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SEP-0023-2021 SEPTIC DISPOSAL PERMIT office use only APPLICATION Permit#iECP— a02-3- Town dQueensbuzy S�r7 Permit Fee:$ �- Invoice#: 742 Bay Road,Queensbury,NY 12804 P:518-761-8256 www.gueensbury.net Septic Variance?(( Y ) N Flood Zone? Y N Wetlands? Y N Reviewed By: Project Location: 33 4ortt-f PLAe Kt-E LJW�e Tax Map#• ZZG-19—1-52 D � RESIDENCE INFORMATION: UNa 202a Year Built Gallons #of bedrooms: X gallons per =total da ly fIUN p per day bedroom BUI I14515 er Yes No 1980 or older 150 Insta e c oose one) ❑ 1981-1991 130 Spa or Hot Tub Yes No 1992-Present 110. 3 1 t O Installed? (choose one) ❑ PARCEL INFORMATION: Topography 2IFlat Rolling ❑ Steep Slope % Slope Soil Nature ❑ Sand aLoam ❑ Clay ❑ Other, explain: Groundwater At what depth? 3 'a'r Law Ca7-N>tv— of L-efr Bedrock/Impervious material At what depth? > Domestic Water Supply ❑ Municipal ell ❑Lake (if well or lake, water supply from any septic system absorption is 37 ft.) Percolation Test Rate:y per minute per inch (test to be completed by a licensed engineer/architect) PROPOSED SYSTEM INFORMATION: Tank size 1cc;,o gallons (min. size 1,000 gallons, add 250 gallons for each garbage cylinder or spa/hot tub System Absorption field w/#2 stone Total length ft.; Each Trench ft. Seepage Pit w/#3 stone How many: ; Size: Alternative System —Cla74,41 Bed or other type: Holding Tank System Total required capacity? ; tank size ; # of tanks Septic Application' Revised April 2021 I CONTACT INFORMATION: PLEASE PRINT LEGIBLY OR TYPE, PLEASE INCLUDE AN EMAIL • Applicant: ; Name(s): Jcv-?GE,* I�OCaEc 2__JZ Mailing Address, C/S/Z: 7FC SCVV f262 'lei-L.-2. LE�s41�Lc�f-E�'�LY Cell Phone: 51S Land Line: Email: • Primary Owners : Name(s): JUtCGE Mailing Address, C/S/Z: Cell Phone: -51$ 9Z-5,21=62Land"Line: Email: .l Check if all work will be performed by property,owner only • Contractor: Contact Name(s): Contractor Trade: Mailing Address, C/S/Z: C� Cell Phone: 'gF1$ Av70-!, Land Line: Email: "Workers' Comp documentation must be submitted with this application" • Engineer(s): _ Name(s): F--t-LV IEg2k Tyler AL- Mailing Address, C/S/Z: 9(=)C> Cell Phone: Land Line: j40, S71-7CPZI Email: &,-nQ-CA__1lrL �� t''•�am Contact Person for Compliance in regards to this project: �r�f Cell Phone: 5t$?�7(Q.y�$•� Land Line: Email: bZVY�c•.c�lnavce� 0 p.Go,M NOTES: 1. Alarm systemiand associated electrical work must be inspected by a Town approved electrical inspection agency; 2. We will no longer allow systems to be covered until such time as an as-built plan is received and approved.The installed system must match the septic layout on file—no exceptions. 3. As- built drawings must be submitted prior to the inspection, if there has been a change to the submitted plans. 4. If, for any reason, the building permit application is withdrawn, 30% of the fee is retained by the Town of Queensbury. After 1 year from the initial application date, 100% of the fee is retained.'. Declaration: Any permit,or approval granted which is based upon or is granted,in reliance upon any material representation or failure to make,a material factor circumstance known by or on-behalf of an applicant, shall be void. I have read the regulations and agree.to abide by these and-all requirements of theTown of Queensbury Sanitary Sewage Disposal Ordinance. PRINT NAME:.?ia e � c SIGNATURE: '�- DATE: Septic Application Revised April 2021 TOVvW OF OUEENSBUIRY': 742 Bay Road, Queensbury,.NY. 128,04 5902 Septic-- System Checklist Plan to scale Received Deep hole pert test results from engineer/Architect if applicable(Town Approved Engineers and _ Architects;June 30 to April 15 Town Engineer for unapproved Engineers and Architects) All wells on property and adjacent properties shown t f Water line shown Municipal or well 10'separation to any part of system etback to property lines show 10'or more for any part of system �(• y CT �->�-� �� Septic tank and ump�sta�tions �from foundation 50'from any well/lake/wetland 10'from any waterline Septic tank to foundation crawl space/slab on grade,grade in crawl space must be above top of septic tank for 0',Separation-required (field verification required) Iseptic tank sized for number of bedrooms and add 250 gals for Jacuzzi tubs/garbage grinder each 1 Leech Field 20'from foundation 100'from any well.10'from water line Seepage pit 150'from well 50'from septic tank . ONeepage Pits.3-times diameter apart Septic tank and pump stations over 30 gallons 50'.from watercourse or wetland distance from bottom of trench or system.24"to bedrock or mottli 6" ' in 1000'of Lake George Leech field 100'from watercourse or wetland Toe of mound or bottom of retaining wall 10'from property line 100'from well 20'from u ZFndation novide Engineer/Architect stamp for bed or:design systems Department of Health Approval for all mobile home park new systems Flood Plain requirements 2'above established flood'elevation to bottom.,of system All tanks anchored or 2'.ab6ve flood.elevation 01/04/2022 18:52 7981584 RON MUMBLO PAGE 01 COMMONWEALTH ELECTRICAL INSPECTIONSERVICE,INC. M Main-Offlee k76 Doe Ran Road-Manhelm,PA P.M$ MUNICIPAL CERTIFICATE � ,ELECTRICAC APPROVAL g Cut-in Card No....... ................... ......gf} Permit No...................... .........cell.N-2 50047 -.-MP .1140 .......... .............. ................................. ....... v. Owner.................. .... Location...............33...... 40 n W......... ►. ............. .............. -------- installation Consisting of.......................................................................................................... .......... ............................................... ........5.�dq ..........J�71...42 0 ............ ...... ................................ ...... ......................... ........... ..................... C: ................... 7- InitalledNo.................................................... 0 and'any ucrfirwa(e prcViuu$1y issued is -n The conditions following governed the issuance of Ibis certificate, 87, cancelled:- 1W This certificate only CONV14 the electrical cquipmktxt and iustalluilon condition,.- m, 01'03tc. Upon, the C: -or inspection. go M additional�quilirhent or alterations,applic ti'mi shall bL prumptly nudc v -)M r-4) 2 '�o C: introduction of, C 0 01 S a, a 0 M 1 0 Lw� �� Inspectors of this Company shall have the privilege of tijakijig ins i tinic. and if its 07- ri & rules are viola ted,the Company shall 1have the right to revoke this (J)C: .......... ............ Date...... .11SIS)'WrOR.— rX.A., cc) 2-1 dd RESOLUTION APPROVING ROGER AND JOYCE RUBRECHT'S APPLICATION FOR SANITARY SEWAGE DISPOSAL VARIANCES RESOLUTION NO.: BOH 60,2021 INTRODUCED BY: Mr.Anthony Metivier WHO MOVED ITS ADOPTION SECONDED BY: Mr. George Ferone WHEREAS, Roger and Joyce Rubrecht (Applicants) filed an application for variances from provisions of the Town of Queensbury On-Site Sewage Disposal Ordinance, Chapter 136, §136-11 which requires applicants to obtain a variance for holding tanks as the Applicants wish to install a holding tank system consisting of two (2) holding tanks one with a capacity of 2,000 gallons and one with a capacity of 1,500 gallons,thus meeting the required total capacity of 3,500 gallons, and WHEREAS, the Applicants have also applied for additional variances from Chapter 136 to allow placement of the holding tank(s) 33' and 34' from a neighboring well in lieu of the required 50' setback(s) on property located at 33 Honeysuckle Lane in the Town of Queensbury, and WHEREAS, the Town Clerk's Office published the Notice of Public Hearing in the Town's official newspaper and the Local Board of Health duly conducted a public hearing concerning the variance requests on Monday, October 4t', 2021, and WHEREAS, the Town Clerk's Office has advised that it duly notified all property owners within 500 feet of the subject property, NOW, THEREFORE, BE IT RESOLVED,that 1. due to the nature of the variances, the Local Board of Health determines that the variances would not be materially detrimental to the purposes and objectives of this Ordinance or other adjoining properties nor otherwise conflict with the purpose and objectives of any Town plan or policy; and 2. the Local Board of Health finds that the granting of the variances is necessary for the reasonable use of the land and are the minimum variances which would alleviate the specific unnecessary hardship found by the Local Board of Health to affect the Applicants; and BE IT FURTHER, RESOLVED, that the Local Board of Health hereby approves the application of Roger and Joyce Rubrecht for variances from the Sewage Disposal Ordinance to allow installation of a holding tank system consisting of two (2) holding tanks one with a capacity of 2,000 gallons and one with a capacity of 1,500 gallons, thus meeting the required total capacity of 3,500 gallons with placement of the holding tank(s) to be located 33' and 34' from a neighboring well in lieu of the required 50' setback(s) on property located at 33 Honeysuckle Lane in the Town of Queensbury and bearing Tax Map No: 226.19-1-52, and BE IT FURTHER, RESOLVED, that the Town Board authorizes and directs the Town Clerk to forward by certified mail a certified copy of this Resolution to the Adirondack Park Agency for its review, and BE IT FURTHER, RESOLVED, that this approval Resolution shall not be effective until 30 days after such notice to the Adirondack Park Agency and shall be subject to review by the Adirondack Park Agency during such period. Duly adopted this 4t'day of October, 2021,by the following vote: AYES Mr. Freer, Mr. Ferone, Mr. Strough, Mr. Metivier NOES None ABSENT: Mr. McNulty Ú»¾®«¿®§ îíô îðîï Ü¿ª» Ø¿¬·² Ü·®»½¬±®ô Þ«·´¼·²¹ ú Ý±¼» Ì±©² ±º Ï«»»²¾«®§ éìî Þ¿§ Î¼ Ï«»»²¾«®§ô ÒÇ ïîèðì Î»æ ÔÊîðîïóðððç Ê¿®·¿²½» ß°°´·½¿¬·±²æ Î«¾®»½¸¬ Ì±©² Î»±´«¬·±²æ ÞÑØ éô îðîï Ì¿¨ Ó¿° Ò«³¾»®æ îîêòïçóïóëî Ü»¿® Ü¿ª» Ø¿¬·²æ ß¼·®±²¼¿½µ Ð¿®µ ß¹»²½§ ¬¿ºº ®»ª·»© ±º ¬¸» ¿¾±ª» ®»º»®»²½»¼ ª¿®·¿²½» ¼»¬»®³·²¿¬·±² ¸¿ ¾»»² ½±³°´»¬»¼ò Ì¸» ¿°°´·½¿²¬ °®±°±» ¬± ·²¬¿´´ ¿ ®»°´¿½»³»²¬ »²¸¿²½»¼ ±²·¬» ©¿¬»©¿¬»® ¬®»¿¬³»²¬ §¬»³ò Î»´·»º · ®»¯«·®»¼ º®±³ ¬¸» º±´´±©·²¹ Ì±©²®»¯«·®»³»²¬æ ïò ß¾±®°¬·±² º·»´¼ ëì º»»¬ º®±³ ¿ ²»·¹¸¾±®·²¹ ©»´´ ·² ´·»« ±º ¬¸» ®»¯«·®»¼ ïðð º±±¬ »¬¾¿½µå îò ß¾±®°¬·±² º·»´¼ íé º»»¬ º®±³ ¬¸» ±²·¬» ©»´´ ·² ´·»« ±º ¬¸» ®»¯«·®»¼ ïðð º±±¬ »¬¾¿½µå íò Ì¿²µ íè º»»¬ º®±³ ¿ ²»·¹¸¾±®·²¹ ©»´´ ·² ´·»« ±º ¬¸» ®»¯«·®»¼ ëð º±±¬ »¬¾¿½µå ìò Ð«³° ¬¿²µ îè º»»¬ º®±³ ¿ ²»·¹¸¾±®·²¹ ©»´´ ·² ´·»« ±º ¬¸» ®»¯«·®»¼ ëð º±±¬ »¬¾¿½µå ëò Ú±®½» ³¿·²ñ°«³° ¬¿²µ ë º»»¬ º®±³ ¬¸» °®±°»®¬§ ´·²» ·² ´·»« ±º ¬¸» ®»¯«·®»¼ ïð º±±¬ »¬¾¿½µå êò ß¾±®°¬·±² º·»´¼ ì º»»¬ º®±³ ¬¸» ©»¬ °®±°»®¬§ ´·²» ·² ´·»« ±º ¬¸» ®»¯«·®»¼ ïð º±±¬ »¬¾¿½µå éò ß¾±®°¬·±² º·»´¼ ê º»»¬ º®±³ ¬¸» ±«¬¸ °®±°»®¬§ ´·²» ·² ´·»« ±º ¬¸» ®»¯«·®»¼ ïð º±±¬ »¬¾¿½µå èò ß¾±®°¬·±² º·»´¼ ë º»»¬ º®±³ ¬¸» ¼©»´´·²¹ ·² ´·»« ±º ¬¸» ®»¯«·®»¼ îð º±±¬ »¬¾¿½µò ×¬ · ²±¬»¼ ¬¸¿¬ ¬¸»² Ì±©² Þ±¿®¼ ½±²¼·¬·±²»¼ ¬¸»·® ¿°°®±ª¿´ ±² ¬¸» ®»·¼»²½» ¾»·²¹ ®»¼«½»¼ º®±³ º±«® ¬± ¬¸®»» ¾»¼®±±³ò ÐòÑò Þ±¨ çç þ ïïíí ÒÇÍ Î±«¬» èê þ Î¿§ Þ®±±µô ÒÇ ïîçéé þ Ì»´æ øëïè÷ èçïóìðëð þ ©©©ò¿°¿ò²§ò¹±ª ÔÊîðîïóðððç Ú»¾®«¿®§ îíô îðîï Ð¿¹» î Þ¿»¼ ±² ¬¸» ·²º±®³¿¬·±² °®»»²¬»¼ ·² ¬¸» ®»½±®¼ô ¬¸» ß¹»²½§ ±ºº»® ²± ½±³³»²¬ ±² ¬¸» ¬±©² ·«»¼ ª¿®·¿²½»ò Ì¸¿²µ §±« º±® §±«® ®»º»®®¿´ ±º ¬¸· ª¿®·¿²½» ¼»¬»®³·²¿¬·±²ò Í·²½»®»´§ô ññÎ±¾§² Þ«®¹» Î±¾§² Þ«®¹» Ð®·²½·°¿´ ß¼·®±²¼¿½µ Ð¿®µ Ô±½¿´ Ð´¿²²·²¹ ß·¬¿²½» Í°»½·¿´·¬ ÎÛÞæÕÑÕ ½½æ Ö±¸² Í¬®±«¹¸ô Í«°»®ª·±®ô Ì±©² ±º Ï«»»²¾«®§ Ý®¿·¹ Þ®±©²ô Æ±²·²¹ ß¼³·²·¬®¿¬±®ô Ì±©²±º Ï«»»²¾«®§ Ý¿®±´·²» Þ¿®¾»®ô Ì±©² Ý´»®µô Ì±©² ±º Ï«»»²¾«®§ î NEW1t©ELK AdirOI' lack STATE OF OPPORTUNtI Park Agency KAT-HY ROCHUL TERRY MARTINO Governor Executive Director October 14, 2021 Dave Hatin D v l5 Director, Building & Codes �c� 5 2021 Town of Queensbury 742 Bay Rd QUEENSBBRY Queensbury, NY 12804 TOBL)ILODING&COD`S Re: LV2021-0106 Variance Application: Rubrecht Town Resolution: 1301-160,2021 Tax Map Number: 226.19-1-52 Dear Dave Hatin: Adirondack Park Agency staff review of the above referenced variance determination has been completed. The applicant proposes to install two holding tanks with a combined capacity of.3,500 gallons. Relief is required from the Town setbacks to neighboring well and for use of holding tanks. s Based on the information presented in the record, the Agency offers no comments on- the town issued variance. Thank you for your referral of this variance determination. Sincerely, Robyn Burgess Principal Adirondack Park .Local Planning Assistance Specialist REBXOK cc: John Strough, Supervisor, Town of Queensbury Craig Brown, Zoning Administrator, Town of Queensbury Caroline Barber, Town Clerk, Town of Queensbury P.O.Box 99•1133 NYS Route'86•Ray Brook,NY 12977•Tel (518)891-4050•www.apa.ny.gov RESOLUTION APPROVING SANITARY SEWAGE DISPOSAL VARIANCES OF ROGER AND JOYCE RU13RECHT RESOLUTION NO.: BOH 7,2021 f INTRODUCED BY: Mr. Tim McNulty FILE C®PY WHO MOVED ITS ADOPTION SECONDED BY: Mr.Harrison Freer WHEREAS, Roger and Joyce Rubrecht(Applicants)filed an application for variances from provisions of the Town of Queensbury On-Site Sewage Disposal Ordinance, Chapter 136 to install a: A 1. Absorption field 54' from a neighboring well in lieu of the required 100' setback; 2. Absorption field 37' from the onsite well in lieu of the required 100' setback; 3. Tank 38' from a neighboring well in lieu of the required 50' setback; 4. Pump tank 28' from a neighboring well in lieu of the required 50' setback; 5. Force main/pump tank 5' from the property line in lieu of the required 10' setback; 6. Absorption field 4' from the west property line in lieu of the required 10' setback; 7. Absorption field 6' from the south property line in lieu of the required 10' setback; 8. Absorption field 5' from the dwelling in lieu of the required 20' setback; on property located at 33 Honeysuckle Lane Road in the Town of Queensbury, and WHEREAS,the Town Clerk's Office published the Notice of Public Hearing in the Town's official newspaper and the Local Board of Health duly conducted a public hearing concerning the variance requests on Monday,February 8t', 2021,and WHEREAS, the Town Clerk's Office has advised that it duly notified all property owners within 500 feet of the subject property, J ' A r NOW,THEREFORE,BE IT RESOLVED,that 1. due to the nature of the variances, the Local Board of Health determines that the variances would not be materially detrimental to the purposes.and objectives of this Ordinance or other adjoining properties nor otherwise conflict with the purpose and objectives of any Town plan or policy; and 2. the Local Board of Health finds that the granting of the variances is necessary for the reasonable use of the land and are the minimum variances which would alleviate the specific unnecessary hardship found by the Local Board of Health to affect the Applicants; and BE IT FURTHER, RESOLVED, that the Local Board of Health hereby approves the application of Roger and Joyce Rubrecht for variances from the Sewage Disposal Ordinance to install a: 1. Absorption field 54' from a neighboring well in lieu of the required 100' setback; 2. Absorption field 37' from the onsite well in lieu of the required 100' setback; 3. Tank 38' from a neighboring well in lieu of the required 50' setback; 4. Pump tank 28' from a neighboring well in lieu of the required 50' setback; 5. Force main/pump tank 5' from the property line in lieu of the required 10' setback; 6. Absorption field 4' from the west property line in lieu of the required 10' setback; 7. Absorption field 6' from the south property line in lieu of the required 10' setback; 8. Absorption field 5' from the dwelling in lieu of the required 20' setback; on property located at 33 Honeysuckle Lane Road in the Town of Queensbury and bearing Tax Map No: 226.19-1-52, and 2 BE IT FURTHER, RESOLVED, that this approval is for use of the property for a three-bedroom residence only and is so conditioned, and BE IT FURTHER, RESOLVED, that this approval is also conditioned on assessment classification of the residence being changed from four bedroom to three bedroom, and BE IT FURTHER, RESOLVED, that the Town Board authorizes and directs the Town Clerk to forward by certified mail a certified copy of this Resolution to the Adirondack Park Agency for its review, and BE IT FURTHER, RESOLVED, that this approval Resolution shall not be effective until 30 days after such notice to the Adirondack Park Agency and shall be subject to review by the Adirondack Park Agency during such period. Duly adopted this 8t'day of February,2021,by the following vote: AYES Mr. Freer,Mr.Ferone,Mr. McNulty,Mr. Strough,Mr. Metivier NOES : None ABSENT:None 3 4 Office Use'Only SEPTIC VARIANCE Permit#: SEP- 0025- 2-02.1 APPLICATION Permit Fee:.$ 110517, `ron fA7nsba y Invoice#: 742 Bay Road,-Queensbury,NY '12804 P:518-761-8256. www.queensburv.net Approvals: Submittal: 1.(one) original &8 copies of the completed application.package Contact fnformation:. PLEASE PRINT LEGIBLY OR TYPE; PLEASE INCLUDE-AN EMAIL Property Owner(s): Roger 8E Joyce Rubercht Owner's Agent: Environmental Design Partnership-Dennis MacElroy Address: PO Box 361 Address:-900 Rt.146 New Lebanon, NY 12125 Clifton Park, NY 12065 Phone M 518 260-2356 Phone#:518 371-7621 Email:Click or tap here to enter text. Email:dmateIroy@edpllp.com D � � o -Site Information: BAN Site Address:33 Honeysuckle Lane. Tax ID#:226.19-1-52 To '92021 OF Directions to Site:Rt.9L to Assembly Point Rd.to Sunset Lane to Honeysuckle-#3 B��tD�NG&FCo��SRy Distance from well on property to septic system (if applicable) 37 feet Is it possible to install a conforming septic system on this property? ❑ Yes No If YES,please-explain and attach a diagram:Click or tap here to enter text. Does the proposed system meet setback requirements for distance from wells&septic systems on neighboring properties? ❑Yes 5XI No If NO,please.explain:A replacement system,anywhere on this lot will require a variances)from the onsite well and a well on the westerly adjacent property. Is the.proposed system to be'installed under a parking area? ❑ Yes ® No 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.): Section 136-9=D V-1:. Horizontal separation of absorption field-to a neighboring well- 54'vs. 100' required V-2: Horizontal separation of absorption field to onsite well -37'vs.100' required V=3: Horizontal separation of tank to a neighboring well -38'vs.50' required V-4: Horiiontal separation of pump tank to a neighboring well -28'vs.50' required V=5 Horizontal separation of force,main/pump tank to property line - 5'vs.10'required V-6: Horizontal separation of absorption field to west property line -4'vs. 10' required Septic Variance Application Revised January 2021 V-7: Horizontal separation of absorption field to south property line- vs.10'required V-8: Horizontal separation of absorption field to dwelling*vs.20`required List the,names, parce[addresses, and tax map numbers of all adjoining property owners_ You may. obtain this information-from the Town of Queensbury's Assessor's Office: Forth Name Tim&Kathy Re-chard Address 7 Iroquois_Ln. Queensbury, NY 12804 Tax Map ID 226.19-1-53 South Name Irwin Allen Address 10654 Eastborne Ave. Los Angeles,CA 90024 Tax Map ID 226.19-1-35 East Name John Kelly-Kelly Irrev.Family Compound Trust . Address_tni,,�',�.`75Moun#ain Creek Poughquag;NY 12570 'i'ax`Map ID 226'19`2-26 West i Name_; ;~;-kO 'jeffrey Lejuez Addr_ess- 43-28 Auburndale Ln. Flushing,NY 11358 Tax Map ID 226.19=1-51 OWNER STATEMENT I/We do:hereby relieve the Town of Queensbury from any liabilities on the plumbing and septic system.located at: Click or tap Here to enter text. IlWe realize that,Putting the well, septic tahk or teaching system less than the required.Click or tap here to enter text. fleet from the Ciicl or tap here to enter text. may increase the risk of pollution. 1� E'rZ To ��.1,2tia�y L_1 Owner—Print Name:Joyce Rubrecht..-) J Owner—Signature; L: .--i Date: / 1 .NEIGHBOR OR TENANT RELEASE STATEMENT (ff applicable) I/We do hereby relieve the_Town of Queensbury.from any liabilities on the plumbing and septic system located at: Click or tap here to enter text. ItWe realize that.putting the well, septic tank or leaching system less than the required Click or tap here to enter text.feet from the Click of tap here to enter text. may increase the risk of. pollution. Neighbor fenant-=Print Name.Click 6y tap here to enter text. Septic Variance Application Revis.ed January 2021 C AUTHORIZATION AND SIGNATURE PAGE T his 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:Roger and Joyce Rubrecht Designates: Bvironmental Design Partnership-'Dennis*MacElroy as agent-regarding the Septic Variance-for Site Address:33 Honeysuckle Lane Tax Map#:226.19-1=S Engineering Fee Disclosure:Applications may referred to the,Town consulting engineer fof review of septic . design,storm drainage;etc.as determined by the Town Board of Health. Fees.for engineering review services will be charged directly to the applicant: ` . Authorization-for Site Visits" Y.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 forthe purpose of:reviewing the application submitted: Please Note-.Other permits maybe required for construction or:alteration activity-subsequent to.approyal by the Town Board of Health. It is the applicant'-s responsibility to.obtain any additional permits. Official Meeting Minutes Disclosure:'lt is the practice of the Town Board of Health to_have-a designated_ stenographer tape record the proceedings of:the,meetirigs 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 rninutestaken:bythe designated stenographer,the.handwritten minutes shall be deemed-the official record.. I-the undersigned; have thoroughly read and uriderstanci the instructions for-submission;agree to the submission requirements and completed checklist: OWNER—PRINT'NAME:Jby e&Roger 116% cht . OWNER—SIGNATURE: �. Ai cr r` DATE: AGENT—PRINT NAME: Dennis MacElroy E_��;; DATE: - Office Use 0T►1y_ Od 2 3 CEP' C V.ARIAN/E P .Zo2t Permit#: APPLICATION Permit Fee:$ 11015 . rokn nrc��.,• Invoice#: 41 ka 742 Bay Road,Queensbury;NY 12804 P:518 761-8256 www.queensbury.nefi Approvals: l Submittal: 1 (one) original &8 copies of the completed application package Contact Information: PLEASE PRINT LEGIBLY OR TYPE, PLEASE INCLUDE AN EMAIL Property Owner's):Roger&Joyce-Rubercht Owner's Agent:Environmental Design Partnership-Dennis MacElroy Address:PO Box 361 Address:900 Rt.146 New Lebanon;NY 12125 Clifton Park,NY 1:2065 Phone#:518 260-2356 Phone#:518 3717621 r� Email;Click or tap here to enter text. Email:dmaceiroy@edpllp.cb D l� SEP 0 7 2021 -Site Information: TOWN OF QUEEN CS BUILDIi4G'& Site Address:33 Honeysuckle Lane, Tax ID#:226.19-1-52 Directions to Site:Rt.9L to Assembly Point Rd.to Sunset Lane to Honeysuckle=#33 Distance from well on property to septic system(if applicable) Is it possible to install a conforming septic system on this property? 0 Yes p No If YES,please explain and attach a diagram:Click or tap here to enter text. Does the proposed system meet setback requirements for distance from wells&septic systems on neighboring properties? ❑Yes ® No If NO,please explain:A replacement system,anywhere on this lot will require a variance(s)from the onsite well and a well on the westerly adjacent property. Is the proposed system to be installed under a parking area? 13 Yes ® No Section of the Sanitary Sewage Ordinance from which you are seeking the variance(i.e.teaching system will be 89 ft. from well in lieu of required 106 ft.): Section 136-9-D V-1 Use of Holding Tanks V-2 Holding Tank to Neighboring Well 33' requested vs. 50' required V-3 Holding Tank to Neighboring Well 34' requested vs. 50' required SepticvaTiance Applitati0n _ Revised January 2621 .List the names, parcel addresses, and tax map numbers of ail adjoining property owners. You may obtain this information from the.Town of Queensbun/s Assessor's Office: North Name Tim&Kathy Bechard Address 1 iroquois Ln. Queensbury,NY 12804 Tax Map 1D 226.19-153 South Name Irwin Alien Address 10654 Eastborne Ave. Los Angeles,CA-90024 Tax Map iD 226.19-1-35 East Name John Kelly-Kelly lrrev. Family Compound Trust Address 75 Mountain Creek Poughquag, NY 125.70 Tax Map 1D 226.19-2-26 West Name -Jeffrey Lejuez Address 43-28 Auburndale Ln. .Flushing,NY 11358 Tax Map ID 226.19-1-51 OWNER STATEMENT VVVe do hereby relieve the Town of Queensbury from any liabilities on.the Plumbing and septic system located at: Click or tap here to enter text. IIWe realize that putting the.well, septic-tank or leaching system less than the required Click or tap here to entertext. feet from the Click or tap here to enter text. may increase the risk of pollution. Owner—Print Name:Joyce Ruhrecht�-� Owner—Signature: i..� }ter Dater NEIGHBOR OR TENANT RELEASE STATEMENT (ffapplicable) I/We do hereby relieve the Town of Queensbury from any liabilities on the plumbing and septic system located at:Click or tap here to enter text.IIWe realize that putting the well, septic tank or leaching system less than the required Click or tap here to enter text.feet from the Click or tap here to enter text may increase the risk of pollution. Neighbor/Tenant-"Print Name:Click or tap Mere to eater text. Septic Variagce Application - Revised January 2021 ;r 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:Roger and Joyce Rubrecht Designates: Environmental Design Partnership-Dennis MacElroy as agent regarding the Septic Variance for Site Address:33 Honeysuckle Lane Tax Map#:226.19-1 S2 Engineering Fee Disclosure:Applications may be referred to the Town consulting engineer for review of septic design,storm drainage,etc.as determined by the Town Board of Health. 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:Joyce&Roger Rub r cht OWNER—SIGNATURE:( y�f DATE: 8// AGENT—PRINT NAME:Dennis MacElroy AGENT—SiGNATURE:�t-41-'1'9) DATE: — -2-� 1 ENVIRONMENTAL DESIGN PARTNERSHIP, LLP 900 Route 146 Clifton Park,NY 12065 (P)518.371.7621 (F).518.371.9540 edpllp.com Shaping the physical environment September 7, 2021 Town of Queensbury Board of Health 742 Bay Road Queensbury, NY 12804 Attn: John Strough,Supervisor Re: Rubrecht-33 Honeysuckle Lane Markert-390 Cleverdale Road O'Neill-85 Pilot Knob Road .BOH Variance Request Dear John: Submitted for your distribution and review are nine sets each of three(3) Board of Health wastewater system variance applications. Each property is a single family residence located in the Lake George waterfront zoning district(WR). The following summarizes each of the properties and associated variance requests. Rubrecht—33 Honeysuckle Lane This property was before the BOH previously (Feb.2021) and received necessary variances for an onsite system using an ETU and pumped, pressurized dispersal to an absorption field. The Owner obtained construction estimates from local contractors and decided against this option due to what he felt was too great an expense. He is now opting for a holding tank system. In addition to a variance for the use of holding tanks,variances are required for separation distances to a neighboring well. Markert—390 Cleverdale Road This property is a small lot out near the north end of Cleverdale. It is approximately 5,000 sf in size with no more than 86' in depth (road side to shoreline). The existing field is approximately 35'from the lake. We are proposing an ETU system with a pumped, pressurized dispersal field. The associated treatment tanks are between the house and the road and the field is in the northwest corner. Numerous variances are required due to the standard setbacks to property line and to the dwelling. The more significant variance is the.shoreline setback to the absorption field. O'Neill—85 Pilot Knob Road This property is currently on a holding tank system. At the time of that BOH approval (2014)the O'Neills didn't have enough suitable land to have use of an onsite absorption field. Recently they were able to obtain additional contiguous land in which to propose a new absorption field area. The system will require pumping up to the new field located approximately 325'from the lake. A variance is required as the required force main piping will need to be installed in an area that is less than the required 10'from a property line. John Strough ENVIRONMENTAL DESIGN PARTNERSHIP, LIP. September 7, 2021 Shaping the physical environirent Page 2 I am available to meet with you and/or other Board members to further discuss these proposals prior to the public hearing. Thank you for your consideration of these requests.. Sincerely, Dennis MlncElroy Dennis MacElroy, PE Environmental Design Partnership Attachments Cc: Dave Hatin Roger&Joyce Rubrecht John &Peg Markert Vince&Anny O'Neill 900 Route 146 Clifton Park,NY 12065 2 (P)518.371.7621 (F)618.371.9640 edpilp.com