SEP-0618-2021 SEPTIC VARIANCE office Use only
Permit#: ' Qkaz- zo
is APPLICATION_ Permit Fee:$
Town ofCzzlccnsbun Invoice#: `7 `t
742 gay Road,Queensbury,NY 12804
P:518-761-8256 www.gueensbury.net Approvals:
Submittal: (one) original & 8 copies of the completed application package
Contact Information: PLEASE PRINT LEGIBLY OR TYPE, PLEASE INCLUDE AN EMAIL
Property Owner(s): Frank Sinatra Owners Agent: Environmental Design Partnership
Address:. 33 Sulgrave Road Scarsdale,NY 10583 Address:, 900 Route 146 Clifton Park,NY 12065
ECEUVIE
Phone#:, 914-963-5263 Phone#:
518-371-7621 D
AUG 19 2021
Email: flsinatra@aol.com Email: nzeglen@edpllp.com
cdemyer@edpllp.com
dmacelroy@edpllp.com TOWN OF QUEENSI;URY
BUILDING& CODES.
Site Information:
105 Rockhurst Rd
Site Address: Tax ID#: 227.9-1-4
Directions to Site: From 9L turn onto Cleverdale Rd,stay right onto Rockhurst,turn left onto Rockhurst.105 on
your left
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.&septic systems on neighboring
properties? ❑x Yes ❑ No If NO, please explain:
Is the proposed system to be installed under a parking area? ❑Yes ❑x 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 PROPERTY LINE-P REQUESTED VS.THE 10'REQUIRED
V-2:ABSORPTION BED TO PROPERTY LINE-3'REQUESTED VS.THE 10' REQUIRED
V-3:FORCE MAIN TO PROPERTY LINE-3'REQUESTED VS.THE 10' REQUIRED
V-4:ABSORPTION BED TO BUILDING FOUNDATION-1T REQUESTED VS.THE 20' REQUIRED
V-5:SEPTIC TANK TO BUILDING FOUNDATION-6 REQUESTED VS.THE 10'REQUIRED
Septic Variance Application Revised January 2021
'rig.jj)6 rh,1,. rtes tp3 r
cal sses, and tax map numbers of all adjoining property owners. You rna, Cibmin this
Il'IfOrMaTi011 frD['[)-thC_"'T0VVl1 Of QUeensbury's Assessor's Office:
North jNaML%.' Ronald Miller
"Address 107RockhurktRoad
Tax Map ID 227.S1-1-5
South Name Vatrick Krilmk
Address 10][RuckhurstRuiLd
Tax Map ID 22-1j1-1-3
East Name Kevin'nieflault
Address. 108 Rockhorst Road
Tax Map ID 227.9-1-11
Fast Name Coicy.T.Lewindowski
Address 10211ockhtirslRoad
Tax Map ID 227.9-1-12
OWNER STATEMENT
I/Wedo hereby relieve the Town Of QUeensburyfrom any liabilities on the plumbing and septic system locatedl at:
I/We realize that putting the well,septic tank or leaching system less than the required feet
trorn the rnay increase the risk of pollution.
owner—Print Name: P-ANKI NPIT RAq
4 �/2`owner—Signature: t1JAAA lu Date:
NEIGHBOR OR TENANT RELEASE STATEMENT(if applicable)
I/We do hereby relieve the Tovin of Queensbury from any liabilities an the Plumbing and septic System located at:
I/We realize that Putting the well, septic tank of,leaching system less than the required feet
from the may increase the risk of pollution.
Neighbor/Tenant—Print Name:
Neighbor/Tenant-Signature: Date:
Septic:Variance Application lte'415ed lanutiry 2021
hftps;Hmail.google.comtmail/u[01#inbox/FMfcgzGkZssgQZmdWokpfXZvkvrQJGKr?projector--1&message Pa rtld=0.2 1/1
PLEASE 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:
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Septic Variance Application Revised January 2021
AUTHORIZATION' AND SiGNATURC 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: as agent regarding the Septic Variance for
Site Address:
Tax Map t1:
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 Hoard 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: R� �J �' �N�iT�� � J F-
OWNER—SIGNATURE:_ rr i� cf1�G�-�� i DATE: rt �•
AGENT—PRINT NAME: 1►� 5
.AGENT SIGNATURE: q _- -_ _ __�. DATE;:
Septic Va tanxe Applicattart Rent r 7sn"ary 2021
<NEWYOW , Adirondack
EaF
aRTurrI.TY Park Agency
KATHYHOCHUL TERRY,MARTIN-0
Governor Executive Director
October 5, 2021
Dave Hatin
Director, Building & Codes
Town of Queensbury D
742 Bay Rd
Queensbury, NY 12804 oCT p 5 2021
Re: LV2021-0098 OF QUEENSBURY
Variance Application: Sinatra 70gUW)ING&C�p�S
Town Resolution: BOH.55, 2021
Tax Map Number: 227.9-1-4
Dear Dave Hatin:
Adirondack Park Agency staff review of the above referenced variance determination
-has been completed. The applicant proposes to replace an on-site wastewater
treatment system. Relief is required from the Town building and property line setbacks.
Based on the information presented in the record, no further Agency review is required
for this variance since the project does not involve.provisions of the Adirondack_ Park
Agency Act.
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
-O(olB . 207-
1
RESOLUTION APPROVING FRANK SINATRA'S APPLICATION FOR
SANITARY SEWAGE DISPOSAL VARIANCES
RESOLUTION NO.: BOH 55,2021
INTRODUCED BY: Mr. George Ferone
WHO MOVED ITS ADOPTION
SECONDED BY: Mr.Timothy McNulty
WHEREAS, Frank Sinatra(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 1' from the property line in lieu of the required 10' setback;
2. absorption bed to be 3' from the property line in lieu of the required 10' setback;
3. force main to be 3' from the property line in lieu of the required 10' setback;
4. . absorption bed to. be 12' from the building.foundation in lieu of the required 20'
setback; and
5. septic tank to be 6' from the building foundation in lieu of the required 10' setback;
on property located at 105 Rockhurst 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, September 27`h,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 Frank
Sinatra 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 1' from the property line in lieu of the required 10' setback;
2. absorption bed to be 3' from the property line in lieu of the required 10' setback;
3. force main to be 3' from the property line in lieu of the required 10' setback;
4. absorption bed to be 12' from the building foundation in lieu of the required 20'
setback; and
5. septic tank to be 6' from the building foundation in lieu of the required 10' setback;
on property located at 105 Rockhurst Road in the Town of Queensbury and bearing Tax Map No:
227.9-1-4, 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
• R
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 270'day of September;2021,by the following vote:
AYES : Mr. Freer,Mr. Ferone,Mr. McNulty,Mr. Metivier
NOES : None
ABSENT: Mr. Strough