SEP-0753-2021 hk SEPTIC VARIANCE Office Use Only
Permit#:
APPLICATION Permit Fee:S ,loot)
Ti,Hm �1'(Zerrishur� 428�+Invoice#:�-
742 Bay Road,Queensbury,NY 12804
P:518-761-8256 wvWw.nueensburymet Approvals:
41
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Submittal: 1 (one)original&8 copies of the completed application package
Contact Information: PLEASE PRINT LEGIBLY OR TYPE, PLEASE INCLUDE AN EMAIL
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Property Owner's): Lamberts Landing LLC Owner's Agent: Hutchins Engineering PLLC
Address: 28 Garrison Road Queensbury, NY 12804 Address: 169 Haviland Rd Queensbury,NY 12804
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703.-932-1753 Brodie Freer 518-745-0307
Phone#: ( ) Phone#: �
brodie0007@gmaii.com tutchins@hutchinsen ineerin com
Email: 9 Email: g g
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Site Information:
Site Address: 117 Rockhurst Road Tax ID#: 227.9-1-8
Directions to Site: last property north end of Rockhurst
Distance from well on property to septic system(if applicable) NSA feet
Is it possible to install a conforming septic system on this property? ❑Yes Z 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 ❑No If NO, please explain:
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.):
Absorption field setback to East lake: propose 57' instead of required 100'
Absorption field setback to West lake: propose 59' instead of required 100' �"' n E
Grinder pump setback to lake: propose 25' instead of 50' D E �Vf
OCT 3 2021
TOWN OF QUEENSB CRY
N N r.1'• -
Septic Variance Application -: Revised January 2021
List the names, parcel addresses, and tax map numbers of all adjoining property owners, You may obtain this
info'rr'nati'ora.ffer ',th,e.To}vn'of'Queensbury's Assessor's Office:
North Naniey�Lake George
Address
Tax Map ID
South Name Lorraine Dickinson /Carl&Michele Weiner
Address 238 Vaughn Rd Hudson Falls, NY 12839 /P.O. Box 2516 Briarcliff Manor, NY 10510
Tax Map ID 227.9-1-7 /227.9-1-9
East Name Lake George
Address
Tax Map ID
West Name Lake George
Address
Tax Map ID
OWNER STATEMENT
1PA+e do hereby relieve the Town of Queensbur y Fromm any liabilities on the plumbing and septic system located at:
117 Rockhurst Road
I/We realize that putting the well,septic tank or leaching system less than the required 100 feet
from the lake may increase the risk of pollution.
Owner—Print Name: Brodie Freer
Owner—Signature:_G�28 Fi2" Date: 10/1/21
NEIGHBOR OR TENANT RELEASE STATEMENT(if applicable)
ONe 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 Flame;
Neighbor,/Tenant-Signature: Date:
Septic Variance Application. Revised January 2021
AUTHORIZATION AND SIGNATURE PAGE
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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.
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Complete the following if the OWNER is using an Agent:
Owner's Name: Lamberts Landing LLC
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Designates; Hutchins Engineering PLLC as agent regarding the Septic Variance for
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Site Address; 117 Rockhurst Road
Tax Map#: .
227.9-1-8
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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 I
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 I
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: Brodie Freer for Lamberts Landing LLC
OWNER—SIGNATURE:_�26 �2�Qi2. DATE; 10/1/21
ANENT—PRINT NAME: G.Thomas Hutchins, P.E.
AGENT—SIGNATURE: DATE:
Septic Va•i 3 nce r.p pli c at!on Revised J a marl 2021
L4NEWYORK Adirondack
STATE Of
OPPORTUNITY- Park Agency
KATHY HOCHUL TERRY MARTINO
Governor Executive Director
November 17, 2021
Dave Hatin
Director, Building & Codes
Town of Queensbury
742 Bay Rd
Queensbury, NY 12804
Re:, LV2021-0114
Variance Application: Lamberts Landing LLC
Town Resolution: BOH 69,2021
Tax Map Number: 227.9-1-8
Dear Dave Hatin:
Adirondack Park Agency staff review of the above referenced variance determination
has been completed. The applicant proposes to replace an existing non-conforming
onsite wastewater treatment system with a new Enhanced Treatment Unit. Relief is
required from the Town 100-foot shoreline setback for the leach field and 50-foot
shoreline setback for the grinder pump. The existing leach field is approximately 40-feet
from the shoreline at its closest point, the proposed system was 57 feet from the
eastern shoreline and 59 feet from the western shoreline of the property.
It is noted that, in agreement with the applicant, the ZBA conditioned the variance upon:
1. Absorption Field to be 62 feet from Lake George (east) instead of the required
100 foot setback;
2. Absorption Field to be 62 feet from Lake George (west) instead of the required
100 foot setback;
3. Grinder Pump to be 25 feet from Lake George instead of the required 50 foot
setback; and
4. Effluent will receive ultraviolet treatment prior to discharge to the Absorption
Field.
Based on the information presented in the record, the Agency respects the findings of
the Local Board of Health and no further review of this variance is required.
P.O. Box 99•1133 NYS Route 86•Ray Brook, NY 12977•Tel:(518)891-4050-www.apa.ny.gov
Mike McCabe
LV2021-0114
Page 2
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
2
RESOLUTION APPROVING LAMBERTS LANDING, LLC'S
APPLICATION FOR SANITARY SEWAGE DISPOSAL VARIANCES
RESOLUTION NO.: BOH 69,2021
INTRODUCED BY: Mr.Anthony Metivier
WHO MOVED ITS ADOPTION
SECONDED BY: Mr. George Ferone
WHEREAS, Lamberts Landing LLC (Applicantl) filed an application for variances from
provisions of the Town of Queensbury On-Site Sewage Disposal Ordinance, Chapter 136 to install
a wastewater treatment system with components of it proposed to be located as follows:
1. Absorption Field to be 62' from Lake George (east) instead of the required 100'
setback;
2. Absorption Field to be 62' from Lake George (west) instead of the required 100'
setback; and
3. Grinder Pump to be 25' from Lake George instead of the required 50' setback;
on property located at 117 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,November 1", 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
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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 Lamberts
Landing, LLC for variances from the Sewage Disposal Ordinance to install a wastewater treatment
system with components of it to be located as follows:
1. Absorption Field to be 62' from Lake George (east) instead of the required 100'
setback;
2. Absorption Field to be 62' from Lake George (west) instead of the required 100'
setback;
3. Grinder Pump to be 25' from Lake George instead of the required 50' setback; and
4. Effluent will receive ultraviolet treatment prior to discharge to the Absorption Field;
on property located at 117 Rockhurst Road in the Town of Queensbury and bearing Tax Map No:
227.9-1-8, 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
C
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 1"day of November,2021,by the following vote:
AYES Mr. Strough, Mr. Metivier,Mr. Ferone,Mr. McNulty
NOES : None
ABSENT: Mr. Freer
SEPTIC DISPOSAL PERMIT Office Use Only
/. .'. APPLICATION Permit#: 2&P-0��5-Zd21
Town of CLucens ury
Permit Fee:$
Invoice#:
742 Bay Road,Queensbury,NY 12804
P:518-761-8256 www.gueensbury.net Septic Variance? N 69, 2021
Flood Zone? Y
Wetlands? Y Reviewed By: �
Project Location: 117 Rockhurst Road E 9
�,
Tax Map#: 227.9-1-8 OCT 2 6 2022
RESIDENCE INFORMATION: OF QUEENSBURY
Year Built Gallons #of bedrooms: X gallons per =total d ily flo\BUl DING
per day bedroom a Yes No
1980.or older 150 Installed? (choose one) ❑ 56
1981-1991 130 Spa or.Hot Tub Yes No
1992-Present 110 Installed? (choose one) ❑ [�
5 110 550
PARCEL INFORMATION:
Topography Flat Rolling ❑ Steep Slope % Slope
Soil Nature Sand ❑ Loam ❑ Clay Other, explain: silt, Cobbles
Groundwater At what depth? >78"
Bedrock/Impervious material At what depth? > 78"
Domestic Water Supply ❑ Municipal ❑ Well RILake
.(if well or lake, water supply from any septic system absorption is
50
Percolation Test Rate: 1-5 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 Fujiclean Cen=7 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: w/34"wide traffic rated open-bottom gravelless chambers
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): Brodie Freer
Mailing Address, C/S/Z:
Cell Phone: 703-932-1753 Land Line:
Email: brodie0007@gmail.com
• Primary Owner(s):
Name(s): Lamberts Landing LLC
Mailing Address, C/S/Z: 28 Garrison Road Queensbury, NY 12804
Cell Phone: 703-932-.1753 Land Line:
Email: brodie0007'agmail.com
❑ Check if all work will be performed by property owner only
• Contractor:
Contact Name(s): Ellsworth&Son Excavating
Contractor Trade: Excavation/ Installation
Mailing Address, C/S/Z: 76 Ellsworth Lane Ext. Lake George NY 12845
Cell Phone: Land Line: (518)792-9246
Email: digging ,ellsworthexcavating.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: thutchins@hutchinsengineering.com
Contact Person for Compliance in regards to this project: Tom Hutchins& Ruben Ellsworth
Cell Phone: Land Line: 518-745-0307/518-792-9246
Email: thutchinslahutchinsengineering.com digging@ellsworthexcavating.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: G.TMomas Hutchins AG !T
SIGNATURE:
i� DATE: 10/26/22
Septic Application Revised April 2021
TOWN OF QUEENSBURY
742 Bay Road, Queensbury, NY. 12804-5902
Septic System Checklist
9/1plan to scale
Lt',/�Recelved
Deep hole perc test results from engineer/Architect if applicable(Town Approved Engineers and
44Arcch�hitects;June 30 to April 15 Town Engineer for unapproved Engineers and Architects)
/ All wells on property and adjacent properties shown u..7qzz
%water line shown Municipal or well 10'separation to any part of system
I(Setback to property lines show 10'or more for any part of system
eptic tank and pump stations 10'from foundation 50'from lake/ etland 10'from any waterline
�beptic 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)
6eptic tank sized for number of bedrooms and add 250 gals for Jacuzzi tubs/garbage grinder each
Leech Field 20'from foundation 100'from any w 0'from water line
�kseepage pit 150'from well 50'from septic tank
tiSeepage Pits 3-times diameter apartMA '
Septic tank and pump stations over 30 gallons S from watercourse or wetland
Zdistance from bottom of trench or system 24"to bedrock or mottlin 6"within 1000'of Lake George
Leech field 100'from watercourse or wetland 56C—
Toe of mound or bottom of retaining wall 10'from property line 100'from well 20'from
�/� Foundation
(f� Provide'Engineer/Architect stamp for bed or design systems
P A Department of Health Approval for all mobile home park new systems Flood Plain requirements
2'above established flood elevation to bottom of system
WAll tanks anchored or 2'above flood elevation
pnaienA d/tG/�M1
SERVICE CONTRACT
FOR THE
FUJI CLEAN TREATMENT TECHNOLOGY
Ellsworth&Son Excavating,-Inc.-has-been-contracted by-Fuji-Clean-USA-and•theirAuthorized--Distributorto-provide
you with the flrsttwo years of service,maintenance,and operation as well as any warranty service should It be required.
This contract has been paid in full on your behalf. This contract is provided in accordance with applicable state and
local regulations.
This contract, entered into between Ellsworth&Son Excavating, Inc. and Lam'ai to t�dtntl n `shalt be binding upon
both parties In accordance with the conditions and terms set forth below:
Contract.Date:. 1. I22
Term of Contract: 2 years
Location of Technology:property address: 117 Rockhurst Road,Queensbury,NY 12804
Model: Fujiclean CE5
Maintenance and Other Services shall consist of:
a. -Inspection,-Maintenance;and-Operation:Service Provider-agrees-to-inspect;maintain and-operate the Fuji-
Clean treatment system per the TN DEC and manufacturer's requirements.This includes but is not limited
to the following:
two service visits per year (6-month intervals). Service visits will include performance of
operation and maintenance activities detailed in the Operation and Maintenance manual;
check the sludge depth to determine the need for pumping;
inspection of the final effluent to determine proper operational performance;and
test the process parameters including but not limited to DO,pH,and turbidity to maintain proper
.-operation;
b. Service Calls:Service Provider will provide services calls within two business days, Service Provider will
apply a charge for labor,travel time and shipping for any necessary replacement parts unless covered by
the manufacturer's warranty_
c. Completed inspection form will be submitted to local and state authorities as required.
d. Contract is transferable in the event of sale of the home.
The owner of the system agrees to use the system as outlined in the owner's manual.The owner also understands that
any abuse of the system may void the manufacturer's warranty.
Owner acknowledges that the following items can overtax the biological process of the system and shall avoid
introducing dental floss,disposable diapers, kitty litter,sanitary napkins,tampons,cigarette butts,condoms and other
items of similar nature.Owner acknowledges that the following can destroy the biological process and agrees to not
Introduce chemicals such as paints,varnishes,thinners,waste oils, photographic solutions, pesticides and excessive
amounts of household chemicals into the system.The owner acknowledges that violation of these terms will void the
manufacturer's warranty and,d may be In violation ofstate law.
Homeowner. "(AAuthodze9Yge'hf--"
-DateService ProvideDate " �� 22.—�`
Please sign and return to the Service Provider whose name and address appear below:;
Ellsworth&Son Excavating, Inc —Q" 0'c5�� 2-02-1
9030Z'Stat®'Route-1-48 D 2 � � n nn
Fort Ann, NY 12827 IS U 1!'/
DEC 1-2 zozz
TOWN OF QUEENSBURY
BUILDING& CODES