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SEP-0567-2021 SEPTIC DISPOSAL PERMIT office Use Only APPLICATION Permit#: 3E�--��6�-- Zorz� rorvn orQuecnsbury Permit Fee:$ CD 5 ' Invoice#: 742 Bay Road,Queensbury,NY 12804 P:518-761-8256 www.aueensbury.net Septic Variance? Y �. N Flood Zone? Y Wetlan s?�Y N eviewed B Project Location: 1 Tax Map#: 2Ze.,. !a —Z--6A{ SEP 08 202i RESIDENCE INFORMATION: OWN OF QUEENSSURY Year Built Gallons #of bedrooms: X gallons per =total daily flow BUILDING CODES per day 'bedroom_ Garbage Grinder Yes No 1980 or older 150 Installed? (choose one) ❑ [•�' i981-1991 130 Spa or Hot Tub Yes No 1992-Present 110 l 1 Installed? (choose one) ❑ PARCEL INFORMATION: Topography Flat Rolling ❑ Steep Slope % Slope Soil Nature ❑'Sand 9<oam ❑ Clay ❑ Other, explain:, Groundwater At what.depth? Bedrock/impervious material At what depth? Domestic Water.Supply ❑ Municipal ❑ Well Lake. (if well or lake, water supply from any septic system absorption is i Loo ft.) Percolation Test . Rate: per minute per inch (test to be completed by a licensed engineer/architect) PROPOSED SYSTEM INFORMATION: Tank size gallons (min. size 1,000 gallons, add 250 gallons for each garbage cylinder or spa/hot tub - L A' -CLxV System Absorption field w/#2 stone Total length ft.; Each Trench ft. .Seepage Pit w/#3 stone How many: ; Size: Alternative System Bed or other type: Z�!5r-y-c A e E I p'x Holding Tank System Total required capacity? tank size # of tanks Septic Application Revised April 2021 i NCONTACT INFORMATION: PLEASE PRINT LEGIBLY OR TYPE, PLEASE INCLUDE AN EMAIL • Applicant: Name(s):` i M- T-Ok=IZlA� Mailing Address, C/5/Z:1Z; LN L.^V-r— Cell Phone: 511a A44t-- Mr,4` Land,Line: 5i$ Email: Cl89Co @J�vs1c'uttii�Q#'. coo • Primary Owner(s): Mailing Address, C/S/Z: Cell Phone: Land Line: Email: ❑ Check Wall work will be performed by property owner. only J • Contractor: _ Contact Name(s): (7-,- Contractor Trade: MailingrAddress, C/S/Z: ��'t-5 W Y &c-K y� Cell Phone: 957lE•4 7n-At�,gtf Land Line: 15Ptg -nr 5-Q!l IZA545 Email: "Workers' Comp documentation must be submitted with this application" ; • Engineer(s)•- Name(s): '�-c�'C' — �vtlZ -1'�i ��.:L- �-Di Mailing A ress, C/S/Z: qOb t�T. 1 46o C %,sVT,=rAeF� %"C J «© Cell Phone: 51$T'7(o--.-44 -.5 Land Line: Email: C.rco_a� Contact Person for Compliance in regards to this project. Cell Phone: ✓flb `57 w-��35 Land Line: Email: ,& NOTES: 1. Alarm system and 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 fact or 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 the Town of Queensbury Sanitary Sewage 'Disposal Ordinance. PRINT NAME::22/'7dzgz OIIC A SIGNATURE: DATE: Septic Application Revised April 2021 TOWN OF O UEENSB URY 742 Bay Road, Queensbury, NY. 12804-5902 Septic System Checklist - Plan to scale Received Deep hole perc 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 Water line shown Municipal Orwell 10'separation to any part of system i Setback to property lines sh 1 ' more for any part of system Septic tank and pump station 10' 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) . l Septic tank sized for number of bedrooms and add 250 gals for Jacuzzi tubs/garbage grinder each Leech Fiel 0' foundati 00' any well 10'from water line VIt i_totN�Ic� 1*5eepage pit 150'from well 50'from septic tank eepage 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 mottl' �36- n.1000'of Lake George Leech field 100'from watercourse or wetland N Toe of mound or bottom of retaining w 1 ' m property lin 10 ' m`�well 20'from ��C, -- Foundation _�(Provide 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'above flood elevation Revised 4/15/2021 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 December 3,2021 p -2 � Town of Queensbury Building&Codes 742 Bay Road Queensbury, NY 12804 D .�. U E 0 V Attn: Dave Hatin, Director DEC 06 2021 Re: Moriarty-12 Honeysuckle Lane TOI/I/N OF QUEENSBURY Replacement Wastewater System BUILDING& CODES Dear Dave: In compliance.with application approvals granted by the Town of Queensbury I offer the following regarding the referenced project. The design plans, prepared by this:office, reviewed and approved by the Town as associated.with the wastewater system application,are as follows: Proposed Wastewater Improvements For 95 Assembly Point Road Applicant: Tim Moriarty 12 Honeysuckle Lane Town of Queensbury August 8,2021 • Sheet 1 Cover Sheet Sheet 2 Existing Conditions , • - Sheet 3 Site Plan �vILT Sheet 4 Variance Plan Sheet 5 Wastewater Details Sheet 6 Enhanced Treatment Details During the course of construction I was on the job site to observe key components of the system installation. The field location of the Clarus Fusion and pump tank are the same as the approved design plan. The absorption field has been positioned to the allowed 2' property line setback(to the north)as granted by the BOH approvals. I have provided an `as-built' plan which indicates those locations. All other aspects of the work were constructed as designed and using the materials as specified. The pump system was set up for operation and,tested/inspected on December 1st. Based on my inspection of the system installation it is my opinion that the wastewater system is in compliance with the intent of the approved design plan and is ready for operation. Sincerely, Dennis MacElroy, PE Attachment Cc:Tim Moriarty Charles Dyer From: Edward Carr <epcarrs6@gmail.com> Sent: Wednesday, December 8, 2021 1:29 PM To: Charles Dyer \2 Subject: Electrical Inspection -Honeysuckle Moriarty TOWN OF QUEENSBURY WARNING: This is an external email.Do not click links or open attachments unless you recognize the sender and know the content is safe. W s��1 1� �- ft Mf •y d.. . - f�, y 1 a�su�tdy.f Racacd'antd certi�i ti ;5 tvs4 12,Y=�h.:tsf:'paii�ll�iit".t� '.us��llca�i9�. cc�ar.. Ins e-tot Sent from my iPhone 1 • Onsite Equipment, Inc. i P.O. Box 6265 I Syracuse, NY 13217 , DCT E 315-254-6891 lJt1 � MAINTENANCEISERVICE AGREEMENT FOR CLARUS FUSLON Project Number: ; 305-2021 Owners Name: ! Tim & Lucille Moriarty Property Location: 12 Honeysuckle Lane, Lake George, NY 12845 Owners Mailing Address: 12 Honeysuckle Lane, Lake George, NY 12845 Email: timm9896@roadrunner.com Phone Number: 518-656-3937 Term: 4 Years; 12-7-21 thru 12-7-25 Start Date: December 7, 2021 This Agreement will serve as acknowledgement that Onsite Equipment, Inc. (Onsite) will provide service on the Clarus Environmental, Inc. (Clarus) Fusion enhanced treatment unit at the above referenced property. Onsite will perform annual scheduled service checks of the Fusion for four years or until the first pump out is required. After this term, the owner must subscribe to the inspection and maintenance program. Applicable regulatory entity may be notified if the agreement is terminated at any time, regardless of the reason. Onsite will check the Fusion for proper operation and notify the owner of any deficiencies that need to be addressed. The cost associated `with additional items including replacement of parts, pumping out accumulated foam/sludge or site grading is not included in this agreement. Property owner agrees to operate the unit in accordance with the manufactures recommendations as presented in the Fusion Owner's Manual. Owner may transfer the benefits of this Agreement to any purchaser or other person who acquires the property where the fusion is located. Onsite is not responsible to nted as a result of delayed lectr c ty at the Fuson panel, or as a or e result of an Act of site limited access to the , no e God. perate the unit in accordance with' the manufactures Property owner agrees to o recommendations as presented in athe Fus ntenance ion Owners Manual. The undersigned agrees to the terms of this Ins ect -Maintenance& � � i A/ Date Owner 5E�rY®�I Adirondack STA7EOF ' " 9PP9RTUNITY.: Park Agency KATHY HOCHUL TERRY MARTINO Governor Executive Director August 30, 2021 - �� ��� � • 202 Dave Hatin EC E OWE Director, Building & Codes D -Town of Queensbury- AUG 3 1 2021 742 Bay Rd Queensbury, NY 12804 TOWN O Q&NS �Y Re: LV2021-0080 . Variance Application: Moriarty Town Resolution: BOH 45, 2021 FILE COPY Tax Map Number: 226.19-2-34 Dear Dave.Hatin: Adirondack Park Agency staff review of the above referenced variance determination has been completed. The applicant proposes to replace an existing on-site wastewater treatment system. Relief is required from the Town setbacks from neighboring well, a property lines and building foundation. 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 REB:KOK 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 w Y RESOLUTION APPROVING TIMOTHY MORIARTY'S APPLICATION FOR SANITARY SEWAGE DISPOSAL VARIANCES RESOLUTION NO.: BOH 45,2021 FILE COPY � ECE0WE INTRODUCED BY: Mr.Harrison Freer D WHO MOVED ITS ADOPTION EEP 0 9 2021 SECONDED BY: Mr. George Ferone TOWN OF OUEENSBURY BUILDING&COMES WHEREAS, Timothy Moriarty (Applicant) filed an application for variances from provisions of the Town of Queensbury On-Site Sewage Disposal Ordinance, Chapter 136 to install a replacement wastewater treatment system with its components proposed to be located as follows: ,l! absorption bed to be 88' from the neighboring well in lieu of the required 100' setback; 00 o f-3 O a P%Vv %Q 6 ,2 pump tank to be 4' from the property line in lieu of the required 10' setback; absorption bed to be 7' from the property line in lieu of the required 10' setback; ,AK' absorption bed to be 2' from the property line in lieu of the required 10' setback; QQAuI�o� Clarus tank to be 5' from the building foundation in lieu of the required 10' setback;' and Id' absorption bed to be 10' from the building foundation in lieu of the required 20' setback; on property located at 12 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,August 23rd,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 Applicant; and BE IT FURTHER, RESOLVED, that the Local Board of Health hereby approves the application of Timothy s Moriarty for variances from the Sewage Disposal Ordinance to install a replacement wastewater treatment system with its components to be located as follows: 1. absorption bed to be 88' from the neighboring well in lieu of the required 100' setback; 2. pump tank to be 4.' from the property line in lieu of the required 10' setback; 3. absorption bed to be 7' from the property line in lieu of the required 10' setback; 4.. absorption bed to be 2' from the property line in lieu of the required 10' setback; 5.. Clarus tank to be 5' from the building foundation in lieu of the required 10' setback; and 6. absorption bed to be 10' from the building foundation in lieu of the required 20' setback; on property located at 12 Honeysuckle Lane in the Town of Queensbury and bearing Tax Map No: 226.19-2-34, 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 23`d day of August,2021,by the following vote: AYES Mr. Ferone,Mr. McNulty, Mr. Strough,Mr. Freer NOES : None ABSENT:Mr. Metivier SEPTIC VARIANCE office Use Only D Permit#: APPLICATION- Permit Fee:$ �Po�)" 3'otti�r aPfZcrccnshur}• , Invoice#: 40 2rb 742 Bay Road,Queensbury,NY 12804 P:518-761-8256 www.gueensbury.net Approvals: 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): Timothy Moriarty Owner's Agent: Environmental Design Partnership Address:" 12 Honeysuckle Lane Address: 900 Route 146 Clifton Park NY,12065 Lake George NY,12845 'FILE COPY Phone#: 518-354-9698 Phone#: 518-371-7621 Email: d=9896@roadrunner.com Email: nzeglen@edpllp.com,(NickZeglen) dmacelroy@edpllp.com(Dennis MaCelroy) cderriyer@edpllp.com(Connor DeMyer) Site Information: 12 Honeysuckle Lane Site Address: Tax ID#: 226.19-2-34 -"directions to Site: From 9L,turn onto Assembly Point Road,turn left onto Sunset Lane,Right onto Honeysuckle Lane,continue to 12 Honeysuckle Distance from well on property to septic system (if applicable) N/A 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 system meet setback requirements for distance from wells 8t septic systems on neighboring properties? Des 0 No If NO, please explain: Proposed setback from neighboring well is88" Is the proposed system to be installed under a parking area? ❑Yes 0 No Section"of the Sanitary Sewage Ordinance from which you are seeking the variance (Le: leaching system will be 89 ft. from well in lieu of required 100 ft.): V-1 Absorption Bed to neighboring well 88'vs the 100'required V-2 Pump Tank to property line 4'requested vs the 10'required V-3 Absorption Bed to property line 7'requested vs the the 10'-required V-4 Absorption Bed to property line 2'requested vs the 10'required V-5 Clarus Tank io building foundation T.requested vs the 10'required V-6 Absorption Bed to building foundation 10'requested vs the 20'required l_ Septic Variance Application. Revised January 2021 List the names, parcel-addresses,-and tax map numbers of all adjoining property owners. You may obtain this information from the�'Town of Queensbury's Assessor's Office: North Name TaulLejuez Ad d reSS 7 Hickory Dr Hickory NY,10580 Tax Map ID 226.19-2-21 South Name BideAWeeLLC Address 36 Liberty Street Hawthorne NY,10532 Tax M a p I D 226.19-2-35 East Name JonathanLejuez Address 49 Palisade Road Rye NY,10580 Tax Map ID 226.19-2-20 West Name Doris Hopper Address- 17 Honeysuckle Lane Lake George,NY 12845 Tax Map ID 226.i9-1-23 OWNER STATEMENT 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 well, septic tank or leaching system less than the required feet from the may increase the risk of pollution. Owner—Print Name: Timothy J. Moriarty Owner—Signature: � Date:. 7124/2021 if NEIGHBOR OR TENANT RELEASE STATEMENT(if applicable) I/We do hereby relieve the Town of Queensbury from any liabilities on the plumbing and,se,ptic system located at:. 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. Neighbor/Tenant—Print Name: r'^` Neigh bor/Tenant=Signature: Date: Septic Variance Application Revised January 2021 eIRLEASE ATTACH THE FOLLOWING TO YOUR APPLICATION: 1. A location map showing the site.within the Town of Queensbury. 2. A plot plan showing existing and proposed features of the property, including: a. Lot dimensions b. North arrow and scale: 1 inch=40 feet c. .. Location & dimensions of existing and proposed buildings, showing setback distances and uses d: Parking layout to scale (if applicable) e. Physical features (street, steep slopes, lakes, wetlands, etc.) f. Location of all wells and septic systems on neighboring properties g. Adjacent ownerships h. All properties within 500 feet A sample plot plan and location are shown below: WMT'tit r ed—IN POD lie �r 4 1 r g Fh1r1 d f. r 2 8 P377m7lp� .�, j-� TvMl�llicea fr'iRTOF ri�r3:sa � Septic Variance Application Revised January 2021 AUTHORIZATION AND SIGNATURE PAGE '' This page includes the Authorization to Act as Agent form, engineering fee disclosure, authorization for site r� visits, other permit responsibilities and agreement to provide documentation required. Complete the following if the OWNER is using an Agent: Owner's Name: Designates: as agent regarding the Septic Variance for Site Address: Tax Map#: 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: Timothy J. Moriarty OWNER—PRINT NAME: OWNER—SIGNATURE: %N.d DATE: 7/2412021 AGENT—PRINT NAME: AGENT—SIGNATURE: DATE: Septic Variance Application Revised January 2021 ' Office Use Only- SEPTIC VARIANCE Permit#: APPLICATION Permit Fee: Toam of Quecnshury Invoice#: 742 Bay Road,Queensbury,NY 12804 P:518-761-8256 www.aueensbury.net Approvals: 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): Timothy Moriarty Owner's Agent: Environmental Design Partnership Address: 12 Honeysuckle Lane Address: 900 Route 146 Clifton Park NY,12065 _ Lake George NY,12845 Phone#: 518-354-9698 Phone#: 518-371-7621 Email: timm9896@roadmnner.com Email: nzeglen@edpllp.com,(Nick Zeglen) dmacelroy@edpllp.com(Dennis MaCelroy) cdemyer@edpllp.com(Connor DeMyer) Site Information: 12 Honeysuckle Lane �o°te Address: Tax ID#: 226.19-2-34 a Uirbctions to Site: From 9L,turn onto Assembly Point Road,turn left onto Sunset Lane,Right onto Honeysuckle Lane,continue to 12 Honeysuckle Distance from well on property to septic system (if applicable) N/A feet Is it possible to install a conforming septic system on this property? ❑Yes Q No If YES, please explain and attach a diagram: Does the proposed system meet setback requirements for distance from wells&septic systems on neighboring properties? []Yes Q No If No, please explain: Proposed setback from neighboring well is88', Is the proposed system to be installed under a parking area? ❑Yes Q 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.): V-1 Absorption Bed to neighboring well,88'vs the 100'required V-2 Pump Tank to property line 4'requested vs the 10'required V-3 Absorption Bed to property line 7'requested vs the the 10'required V-4 Absorption Bed to property linen'requested.vs the 10'required V-5 Clarus Tank to building foundation 5'requested vs the 10'required V-6 Absorption Bed to building foundation 10'requested vs the 20'required Septic Variance Application Revised January 2021 List the names, parcel-addresses, and tax map numbers of all adjoining property owners. You may obtain thT, - information from the Town of Queensbury's Assessor's Office: North Name PaulLejuez Ad d reSS 7 Hickory Dr Hickory NY,10580 Tax Map ID 226.19-2-21 South Name BideAWeeLLC Ad d reSS 36 Liberty Street Hawthorne NY,10532 Tax M a p I D 226.19-2-35 East Name Jonathan Lejuez Address 49 Palisade Road Rye NY,10580 Tax Map ID 226.19-2-20 West Name Doris Hopper Address 17 Honeysuckle Lane Lake George,NY 12845 Tax Map ID 226.19-1-23 OWNER STATEMENT 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 well, septic tank or leaching system less than the required feet from the may increase the risk of pollution. Owner—Print Name: Timothy J. Moriarty Owner—Signature: Date: 7/24/2021 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 well, septic tank or leaching system less than the required feet from the may increase the risk of pollution. Neighbor/Tenant—Print Name: Neigh bor/Tenant-Signature: Date: . Septic Variance Application Revised January 2021 PL'SE ATTACH THE FOLLOWING TO YOUR APPLICATION: 1. A location map showing the site within the Town.of Queensbury 1 2. A plot plan showing existing and proposed features of the property, including: a. Lot dimensions b. North arrow and scale: 1 inch=40 feet' c. Location & dimensions of existing and proposed buildings, showing setback distances and uses d. Parking layout to scale (if applicable) e. Physical features (street,-steep slopes, lakes, wetlands, etc.) f. Location.of all wells and septic systems on neighboring properties g. 'Adjacent ownerships h.- All properties within 500.feet A sample plot plan and location are shown below: _ tie,__� ,.s�� _� � -• PSa - _ rs* .�` - -�S�f0�1k9td�(i615fA8i• .��a-'- . I,F4SK11YIM 7N Wei fJ F r a .a r R - rah•... plc g4sl Al"�+� •+ e a p7mr=4031pp ,s. ,r T fl III®c Imp 'Ilol3:aM cti . Septic Variance Application Revised January 2021 AUTHORIZATION AND SIGNATURE PAGE This page includes the Authorization to Act as Agent form, engineering fee disclosure, authorization for site l visits, other permit responsibilities and agreement to provide documentation required. Complete the following if the OWNER is using an Agent: Owner's Name: Designates: as agent regarding the Septic Variance for Site Address: Tax Map#: 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 maybe 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: Timothy J. Moriarty OWNER—PRINT NAME: OWNER—SIGNATURE: %late DATE: 7/24/2021 AGENT—PRINT NAME: 01C)ACLS AGENT—SIGNATURE: DATE: Septic Variance Application Revised January 2021 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 July 27,2021 Town of Queensbury Board of Health J l°�� 742 Bay Road cl�OF :'• Queensbury, NY 12804 4' o� Attn: John Strough,Supervisor '�t,��,� . fifc Re: Moriarty Residence—12 Honeysuckle Lane BOH Variance Request Dear John: Submitted for your distribution and review are nine sets of a Board of Health wastewater variance application for a single-family residence located at 12 Honeysuckle Lane.The Moriarty residence is proposing to replace their existing wastewater system at this:property and is requesting Board of Health Variances for relief from certain'setback requirements. The application documents include' the following: • Proposed Wastewater Improvements Moriarty Residence Sheet 1 Cover Sheet Sheet 2 Existing Conditions Sheet 3 Site Plan Sheet 4 Variance Plan Sheet 5 Wastewater Details Sheet 6 Enhanced Treatment Details • Queensbury Town Board of Health Application for Septic Variance Application Fee-$165 check I am available to meet with you and/or other Board members to further discuss this proposal prior to the public hearing. Thank you for your consideration of this request. Sincerely, Dennis MacElroy Dennis MacElroy, PE Environmental Design Partnership Attachment cc: Dave Hatin Tim Moriarty (timm9896@roadrunner.com)