SEP-0628-2022 SEPTIC DISPOSAL PERMIT Office Use Only
APPLICATION Permit#:
Town of Quemsbury
Permit Fee:$ bprj—
Invoice#:
742 Bay Road,Queensbury,NY 12804
P:518-761-8256 www.gueensbury.net Septic Variance? Y O
Flood Zone? Y N
Wetlands? Y Reviewed By✓
I IF_
Project Location: 2999 State Route 9L(Dunham's Bay Resort) D
Tax Map #: 252A.-75.1 OCT IW2
RESIDENCE INFORMATION: TOWS! OF QUEENSBURY
g P v BUILDING g, CODES
Year Built Gallons #of bedrooms: X gallons per =total daily flow - - - 4- --- -•
per day bedroom Garbage Grinder Yes No
1980 or older 150 Installed? (choose one) ❑ Q
1981-1991 130 Spa or,Hot Tub Yes No
1992-Present 160 10+kitchenette 160 1,920 Installed? (choose one) ❑ x❑
PARCEL INFORMATION:
Topography ❑■ Flat Rolling ❑ Steep Slope % Slope
Soil Nature ❑■ Sand ❑ Loam ❑ Clay M Other, explain: Silt
Groundwater At what depth? > 68"
Bedrock/Impervious material At what depth? > 68"
Domestic Water Supply ❑ Municipal ❑■ Well ❑Lake
(if well or lake, water supply from any septic system absorption is
300 ft.) DOH public water supply well
Percolation Test Rate: 5:20/4:00 per minute per inch (test to be completed by a
licensed engineer/architect)
PROPOSED SYSTEM INFORMATION:Existing 1,000 gal. precast concrete tank&existing 2,000 gal precast concrete tank
Tank size n-1,500 gallons (min. size 1,000 gallons, add 250 gallons for.each garbage cylinder or
spa/hot tub 1,500 gallon series septic tank -.Total 4,500 capacity + 1 Dosing tank
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: Absorption Bed: (4) 15' x 45' =2,700 SF
—1
Holding Tank System Total required capacity? ; tank size ;
# of tanks
Septic Application Revised July 2022
CONTACT INFORMATION: PLEASE PRINT LEGIBLY OR TYPE, PLEASE INCLUDE AN EMAIL
• Applicant:
Name(s): Swordfish Realty LLC
Mailing Address, C/S/Z: 2999 State Route 9L Lake George NY 12845
Cell Phone: (518)932-1145 (Rich Gordon) Land Line:
Email:
• 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): Sanitary Sewer Service
Contractor Trade: excavation/installation
Mailing Address, C/S/Z: 144 Luzeme Rd#7947, Queensbury, NY 12804 .
Cell Phone: (518)796-3760 Land Line:
Email: gdrellos@gmail.com
**Workers' Comp documentation must be submitted with this application**
• Engineer(s)•
Name(s): Hutchins Engineering PLLC
Mailing Address, C/S/Z: 169 Haviland Road Queensbury, NY 12804
Cell Phone: Land Line: 518-745-0307
Email: tutchins@hutchinsengineering.com
Contact Person for Compliance in regards to this project: Rich Gordon or Tom Hutchins
Cell Phone: Rich (518)932-1145 Land Line: Tom (518)745-0307
Email:
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:
SIGNATURE: DATE:
Septic Application Revised July 2022
TOWN OF QUEENSBURY
742 Bay Road, Queensbury, NY. 12804-5902
Septic System Checklist
Plan to scale
NI/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 or well 10'separation to any part of system
Setback to property lines show 10'or more for any part of system
Septic tank and pump stations 10'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)
Septic tank sized for number of bedrooms and add 250 gals for Jacuzzi tubs/garbage grinder each
Leech Field 20'from foundation 100'from any well 10'from water line
I�kseepage pit 150'from well 50'from septic tank
PILSeepage 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
XLeech field 100'from watercourse or wetland
YToe of mound or bottom of retaining wall10'from property line 100'from well 20'from
Foundation
Provide Engineer/Architect stamp for bed or design systems
Department of Health Approval o
V c2' above established flood elevation to bottom of system
`�6II tanks anchored or 2'above flood elevation
NEW YORI6 Department
Z�LSTATE OF
OPPORTUNITY.. of Health
KATHY HOCHUL MARY T. BASSETT,M,D.,M.P.H. KRISTIN M. PROUD
Governor Commissioner ,acting Executive Deputy Commissioner
October 12, 2022
Thomas Hutchins, P.E.
Hutchins Engineering
169 Haviland Road
Queensbury, NY 12804 FILE COPY
RE: Dunham's Bay Resort, Facility 56-6810
Replacement septic
Lake George (V), Warren County
Mr. Hutchins:
We have this day, approved the plans and specifications for the above-referenced
project. Application for this project was duly made by you on plans titled, "Replacement
Absorption Field for Porch Cabins," and was most recently received by this office
October 11, 2022. The project includes the installation of a new 1,500-gallon septic tank
and replacing the existing absorption field with 4 new 15' by 45' beds to serve 6 cabins
with 2 units each. Approval of these plans is conditioned on the following:
1. That the proposed works 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 that have
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 water and sanitary system lies solely with the
design.professional and the proper operation of the water and 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 in our files.
Glens Falls District Office,77 Mohican Street,Glens Falls,NY 12801,518-793-38931sfdo@health.ny.gov
Sincerely,
Brendan O'Connell
Engineer Trainee
NYSDOH — Glens Falls District Office
77 Mohican St.
Glens Falls, NY 12801
(518) 793-3893
cc: Rebecca Bussert, District Director, Glens Falls District Director
Kevin Kenyon, P.E., Glens Falls District Office
Dan MacElrath, Glens Falls District Office
Matthew Taormino, Owner
Dan Barusch, Village of Lake George
S .l'
169 Haviland Road
Queensbury, NY 12804
Hutchins Engineering Phone:(51 )74-0307
45308
July 6, 2022
i
Mr. Brendan O'Connell
NYS Department of Health
Glens Falls District Office
77 Mohican Street
Glens Falls, NY 12801
Re: Dunham's Bay Lodge; DOH Facility 56-6810; Marin Hospitaliity dba Dunham's Bay Lodge
Replacement Absorption Filed for Porch Cabins
Dear Brendan::
In follow-up to our field visit and evaluation of May 10, attached please find Notice of Intent
Application, Plan Review Fee Determination form (with $200 review fee) and plans describing
replacement of the absorption field serving the "porch cabins" wastewater absorption field. The
porch cabins are six duplex cabin units containing a total of 12 motel sleeping units.
The proposed system is comprised of one additional 1,500 precast concrete septic tank, a precast
concrete dosing tank, and two 15'x 75'absorption beds. Each bed will be dosed on an alternating
basis.
Please contact me if you have any questions or if you require additional information.
Best Regards,
G. Thomas Hutchins, P.E.,
Cc Rich Gordon—Dunhams Bay Lodge
John O'Brien —.Town of Queensbury
G.Thomas Hutchins,P.E. thutchins@hutchinsengineering.com
Notice of Intent to Construct,
NEW YORK STATE DEPARTMENT OF HEALTH
Bureau of Community Environmental Health and Food Protection Enlarge or Convert a Facility
Please read instructions on back before completing form.
Proposed facility name: F
If existing,current facility name: Dunham's Bay Lodge(DOH Facility No.56-6810/Marlin Hospitality dba Dunham's Bay Lodge)
The property will be used as: ✓❑ Food service establishment ❑ Agricultural fairground
✓❑ Temporary residence ❑ Migrant farmworker housing
® Children's camp ❑ Mobile home park
® Campground Swimming pool
❑ Mass gathering Bathing beach
County: Warren -- Town,Village or City: Town of Queensbury
❑ New ❑✓ Renovation 1__l Conversion Are plans attached? ❑✓ Yes ❑ No
Detailed location(e.g,road,street,building number,distance from well-known point):
2999 State Route 9L
Name of owner. Swordfish Realty Address: 2999 State Route 9L Phone:( 518 ) 656-9242
Lake George NY 12845
Name of operator.,Dunham's Bay Lodge Address: 2999 State Route 9L Phone:( 518 ) 656-9242
Lake George NY 12845
It is proposed to(describe in detail:use additional sheets if necessary):
Replace existing wastewater absorption field serving the"porch cabins"(12 Sleeping Units)
The following permits or approvals for the proposed construction,enlargement or conversion have been applied for or received:
Town of Queensbury Building Permit will be required(not yet applied)
Name of local code enforcement officer for facility location: Address: 742 Bay Road Phone:( 518 ) 761-8256
John O'Brien,Town of Queensbury Building&Codes Queensbury NY 12804
Signature: Date: 9/6/22
Title: !i�t Owner ❑ Operator ❑ Other,specify
Mailing Address: Phone;( 518 ) 656-9242
2999 State Route 9L,Lake George NY 12845
DOH-154(4/04)Page 1 of 2 (GEN-140)
1
Instructions for completing form
The following facilities are regulated by the State Sanitary Code and require a permit from the local health department
to operate:
• Swimming pools • Bathing beaches
• Temporary residences(hotels/motels,cabins or bungalow colonies) • Campgrounds
• Migrant farm worker housing and other labor housing • Children's camps
• Farm worker housing • Mobile home parks
• Food service establishments • Agricultural fairgrounds
• Mass gatherings
The following changes,modifications or construction are required to be reported to the local health departments:
• a new building or facility is to be built;
• an existing building or facility is to be enlarged or remodeled;
• an existing property(that is not a regulated facility)is to be converted to a regulated facility,
with or without remodeling;
• the addition to or modification of any system serving the facility(examples:water supply system,sewage treatment
system or fire alarm and detection system);
• changes that will or may increase water consumption and/or the volume of sewage requiring treatment,or both.In
reporting such changes,list the number,if any,of the new fixtures/facilities(examples:bedrooms,dining or seating
capacities,toilet fixtures,lavatories,showers/bathtubs,dishwashing facilities,swimming pools,camping sites or
mobile home sites).
For your information,the following are some additional PERMITS that may be required before you proceed:
• Construction Permit(Uniform Fire Prevention and Building Code);
• State Pollution Discharge Elimination System(SPDES)-Article 17 of the State Environmental Conservation Law,
if applicable.
This form must be returned to the local health department having jurisdiction at least 30 days priorto the date of the proposed
construction,enlargement or conversion or as otherwise required.
Plans or specifications may be required by the Permit-Issuing Official prior to commencement of any such construction,
enlargement or conversion.
DOH-154(4/04)Page 2 of 2