SEP-0894-2021 O'
SEPTIC VARIANCE °ire use only.
a r"Y Prmmit#: -DC-'-b8f�4- 2424
APPLICATION Permit Fee:$ )10t>—
fmm �rcn.sturs Invoice
I 742 Bay Road,QueensbuM NY 22804
P:518-761-9256 w4 v. isr n bu a rovail:s
Submittal: I (one)original&8 copies of the completed application package
Contact Information: PLEASE PRINT LEGIBLY OR TYPE, PLEASE INCLUDE AN EMAIL
Property Owner's): Michael Carey,Jr. Owner's Agent: Hutchins Engineering PLLC-Torn Hutchins
Address: Address: 169 Haviland Road Queensbury, NY 12804
Phone#: 518-283-5431 x2 Phone#: 518-745-0307
Email: mcareyir@careyelectricinc.com Email: tutchins@hutchinsengineering.com
Site Information:
Site Address: 28 Holly Lane Tax ID#: 239.12-.2-57
Directions to Site,from NY-91-5,turn left on New Assembly Pt.Rd for 0.3 mi,turn right on Brayton Lane N for 450 ft,left on Holly Lane for 0.1 mile(on rig
Distance from well on property to septic system(if applicable) feet (Lake Water)
Is it possible to install a conforming septic system on this property? ❑Yes 4 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? QYes a No if NO,please explain:
Is the proposed system to be installed under a parking area? ❑Yes g 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.l:
Enhanced Treatment Unit effluent absorption field to be 82'from neighboring well in lieu of required 100 ft.
Enhanced Treatment Unit effluent absorption field to be 87 from Lake George in lieu of required 100 ft.
Septic Variance Appli-,Xian
ReuisedImuary2021
4
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 Brian Hogan
Address 34 Holly Lane
Tax Map ID 239.1-2-2-56
South Name Frances Goldsehelder
Address 24 Holly Lane -
Tax Map ID 239.12-2-58
East Name Lake George
Address
Tax Map 1D
West Name Donald Fane / Brian Hogan
Address 27 Holly Lane / 33 Holly Lane
Tax Map ID 239.12-2-40 / 239.12-2-37
OWNER STATEMENT
Ifi e do hereby relieve the Town of Queensbury from any liabilities on the plumbing and septic system located at:
28 Holly Lane --
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: Michael Carey,Jr.
Owner—Signature: _ 4 /�~ Date:
NEIGHBOR O TENANT TENANT RELEASE STATEMENT(if applicable)
I/We do hereby relieve t;ne 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: Neighbor is unwilling to sign
Neighbor/Tenant-Signature: _ _ Date:
Septic Variance Application RevcsedJanuary 2021
AR
Ve
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AUTHORIZATION AND SIGNATURE PAGE
f
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: Michael Carey,Jr.
Designates: Hutchins Engineering.PLLC as agent regarding the Septic Variance for
Site Address: 28 Hoily Lane
Tax Map#: 239.12-2-57
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:.B.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 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 bythe 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: Michael Carey, Jr.
OWNER—SIGNATURE: DATE:
AGENT—PRINT NAME: G. . ., mas Hutchins; PA__
AGENT—SIGNATURE:_ DATE:
f
Septic Variance Application Revised January 2021
r
2o2I
RESOLUTION APPROVING MICHAEL CAREY,JR.'S APPLICATION
FOR SANITARY SEWAGE DISPOSAL VARIANCES
RESOLUTION NO.: BOH 4,2022
INTRODUCED BY: Mr.Harrison Freer I
IE C E 0 W E
WHO MOVED ITS ADOPTION
JAN 2 5 2022
SECONDED BY: Mr.Timothy McNulty
TOWN OF QUEENSBURY
BUILDING&CODES
WHEREAS, Michael Carey, Jr., (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 Enhanced Treatment Unit (ETU) Effluent
Absorption Field to be located:
1. 82' from the neighboring well instead of the required 100' setback; and
2. 87' from Lake George instead of the required 100' setback;
on property located at 28 Holly 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 January 24 h,2022, 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
1
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 Michael
Carey, Jr., for variances from the Sewage Disposal Ordinance to install a replacement wastewater
treatment system with its Enhanced Treatment Unit(ETU)Effluent Absorption Field to be located:
1. 82' from the neighboring well instead of the required 100' setback; and
2. 87' from Lake George instead of the required 100' setback;
on property located at 28 Holly Lane in the Town of Queensbury and bearing Tax Map No:
239.12-2-57, and
BE IT FURTHER,
RESOLVED, that the Enhanced Treatment Unit shall be maintained by the property owner
in accordance with the manufacturer's recommendations for the life of the system, and
BE IT FURTHER,
RESOLVED,that this Resolution and the permit shall provide that:
1. the system will be installed by June 15; and
2. the property shall not be used for short-term rentals until after the system is properly
installed to the satisfaction of the Town;
r �
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 any lawful action by the Adirondack
Park Agency during such period.
Duly adopted this 24 h day of January, 2022,by the following vote:
AYES: Mr.Freer,Mr.Ferone,Mr. McNulty,Mr. Strough,Mr.Metivier
NOES: None
ABSENT:None
%6Q.
SEPTIC DISPOSAL PERMIT Office Use Only
APPLICATION Permit#:_
Permit Fee:$
(� n oice#: `G
742 Bay Road,Queensbury,NY 12804 D L� if 0
P:518-761-8256 www.gueensbury.net �w- -- a tic Variance? N ��� 4, 2 ZZ
i
a� 0229 1 lood Zone? Y �.:�
etlands? Y Reviewed By �
TOWN OF QUEENSDUR �-'
Project Location: 28 HoIN LanEBUILDING&CODES
Tax Map #: 239.12-5-57
RESIDENCE INFORMATION.-
Year Built Gallons #of bedrooms: X gallons per =total daily flow
per day bedroom Garbage Grinder Yes No
1980 or older 150 Installed? (choose one) ❑ W
1981-1991 130 Spa or Hot Tub Yes No
1992-Present 110 Installed? (choose one) ❑
2+2=4 110 440
PARCEL INFORMATION:
Topography ❑ Flat Rolling ❑ Steep Slope % Slope
Soil Nature Sand ❑ Loam ❑ Clay Other, explain: silt
Groundwater At what depth? >52"
Bedrock/Impervious material . At what depth? >52"
Domestic Water Supply_ ❑ Municipal ❑ Well [Lake
(if well or lake, water supply from any septic system absorption is
ft.)
Percolation Test Rate: 6:45 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 Norweco NSF-40 Enhanced Treatment Unit+ 1,000 gallon precast concrete pump station
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: Bed: 15'x 25'=375 SF
Holding Tank System Total required capacity? ; tank size
# of tanks
Septic Application Revised April 2021
CONTACT INFORMATION: PLEASE PRINT LEGIBLY OR TYPE, PLEASE INCLUDE AN EMAIL
• Applicant:
Name(s): Michael Carey, Jr.
Mailing Address, C/S/Z:
Cell Phone: 518-283-5431 x2 . Land Line: .
Email: mcareyjr@careyelectricinc.com
•. Primary Owner(s):
Name(s): same as applicant
Mailing Address, C/S/Z:
Cell Phone: Land Line:
Email:
❑ Check if all .work will be performed by property owner only
• Contractor:
Contact Name(s): Ivan Bell (IBS Septic)
Contractor Trade: Excavation/Installation
Mailing Address, C/S/Z: 2 Lower Warren Street Queensbury, NY 12804
Cell Phone: Land Line: 518-798-8194
Email:
"Workers' Comp documentation must be submitted with this application"
• Engineer(s):
Name(s): Hutchins Engineering PLLC
Mailing Address, C/S/Z: 169 Havi land Road Queensbury, NY 12804
Cell Phone: Land Line: 518-745-0307
Email: thutchins@hutchinsengineering.com
Contact-Person for Compliance in regards to this project: Tom Hutchins
Cell Phone: Land Line: 518-745-0307
Email: thutchins(cDhutchinsenaineering.com
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: (CA
SIGNATURE: DATE: -�J
Septic Application Revised April 2021
TOWN OF QUEENS.BURY
742 Bay Road, Queensbury, NY. 12804-5902
Septic -System Checklist
tc*4 Plan to scale
' Received Deep hole perc-test results from engineer/Architect if applicable(Town Approved Engineers and
' rchitects;June 30 to April 15 Town Engineer for unapproved Engineers and Architects)
All wells on property and adjacent properties shown
,2SWater line shown Municipal or well 10'separation to any part of system
V'
S Setback to property lines show 10'or more for any part of system
jeptic tank and pump stations 10'from foundation 50'from any well/lake/wetland 10'from any waterline
.r
r.J�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) .
Septic tank sized for number of bedrooms and add 250 gals for Jacuzzi tubs/garbage grinder each
Leech Field 20'from foundations'from any well 10'from water line Vo^(61 e�Li
Seepage pit 150'from well 50'from septic tank
4Seepage 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 mottling 36"within 1000' of Lake George
NOLeech field 100'from watercourse or wetland
Toe of mound or bottom of retaining wall 10'from property line 100'from well 20'from
�/ Foundation
01 `''Provide Engineer/Architect stamp for bed or design systems
Department of Health Approval for all mobile home park new systems Flood Plain requirements
r"" 2' above established flood elevation to bottom of system
All tanks anchored or 2' above flood elevation
R P.VISPCI 4/15/2021
169 Haviland Road
Queensbury;NY 12804
Hutchins Engineering PLLC Phone: (518)745-0307
Fax: (518)745-0308
December 20, 2021
Town of Queensbury Local Board of Health
742 Bay Road
Queensbury, NY 12804
Re: Michael Carey, Jr.
28 Holly Lane
Tax Map ID: 239.12-5-57
Dear Supervisor Strough & Board Members:
This office represents Michael Carey with respect to the pursuit of wastewater variances for a
replacement wastewater system at his Holly Lane home.
The proposed replacement wastewater system includes a Norweco Singulair Green, NSF-40
Enhanced Treatment Unit (ETU), new 500-gallon precast concrete pump station, and 15' x 25'
absorption bed.
The proposed wastewater system requires variances for setback from the absorption field to
lake (87' proposed instead of 100' required) and absorption field to neighbor's well (82'
proposed instead of 100' required).
Enclosed please find ten submission packages for this project. We respectfully request that this
item be placed upon the agenda of the next available town.board meeting. Please contact me if
you have any questions or if you require additional information.
Best Regards,
�i
G. Thomas Hutchins
� � �nCEnclosures LTOOF
c: Michael Carey, Jr. 2021
4ECNSBURy
IBS Septic&Drain Services, Inc
2 Lower Warren Street
Queensbury, NY 12804
(518)798-8194
Service Agreement:Norweco System
Customer Information
Name Michael Carey Email Address
Street Address 28 Holly Lane County Warren
City Lake George State NY Zip Code 12845
Home Telephone 518-858-6624 Mobile Telephone
Mailing Address( If different) Street Same
City State Zip Code
System Information
Install Date 04/26/2022 Install Type : XX Residential / Commercial
Singular System Model: _960-500GPD _980-750GPD _960-1000GPD
960-1250GPD 960-1500GPD TNT-500GPD
Aerator Serial Number 970132LX Control Serial Number LZ29492
Control Model 206C Effluent Disposal Method_Leach Bed
Pump Station