SEP-0040-2022 �► SEPTIC VARIANCE Office Use Only
-7
Permit
APPLICATION Permit Fee:$ i oo
rown dr(L&!3s-H17:
Invoice#: q✓
742 Bay Road,Queensbury,NY 12804
P:518-761-8256 www.gueensbury.net Approvals:
Submittal: 1 (one) original & S copies of the completed application package
PLEASE PRINT LEGIBLY OR TYPE, PLEASE INCLUDE AN EMAIL
Section 1:
Contact Information:
Property Owner(s): Steven Cardona uJ } 0 ner's Agent: Environmental Design Partnership LLP
Address: 17 Honeysuckle Lane E dress: 900 Route 146 Clifton Park NY 12026
N co
Lake George NY 12845 W O
00 UJ 06
Phone#: 518-365-7013 ® one#: 518-371-7621
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Email: smcardona63@gmail.com V 1L z� ail: dmacelroy@edpllp.com,cdemyer@edpllp.com
Section 2: �.
Site Information:
Site Address: 17 Honeysuckle Lane Tax ID#: 226.19-1-23,24,25
Directions to Site: From 9L turn onto Assembly Point Road,Turn left onto Sunset Lane,Right.onto Honeysuckle,site will be
on the left.
Section 3:
Distance from well on property to septic system (if applicable) 68' feet
Section 4:
Is it possible to install a conforming septic system on this property? ❑Yes X❑ No
If YES, please explain and attach a diagram:
Section 5:
Does the proposed system meet setback requirements for distance from wells &septic systems on neighboring
properties? ❑X Yes ❑ No If NO, please explain:
Section 6:
Is the proposed system to be installed under a parking area? ❑Yes ❑X No
Section 7:
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 ZOO ft.): V-1:WASTEWATER ABSORPTION FIELD TO WELL 68'REQUESTED VS THE 100'REQUIRED
V-2:TANK TO FOUNDATION T REQUESTED VS.THE 10'REQUIRED
V-3:WASTEWATER ABSORPTION FIELD TO FOUNDATION 10'REQUESTED VS.THE 20'REQUIRED
Septic Variance Application V-4:WASTEWATER ABSORPTION FIELD TO PROPERTY LINE S REQUESTED VS.THE 10'REQUIRED
Section 8:
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 Mary Munhall
Address 4 Pine Tree Lane
Tax Map ID 226.19-1-34
South Name Michael Kelly
Address 5 Honeysuckle Lane
Tax Map ID 226.19-1-11
East Name Tara Pipikis
Address 20 Honeysuckle Lane'
Tax Map ID 226,19-2-32
West Name 'Laura McNeice
Address 8 Chestnut Lane
Tax Map ID 226.19-1-22
Section 9:
OWNER STATEM ENT
I/We do hereby relieve the Town of Queensbury from any liabilities on the plumbing and septic system located at:
17 Honeysuckle'Lane. I/We realize that putting the well, septic tank or leaching system less than the required 100' feet
from the on site well may increase the risk of pollution.
Owner—Print Name:
Owner—Signature: Date:
Section 10•
NEIGHBOR OR TENANT RELEASE STATEMENT(if applicable)
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.
Neighbor/Tenant—Print Name:
Neighbor/Tenant-Signature: Date:
Septic Variance Application Revised December 2021
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 December 2021
�4
Section 11:
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: Steven Cardona
Des ign ate s:Enviromtiental Design Partnership as agent regarding the Septic Variance for Steven Cardona
Site Address: 17 Honeysuckle-Lane
Tax Map#: 226.19-1-23,24,25
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: 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: ��iL�l /trite
OWNER—SIGNATURE: DATE:
AGENT—PRINT NAME: Environmental Design Partnership
AGENT—SIGNATURE: DATE: A119,Z2P
Septic Variance Application Revised December 2021
RESOLUTION APPROVING STEVEN CARDONA'S APPLICATION FOR
SANITARY SEWAGE DISPOSAL VARIANCE AND EXTENSION OF
TIME TO COMPLETE WASTEWATER SYSTEM IMPROVEMENTS
RESOLUTION NO.: BOH 13,2022
INTRODUCED BY: Mr.Timothy McNulty A�
WHO MOVED ITS ADOPTION a � �
SECONDED BY: Mr.Anthony Metivier
WHEREAS, Steven Cardona(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 system with certain of its components to be located as follows:
1. Wastewater Absorption Field to be 68' from the well instead of the required 100'
setback;
2. Tank to be 8' from the foundation instead of the required 10' setback;
3. Wastewater Absorption Field to be 10' from the foundation instead of the required
20' setback; and
4. Wastewater Absorption Field to be 5' from the property line instead of the required
10' setback;
on property located at 17 Honeysuckle 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 request on Monday,February 28t`,2022, and
WHEREAS, the Town Clerk's Office has advised that it duly notified all property owners
within 500 feet of the subject property, and
WHEREAS, Town Code Chapter 137 requires inspection of Onsite Wastewater
-APPOP ;- k
Treatment Systems (OWTS) prior to the sale of certain real property and provides that a $2,000
escrow deposit will be forfeited to the Town in the event that completion of a wastewater
treatment system meeting all standards is not completed within the time provided as established
by Chapter 137, and
WHEREAS, a change of deed for the Applicant's property occurred on or about
November 21, 2021 and when the required property transfer septic inspection took place, it was
found that the existing wastewater system was deficient; however, the proposed new system is
not able to be completed within the required six (6) month time period due to the time of year
and timing of permitting, and
WHEREAS, the Applicant has therefore applied for a timeline extension or until July 19",
2022 to install the system and to extend the date on which the $2,000 escrow deposit he
previously deposited with the Town shall be automatically forfeited to the Town, and
WHEREAS, the Acting Director of Building and Codes Enforcement has recommended
Town Board approval of this requested extension,
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 Steven
Cardona for variances from the Sewage Disposal Ordinance to install a replacement wastewater
system with certain of its components to be located as follows:
1. Wastewater Absorption Field to be 68' from the well instead of the required 100'
setback;
2. Tank to be 8' from the foundation instead of the required 10' setback;
3. Wastewater Absorption Field to be 10' from the foundation instead of the required
20' setback; and
4. Wastewater Absorption Field to be 5' from the property line instead of the required
10' setback;
on property located at 17 Honeysuckle Lane in the Town of Queensbury and bearing Tax Map Nos:
226.19-1-23, 24,25, and
BE IT FURTHER,
RESOLVED, that such variances are contingent upon the well and water supply located on
the premises having a working UV disinfection system at all times, and
BE IT FURTHER,
RESOLVED, that the Local Board of Health further authorizes and grants the Applicant
additional time to obtain a certificate of compliance from the Town's Building and Codes
Enforcement Office as set forth in Chapter 137 to complete installation of the replacement
wastewater system and extends the date on which the $2,000 escrow deposit the Applicants
previously deposited with the Town be automatically forfeited to the Town until July 19`h, 2022
u;
and authorizes and directs the Building and Codes Enforcement Office to take any and all actions
necessary to effectuate the terms of this Resolution, and
BE IT FURTHER,
RESOLVED, that the Town Board authorizes and directs the Town Clerk to forward by
certified mail a certified copy of this Resolution to the Adirondack Park Agency for its review, and
BE IT FURTHER,
RESOLVED, that this approval Resolution shall not be effective until 30 days after such
notice to the Adirondack Park Agency and shall be subject to any lawful action by the Adirondack
Park Agency during such period.
Duly adopted this 281h day of February, 2022,by the following vote:
AYES: Mr. Ferone, Mr. McNulty,Mr. Strough,Mr. Metivier,Mr. Freer
NOES: None
ABSENT:None
SEPTIC DISPOSAL PERMIT Office Use Only
APPLICATION Permit#: P-tea• ?�El?�- _
7ewn caFfj+Jiensbtuv; Permit Fee:$ �5
Invoice#: �2
742 Bay Road,_40eeiisbury,NY 12804
P:518-161.8256 www:gueensburv.net Septic Variance? N fj0t_� LL5 Zb21a_
Flood Zone? Y , N
Wetlands? Y Reviewed By-
project Location: 17 Honeysuckle >
Tax Map #: 226.19-1-23.2425 �oZr�
JUN p b
RESIDENCE INFORMATION: OF a IEENSBURY
Year Built Gallons #of bedrooms: X gallons per =total daily flow TOWN CODES
per day bedroom G 6e'r� Yes No
1980 or older 150 Installed? (choose one) ❑ 0
1981-1991 130 Spa or Hot Tub Yes No
Installed? (choose one) ❑ 0
1992-Present 110 3 110 330
PARCEL INFORMATION:
Topography ❑ Flat Rolling ❑ Steep Slope 10 % Slope
Soil Nature R Sand ❑ Loam ❑ Clay ❑ Other, explain:
Groundwater At what depth? 24"
Bedrock/Impervious material At what'depth? >24"
Domestic Water Supply ❑ Municipal 0 Well ❑Lake
(if well or lake, water supply from any septic system absorption is
68'
Percolation Test Rate: r,7 per minute per inch (test to be completed by a
licensed engineer/architect)
PROPOSED SYSTEM INFORMATION:
Tank size 1,250 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: ELJENGSFDistributionTrenches
Holding Tank System Total required capacity? ; tank size ;
# of tanks
Septic Application Revised April 2021
�r
r CONTACT INFORMATION: PLEASE PRINT LEGIBLY OR TYPE, PLEASE INCLUDE AN EMAIL
• Applicant:
Name(s): Sleven Cardona
Mailing Address, C/S/Z: 17Nnnevsuckle 1_ane
Cell Phone: 515-365-7013 Land Line:
Email: smearduna63Cn�emaii.com
• Primary Owner(s):
Name(s):
Mailing Address, C/S/Z:
Cell Phone: Land Line:
Email
0 Check if all work will be performed by property owner only
• Contractor:
Contact Name(s):
Contractor Trade:
Mailing Address, C/S/Z:
Cell Phone: Land Line:
Email:
"Workers' Comp documentation must be submitted with this application"
• Eneineer(s):
Name(s): Environmenial Design ParuiershipLLP
Mailing Address, C/S/Z: 900 Route 146 Clifton Park NY 12065
Cell Phone:518-371-7621 Land Line:
Email: dmacelroy@edpllp.com cdemver@edpllp.coJn
Contact Person for Compliance in regards to this project: bSA0 ,% t�1u�c.�'1vo•�
Cell Phone: 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: ,_5;ryerd 61TOOAIGiZ
SIGNATURE: .�� � � DATE: ^3-�
Septic Application Revised April 2021
ENVIRONMENTAL DESIGN
PARTNERSHIP, LLP. 900 Route 146 Clifton Park,NY 12065
(P)518.371.7621 (17 518.371.9540 edplip.com
Shaping file physical environment
February 8, 2023 -bc—IP 202?,
Town of Queensbury Building &Codes
ITOWN
� � oWE742 Bay RoadQueensbury, NY 12804 FEB 0 8 29123Attn: John O'Brien, Director OF QUEENSSURYLDING& CODES
Re: Cardona Residence—17 Honeysuckle Lane
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 Cardona Residence
17 Honeysuckle Lane, Town of Queensbury c
January 14, 2022
Sheet 1- Cover Sheet
Sheet 2- -Existing Conditions
Sheet 3- Site Plan
Sheet 4- Wastewater Details
During the course of construction Environmental Design Partnership LLP was on the job site to observe key
components of the system installation on June 30, 2022. 1 have provided an 'as-built' plan which indicates
the system component locations, in accordance with the approved BOH variance and Town plans.
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: