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SEP-0661-2021 Office Use Only .. SEPTIC VARIANCE Z i. l Permit#:_ — O Io1 '� 1 APPLICATION , Permit Fee:$ 15 Torrn.efCZimmburq Invoice#: � 4 742 Bay Road,Queensbury,NY 12804 Approvals: P:518-761-8256 www.aueensburv.net SubmIttak 1 jonel original&8 copies of the completedapp[Is:ation package Cbntact Information:. PLEASE PRINT LEGIBLY OR TYPE, PLEASE INCLUDE AN EMAIL PropertyOwner(s): vinantoweili Owner's Agent:• Environmental Design Partnership Address-• 24 Lakewood Drive Saratoga Address' 900 Route 146 Clifton Park NY, Springs NY,12866 12065 Phone#: K—RA-t Wo5 Phone#: 518-371-7621 Email: annyoneim4 ftw1cwm Email: d=cpI oy@edpllp.com(Dennis Mapelroy) cdemyer@edpllp.com(ConnorDeMyer) Site information: Site Address: 85PilotKnob ID#:227.18-1-13.16 Directions to Site' From 91,turn onto Pilot Knob Road,85 Pilot Knob 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 0 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 ❑No If NO,please explain: Is the proposed system to be Installed under a parking area? Q Yes 0 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-1:2"Forcemain to Property Line:2'requested vs the 10'required TOWN OF OUECNSEURY BUILDING CODES Septic VarianceApplication Revised January 2021 -AUTHORIZATION AND SIGNATURE 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: : tt4c_STS Tim'R rlV1►f`1' : _� L�11�1LL, . Designates: as agent regarding the,Septic Variance for Site Address: Tax Map#: 2Z-7. m 1--15 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. r 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 re quirements.and completed checklist: OWNER—PRINT NAME: 1� =N� �• ► 1L�- OWNER-=SIGNATURE: DATE: 9 :4 2 AGENT--PRINT NAME:��r4 ti K&`c'2L2C DATE- AGENT—SIGNATURE 2b -3-Z1 Revised January 2021 Septic Variance Application 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 craigcoodman .. Address 95 Piloi Knob Road Tax Map ID 227.18-1-21 South Name T6omasvatentinb Address 83CPiiot Knob Road .Tax Map ID 227.18-1-12 East_ Name Zoom=Kubricky' Address 99 Not Knob Road- Tax Ma ID. P_ zzzls-l-ls ' WORTH Name nomasUncher Address 14 Hickok Place Tax Map ID 2V.18-1-17 OWNERSIAIEMENI 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: Owner—Signature: Date: t l Z NOGHBORORIENANTRELEASESTAIEMENT Vappfxahk) I/We do hereby relieve the To 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/Tenant-Signature: Date: Revised January 2M1 Septic Variance Application PP ENVIRONMENTAL DESIGN PARTNERSHIP, LLP 900 Route 146 Clifton Park,NY 92055 ;\ coo (P)518.371.7621 (F)518.371.9540 edpllp.com Shaping the physical environment September 7, 2021 Town of Queensbury Board of Health 742 Bay Road Queensbury, NY 12804 Attn: John Strough,Supervisor Re: Rubrecht-33 Honeysuckle Lane Markert—390 Cleverdale Road O'Neill—85 Pilot Knob Road BOH Variance Request Dear John: Submitted for your distribution and review are nine sets each of three(3) Board of Health wastewater system variance applications. Each property is a single family residence located in the Lake George waterfront zoning district(WR). The following summarizes each of the properties and associated variance requests. Rubrecht—33 Honeysuckle Lane This property was before the BOH previously (Feb. 2021) and received necessary variances for an onsite system using an ETU and pumped, pressurized dispersal to an absorption field. The Owner obtained construction estimates from local contractors and decided against this option due to what he felt was too great an expense. He is now opting for a holding tank system. In addition to a variance for the use of holding tanks,variances are required for separation distances to a neighboring well. Markert—390 Cleverdale Road This property is a small lot out near the north end of Cleverdale. It is approximately 5,000 sf in size with no more than 86' in depth (road side to shoreline). The existing field is approximately 35'from the fake. We are proposing an ETU system with a pumped, pressurized dispersal field. The associated treatment tanks are between the house and the road and the field is in the northwest corner. Numerous variances are required due to the standard setbacks to property line and to the dwelling. The more significant variance is the shoreline setback to the absorption field. O'Neill—85 Pilot Knob Road This property is currently on a holding tank system. At the time of that BOH approval (2014)the O'Neills didn't have enough suitable land to have use of an onsite absorption field. Recently they were able to obtain additional contiguous land in which to'propose a new absorption field area. The system will require pumping up to the new field located approximately 325'.from the lake. A variance is required as the required force main piping will need to be installed in an area that is less than the required 10'from a property line. s John Strough ENVIRONMENTAL DESIGN PARTNERSHIP, LLP. September 7, 2021 Shaping the physical environment Page 2 I am available to meet with you and/or other Board members to further discuss these proposals prior to the public hearing. Thank you for your consideration of these requests. Sincerely, Dennis MncElroy Dennis MacElroy, PE Environmental Design Partnership Attachments - -Cc: Dave Hatin Roger&Joyce Rubrecht John & Peg Markert Vince&Army O'Neill 900 Route 146 Clifton Park,NY 12065 2 (P)518.371.7621 (F)518.371.9540 edpllp.com I l Adirondack STATE OF TA7F OF 9P1'ORTUHITY- Park Agency KATHY HOCHUL TERRY.MARTINO Governor Executive Director Ze? Q kA 4 - 20 2A October 14, 2021 �T►. Dave Hatin Director, Building & Codes Town of Queensbury OCT 742 Bay Rd T 5 20Z� Queensbury, NY 12804 O N OF eUILDIIVNU 81vSeURY Re: LV2021-0105 & cot`S Variance Application: O'Neill Town Resolution: 1301-159,2021 Tax Map Number: 227.18-1-13 & 227.18-1-16 Dear Dave Hatin: Adirondack Park Agency staff review of the above referenced variance determination has been completed. The applicant proposes to install a force main. Relief is required from the Town property line setback. 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 REBXOK 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 �Q�00-2021 RESOLUTION SETTING PUBLIC HEARING ON SEWAGE DISPOSAL VARIANCE APPLICATION OF VINCENT O'NEILL RESOLUTION NO.: BOH 52,2021,2021 INTRODUCED BY: Mr. George Ferone WHO MOVED ITS ADOPTION 'KIL� C;0py,® SECONDED BY: Mr. Anthony Metivier WHEREAS, the Queensbury Town Board serves as the Town's Local Board of Health and is authorized by Town Code Chapter 136 to issue variances from the Town's On-Site Sewage Disposal Ordinance, and WHEREAS, Vincent O'Neill (Applicant) has applied to the Local Board of Health for a variance from Chapter 136 to install a force main 2' from the property line in lieu of the required 10' setback on property located at 85 Pilot Knob Road in the Town of Queensbury, NOW, THEREFORE, BE IT RESOLVED, that the Town of Queensbury Local Board of Health will hold a public hearing on Monday, October 0', 2021 at 7:00 p.m. at the Queensbury Activities Center, 742 Bay Road, Queensbury, to consider Vincent O'Neill's sewage disposal variance application concerning property located at 85 Pilot Knob Road in the Town of Queensbury (Tax Map No.: 227.18-1-13; 227.18-1-16) and at that time all interested persons will be heard, and BE IT FURTHER, RESOLVED, that the Local Board of Health authorizes and directs the Queensbury Town Clerk to publish the Notice of Public Hearing presented at this meeting and send a copy of the Notice to neighbors located within 500 feet of the property as required by law. Duly adopted this 13"' day of September, 2021, by the following vote: AYES : Mr. Freer, Mr. Ferone,Mr. McNulty, Mr. Strough,Mr. Metivier NOES None ABSENT:None 41. SEPTIC DISPOSAL PERMIT office use only APPLI Is Permit#: 56�--© 20 Z I Town of Queensbury D S 5 i Permit Fee:$ pEC 06 Z021 Invoice#: Z)iA 742 Bay Road,Queensbury,NY 12804 P:518-761-8256 www. ueensbu .ne OF QVEE�SB CRY Septic Variance? OY N PnH 5Z, 2d a( TGgUG&CdDF 1LD1N C� Flood Zone? Y Wetlands? Y Reviewed Project Location: g'� ��d, �-to� }�Z�_ Tax Map #: 227_18-1-i3 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) ❑ 1981-1991 130 Spa or Hot Tub Yes No 1992-Present 110 Installed? (choose one) ❑ [✓]� PARCEL INFORMATION: Topography ZFlat Rolling ❑ Steep Slope % Slope Soil Nature Zsand ❑ Loam ❑ Clay ❑ Other, explain: Groundwater At what depth? > 3' Bedrock/Impervious material At what depth? Domestic Water Supply ❑ Municipal ❑ Well ',Lake (if well or lake, water supply from any septic system absorption is 33 ,5tft.) Percolation Test Rate: 5 per minute per inch (test to be completed by a licensed engineer/architect) PROPOSED SYSTEM INFORMATION: Tank size 3000 gallons (min. size 1,000 gallons, add 250 gallons for each garbage cylinder or spa/hot tub 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: Fi..J£M G5*F Holding Tank System Total required capacity? ; tank size ; # of tanks . 7 Septic Application Revised April 2021 r CONTACT INFORMATION: PLEASE PRINT LEGIBLY OR TYPE, PLEASE INCLUDE AN EMAIL • Applicant: Name(s): %t-LCV_7 Ar- ®1-4y-ALL. Mailing Address, C/S/Z: 7- �} Cell Phone: 51$ 3Coq - 1-7605 Land Line: � 1o1Q Email: • Primary Owner(s): Name(s): s�1�E 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): Contractor Trade: Mailing Address, C/S/Z: (Q3 Cell Phone: 518 -TO—!ot� Land Line: 45i18 -793-g=>LM 5 Email: _c.hr��c.«�ya�l1 c�m &,5Ty.. Q10 .C,a,f111 **Workers' Comp documentation must be submitted with this application** • Engineer(s)• Mailing A ess, C/S/Z: ctdC> 1 • JoA(az Cell Phone: 51& 5-7(g­A* $5 Land Line: 151f5 7`12_—e'Zc>cf> Email: c�,rv1- Contact Person for Compliance in regards to this project: C 7_1'5 Cell Phone: 7�1`8 AA70 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: �.►1`41'��� SI _� SIGNATURE: C-01C-17 DATE:LZ ZJ-Z.J Septic Application Revised April 2021 (awTOWN OF QUEENSBURY 742 Bay Road, Queensbur�, NY. 12804-5902 Septic System Checklist '1 Plan to scale Received Deep hole pert 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 systemJ � '0—' Septic tank and pump stations 10'from foundation 50'from any well/lake/wetland 10' from any waterline N 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) YSeptic tank sized for number of bedrooms and add 250 gals for Jacuzzi tubs/garbage grinder each YLeech Field 20'from foundation 100'from any well 10'from water line Seepage pit 150'from well 50'from septic tank Seepage Pits 3-times diameter apart YSeptic tank and pump stations over 30 gallons 50'from watercourse or wetland distance from bottom of trench or system 24"to bedrock or mottl' g 36" hin 1 00' of Lake George Leech field 100'from watercourse or wetland YToe of mound or bottom of retaining wall 10'from property line 100'from well 20'from Foundation Provide Engineer/Architect stamp for bed or design systems N 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 900 Route 146 Clifton Park, NY 12065 (P) 518.371.7621 (F) 518.371.9540 edpllp.com December 28, 2022 Town of Queensbury Building & Codes 742 Bay Road Queensbury, NY 12804 Attn: John O’Brien, Director Re: O’neill Residence – 85 Pilot Knob Road Dear Mr. O’Brien: 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 O’neill Residence 85 Pilot Knob Road Town of Queensbury April 7, 2021 Sheet CS-1 Cover Sheet Sheet S-1 Existing Conditions Overall Lot Sheet S-2 Existing Conditions Residence Lot Sheet S-3 Existing Conditions Vacant Lot Sheet S-4 Wastewater Plan Sheet S-5 Wastewater Details During the course of construction Environmental Design Partnership LLP was on the job site to observe key components of the system installation culminating with the ‘start-up’ of the pump assembly and control panel system on May 27, 2022. I have provided an ‘as-built’ plan which indicates the system component locations. The pump system was tested/inspected on May 27th with the pump and alarm working as designed. The time-dose control panel was programmed for operation and the Owner was provided basic operational guidance. 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, Connor DeMyer, Project Engineer. Attachment Cc: Anny O’neill IRFIPFShedIPFIPFIPFIRFIRFIPFIPFSlateConc.Screen PorchWood DeckConcrete Crushed Stone DriveIRFConcreteCatchBasin ParkingStoneCrushedConcrete PadScreen PorchPropaneTanks A.C.DECKCellarEntryDeckPatioCrushed Stone DriveCIRFCIRFIRFConc.Porch L1L2L3L4L5L6L7IPFIPF IPFIRFConcrete17' Right o f W a y10' Right of WayOne StoryWood FrameHouseTwo StoryWood FrameHouseAdjoiningBuildingAdjoiningBuildingAdjoiningBuildingAdjoiningBuildingLands N/F ofIsabella GrantLands N/F ofThomas J. UncherLands N/F ofThomas ValentineN 02°30' 3 9 " E 60.39'263.21'N 86°58'31" WN 84°38'18" E303.83'165.46'S 84°10'00" WN 04°03'30" E9.76'N 01°55' 0 9 " E 59.81'50.55'S 86°10'00" W8041.3± Sq. Feet0.18± AcresAreaRight of Way for Ingress and Egress(Deed Reference No. 7)Crushed StoneDrive10' Right of WayWell Casing2.0'±3.5'±0.5'±WellCasingWASTEWATERPLANS-4PROPOSED WASTEWATER 85 PILOT KNOB ROAD TOWN OF QUEENSBURY APRIL 7, 2021 O'NEILL RESIDENCE WARREN COUNTY, NEW YORK TAX MAP. No. 227.18-1-13, 227.18-1-16900 Route 146 Clifton Park, New York 12065 edpllp.com(518) 371-7621 E N V I R O N M E N T A L D E S I G N P A R T N E R S H I P, L L P. IMPROVEMENTS FOR 1" = 30' WASTEWATERDETAILSS-6PROPOSED WASTEWATER 85 PILOT KNOB ROAD TOWN OF QUEENSBURY APRIL 7, 2021 O'NEILL RESIDENCE WARREN COUNTY, NEW YORK TAX MAP. No. 227.18-1-13, 227.18-1-16900 Route 146 Clifton Park, New York 12065 edpllp.com(518) 371-7621 E N V I R O N M E N T A L D E S I G N P A R T N E R S H I P, L L P. IMPROVEMENTS FORAS SHOWN