? Yes No . If NO, please explain:
Is the proposed system to be installed under a parking area? Yes o
Section of the Sanitary Sewage Ordinance from which you are seeking the variance (i.e. leaching system will be 89 ft.
from well in lieu of required 100 ft.):
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Septic Variance Application �� a�,�/ February 2018
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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 / Y4
Tax Map ID Z 'tI
South Name
Address
Tax Map ID 7
East Name , 3ra
Address i 2 Z
Tax Map ID
West Name
i
Address IM
Tax Map I D
OWNER STATEMENT
I/We do hereby relieve the Town of Queensbury from any liabilities on the plumbing and septic system located at:
t 3�le -
I/We realize that putting the well,septic tank or leaching system less than the required feet from the
may increase the risk of pollution.
Owner—Print Name: C' Date:
Owner—Signature: Date: ft�-
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 the risk of pollution.
Neighbor/Tenant—Print Name: Date:
Neighbor/Tenant-Signature: Date:
Septic Variance Application February.2018
AUTHORIZATION AND 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:
Owner's Name:
Designates: V\Qr4&,, as agent regarding the Septic Variance for
Tax Map#: 7_-a- , °t '3 1
e—
U
OWNER'S SIGNATURE: - DATE:
Engineering Fee Disclosure: Applications may be referred to the Town=cerisulting engineer for review of septic
design,storm drainage, etc. as determined by the Town Board of Heaffh°: 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-Meeting 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 the application, and that the
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 checklist:
OWNER—PRINT NAME. �
OWNER—SIGNATURE: DATE: �a
AGENT—PRINT NAME: o,..
AGENT—SIGNATURE: DATE: (o G
Septic Variance Application February 2018
7/31/2020 136 Cleverdale Rd-Google Maps
Google Maps 136 Cleverdale Rd
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Morgan J. Gazetos
57 Chapman Street•Ballston Spa,NY 12020
Phone:(518)260-9878•E-Mail:morganbuilds@hotmail.com
August 27, 2020
RE: 136 Cleverdale Rd., Queensbury,NY
To whom it may concern,
I'm writing this statement as directed by Town of Queensbury Building and Codes Dept. I am the
agent, friend, and buyer-under-contract for the residence referenced above and at issue, which is
currently owned by James Broda of 122 Cleverdale Rd, Queensbury,NY. The purpose is to explain
my request-for a septic variance for a 1,220 square foot seasonal 2-bedroom camp located 136
Cleverdale Road in the town of Queensbury,NY for a pre-existing non-conforming septic system
without proposed changes or input form an NYS licensed engineer. All of that is true,but it leaves
out some very pertinent information.
The current system is conforming per the UNOFFICIAL COMPLIATION OF CODES, RULES
AND REGULATIONS OF THE STATE OF NEW YORK TITLE 10. DEPARTMNET OF
HEALTH. CHAPTER H. PART 75. STANDARDS FOR INDIVIDUAL ONSITE WATER
SUPPLY AND INDIVIDUAL ONSITE WASTEWATER TREATMENT SYSTEMS.
APPENDIX 75-A with regards to the size of the septic tank(table 3)and the size of the seepage pit
(tables 6&7)for a year-round 2-bedroom domicile. As far as my research has led me, I cannot find
specific codes for seasonal 2-bedroom cottages, camps, guesthouses, etc.
In September of 2019, the town building and codes office conducted a septic inspection per
regulations required for a transfer of sale. The septic tank and seepage pit were uncovered, and the
septic tank was pumped out. The inspector visually inspected the unit while it operated. The system
was passed as operational. The hand-drawn bird's eye view done by the building inspector is
included in this application; that drawing combined with the included survey was the basis for a plot
plan containing all the required elements for the application. The inspector did not include any
notes.
The reason for my application is the current leaching system is 65 ft from the existing well when
current code requires it to be 150 ft. The current leaching system is also 10 ft from the dwelling
when it is required to be 20ft. The hardship created by the pursuit of conformity is that the lot and
the adjacent lot next door are+/- .2 acre lots,which would already be non-conforming building lots
Page 2
in the water front zone that requires 2.2 acre lots. There is not enough acreage to construct a fully
conforming traditional system that meets all current DOH setbacks and requirements.
I am applying for a variance so that I may acquire a building permit to replace approximately 80 sq.
ft. of bathroom floor that rotted as a result of a leaky tub drain. Until the floor is replaced, there is
no other bathroom, and the house is rendered unusable. The hardship created by investing
thousands to pursue another avenue seems unnecessary when compared to the scope of the project
and nature of the property.
I ask you to grant this variance, which would allow me to fix the bathroom, finish painting and
cleaning up the house, and purchase this home from my friend.
Very Truly Yours,
Morgan I Gazetos
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