1.5 1.5
WASTEWATER-SEWER\Set PFFRollars-Absorption Field to Lane and Foundation—In APA-4-3-2023
RESOLUTION SETTING PUBLIC HEARING ON
SEWAGE DISPOSAL VARIANCE APPLICATION OF
JEANNE L. ROLLINS REVOCABLE TRUST
RESOLUTION NO.: ,2023
INTRODUCED BY:
WHO MOVED ITS ADOPTION
SECONDED BY:
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, Jeanne L. Rollins, Trustee, on behalf of the Jeanne L. Rollins Revocable Trust,
has applied to the Local Board of Health for variances from Chapter 136 to install an absorption field:
1. 16' from the foundation in lieu of the required 20' setback; and
2. 5' from the property line in lieu of the required 10' setback;
on property located at 377 Cleverdale 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, April 17t", 2023 at 7:00 p.m. at the Queensbury Activities Center, 742 Bay Road,
Queensbury, to consider the Jeanne L. Rollins Revocable Trust's sewage disposal variance application
concerning property located at 377 Cleverdale Road in the Town of Queensbury (Tax Map No.:
226.12-1-56) 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 3rd day of April, 2023,by the following vote:
AYES
NOES
ABSENT:
r
r
OPfi�U�e Only WAR Q �,r�
SEPTIC VARIANCE Peel #: nL f BURY
APPLICATION Permit Fee: s (;L'ERK S OFFICE
WOr Invoice '
74Z Bay Road. Queensbury. NY 12904
Approvals.
P. $19-761-6256 M Mrw.gueensbury.nwt
Submittal: 1 (one) original & 8 copies of the completed application package
PLEASE PRINT LEGIBLY OR TYPE, PLEASE INCLUDE AN EMAIL
Section 1•
Contact Information:
Property owner(s): .Jeanne L Rollins, Trustee owners Agent: _ Hutchins Enaineering PLLC
Address_ 3 Plover Lane Address: 169 HavRand Road
Mystic, CT 06355 Queensbury, NY 12804
Phone #_ Phone #. 518w745"0 3017
Email: Email: thutch ins 0hutChinsengineering.com
Section 2:
Site Information:
Site Address: 377 Cloverdale Road Tax ID#_ 226.12-1 -56
Directions to site-
Section 3:
Distance from well on property to septic system (if applicable) N/A feet
Section 4•
Is it possible to install a conforming septic system on this property? ❑ Yes Q No
if YES, please explain and attach a diagram:
Section 5
i
Does the proposed system meet setback requirements For distance from wells & septic systems an neighboring
properties? WYes ❑ No If No, please explain:
Section B:
Is the proposed system to be installed under a parking, area? ❑ Yes Q 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 too ft.). Absoption 'field 16' from foundation where 20' is required
Absorption field will be 5' from }property line where 10' is required
Septic Variance Apphcatinn Revised December 2021
SeC IQ 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 William Davidson
Address 387 Cieverdale Road _
Tax Map ID 226.8- 1 -1
South Name Morris Family Irrevocable Trust
Address 371 Cleverdale Road
Tax Map ID 226. 12-1 -55
East Name Peter Rienzi / Christopher Martin
Address 374 Cleverdale Rd_ / 370 & 372 Cleverdale Rd.
Tax Map ID 226A 2-1 -60 ! 226. 12-1 -61
West Name Lake George
Address
Tax Map ID
Seetlon 9:
OWNER STATEMENT
I/We do 'hereby relieve the Town of Queensbury from any Iiabilities. on the plumbing and septic system located at:
377 Cleverdale Rd . Vwe realize that putting the well, septic tank or leaching system less than the required 20 feet
from the residence may increase the risk of pollution.
Owner—Print Name; Jeanne Rollins, Trustee
Owner—Signature; r (_. S C Date: 292023
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 poflution.
Neighbor/-Tenant--Print Name
Neighbor/Tenant-Signature: Date_
SeptK vaname ARPit[atcon
Ae lsed December 2021
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f
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: Jeanne Rollins Revocable Trust
Designates: Hutchins Engineering PLLC as agent regarding the Septic Variance for
Site ,address: 377 Cleverdale Road
Tax Map M 226. 12-1 -56
Entrineerinrg 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 applicants responsibility to obtain any additional permits.
Official Meetine 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: Jeanne Rollins, Trustee �y
OWNER--SIGNATURE: L" J� f-Ir. 'e, DATE: 03/29/2023
AGENT—PRINT NAME: as Hutchins P. E.AGENT—SIGNATURE: DATE: !_ ;hq t2 2=—�''
se puc vi riance Ap ploCa DO Revived December =021
N
W
0
w
NORTHERLY ALONG THE
MEAN HIGH WATER MARK
OF LAKE GEORGE 215'f
AS IT WINDS AND TURNS
EAVES
36
RETA/N/NG
WALLS 226.8-1-1
/ LAKE WATER SUPPLY
6.0'
S86'31'00"E�"�
1.
114.16'f
I.P.F.
I j
CONCRETE
7-% STEPS
WALKWAY
SUN irowR�ATSUP l STEPS
STEPS
AN M
/ 105' TO
i�
LAKE GEORGE 34
j /b
F1
•:/ Al LEA — PORCH
/ � / co - 0. v 8z`' ACR�'S / ` „' ! /j;' 16.4
J/ ('V 0)
^
1 OU /1P-11
NT TO NEW SEPTIC TANK TO RAI l / '�
ELEVA7ION APPROXIMATELY 1 FOOT ' PT
oN
PIPED INTO NEW BUILDING
! / % /.R.F ' off i I.P.F. IN
®_____- coNCREr
/� --�
Ei /LEL. PED. / 10, �gc
//. 10' P.L. SETBACK
GENERATOR
BURIED
1 LR.F �"'® — —��_ 135.63' PROPANE
• ' / /.R.F. N84750 00' W TANK
'-
1 i • I.R.F.I - -
1 / I.R.F. IN
CONCRETE J�
• / ) LR.F IN
CONCRETE '
32 226.12-1-55 k
% / LAKE WATER SUPPLY /
STOCKADE
FENCE
F
LANDS N/F OF ,
KIMBERLY M. LARSEN AS TRUSTEE OF THE x
MORRIS FAMILY IRREVOCABLE TRUST
31 LIBER 4908 PAGE 278
WASTEWATER SYSTEM PLAN
SCALE.. 1 "=20'
GRAPHIC SCALE
10 0 5 10 20 40
( IN FEET )
CONTRACTOR TO FIELD VERIFY LOCATIONS AND DISTANCES
MAP REFERENCE:
BASE MAP INFORMATION FROM "MAP OF A SURVEY
MADE FOR JEANNE L. ROLLINS & CHARLES J.
ROLLINS," IN THE TOWN OF QUEENSBURY, WARREN
COUNTY, NEW YORK. DATED AUGUST 5, 2020.
PREPARED BY BARDIN LAND SURVEYING, P.C.
WASTEWATER SYSTEM SETBACK REQUIREMENTS
PROPERTY LINE
HOUSE
STREAM, WE,
WATERCOURSE,
WETLAND
WATERUNE
SEPTIC TANK
10'
10'
50'
10'
ABSORPTION FIELD
10'
20'
100'
10'
SITE SOILS DATA
TEST PIT
TP-1 - 3/28/2023 BY TOM HUTCHINS, P.E.
0-4" - TOPSOIL
4-26" - DARK BROWN MEDIUM AND COARSE
SAND FILL
26-52" - YELLOWISH BROWN FINE SANDY LOAM
FEW COBBLE AND BOULDERS
52-78" - MED BROWN FINE SAND W/ SOME SILT
PERCOLATION TEST
PT-1 - 312812023 BY TOM HUTCHINS, P.E.
STABILIZED PERCOLATION RATE: 6-7 MIN
GROUNDWATER 0 78"
PROVIDE 24' VERTICAL SEPARATION TO
BOUNDARY CONDITION
f F 135, TO
l LAKE GEORGE
aw
'<
226.12-1-59
�X l LAKE WATER SUPPLY
fl"� �4 = I
5 ."
4 I
3
OSED 13 x34 ELJEAI A
442 SF OF BED AREA WITH 16
�F°..
226.12-1-60
3 , '
LAKE WATER SUPPLY
1
I
1
1
12" MIN.
COVER
d.
" PVC SDR-35 2"
INLET I
MIN. SLOPE
1/4" PER FOOT
/ d
WATERTIGHT SLEEVE)
AND SEAL (TYP)
PROPOSED 1250 GAL
DUAL COMPARTMENT
PRECAST CONCRETE
SEPTIC TANK
4" MIN. TOPSOIL,
ESTABLISH TURF
4" SCH 40 PVC
PERFORATED PIPE
GEO-TEXTILE COVER
WASHED CONCRETE
SAND CONFORMING TO
NYSDOT SPECIFICATION
703-07
IN -DRAIN UNIT
HOLES ® 5&7 O'CLOCK
2' MIN SPACING
BETWEEN LATERALS
WASTEWATER SYSTEM DESIGN
3-BEDROOM RESIDENCE WITH GARBAGE GRINDER
WATER SAVING FIXTURES
(1.6 GPF MAX. FLUSH, 3.0 GPM MAX FAUCETS REPLACE
EXISTING FIXTURES AS NECESSARY)
DESIGN FLOW - 110 GPO/BEDROOM
SYSTEM DESIGN FLOW - 330 GPD
SEPTIC TANK - PROPOSED 1,250 GALLON PRECAST CONCRETE
LEACH FIELD - ELJEN ABSORPTION BED
DESIGN PERCOLATION RATE = 6-7 MIN/IN
ABSORPTION BED AREA REQUIRED = 413 LF
15 ELJEN MODULES REQUIRED
(PER ELJEN NEW YORK DESIGN & INSTALLATION MANUAL)
PROVIDE 13'X34' ELJEN BED WITH 2 ROWS OF 8 MODULES
442 SF OF BED & 16 MODULES TOTAL PROVIDED
POTABLE WATER SUPPLY IS LAKE GEORGE
APPROXIMATE
EXISTING GRADE
F--SLOPE
APPROXIMATE POLYETHYLENE EXTENSION TO GRADE
FINISHED GRADE / W17H TAMPER RESISTANT ACCESS COVER
6" MIN.
N
16" 4"H x18"W SLOT,
(2) 4" ELBOWS
OR 6" ELBOW
2 >C
M 60- 75X OF
CO TANK VOLUME
0
SCALE. NTS
ASTM C33 SAND SPECIFICATION
SIEVE
PERCENT PASSING
3/8" (9.5-mm)
100%
No. 4 (4.75-mm)
95-100%
No. 8 (2.36-mm)
80-100%
No. 16 (1.18-mm)
50-85%
No. 30 (600-µm)
25-60%
No. 50 (300-µm)
5-30%
No. 100 (150-µm)
0-10%
No. 200 (75-µm)
0-5%
(MUST BE OBTAINED BY WASHING)
INSTALLER TO PROVIDE SIEVE ANALYSIS FOR
SYSTEM CONCRETE SAND TO DESIGN ENGINEER
PRIOR TO TRANSPORTING SAND TO THE SITE
VARIANCE SUMMARY
rvy20' REQUIRED
16' PROPOSED
4' RELIEF REQUESTED
-ABSORPTION FIELD TO PROPERTY LINE
10' REQUIRED
5' PROPOSED
5' RELIEF REQUESTED
13' BED WIDTH
6' CENTER -TO -CENTER ELJEN SPACING
SCALE. NTS
2" MIN. DROP
BETWEEN INVERTS
SUGGESTED: INSTALL POLYLOK
PL-122 FILTER SUCH THAT IT
IS READILY REMOVABLE THROUGH 12" MAX.
TANK ACCESS COVER COVER
DISTRIBUTION BOX
4" PVC SDR-35
OUTLET 2" MIN.
MIN. SLOPE BAFFLE
1 /8" PER FOOT
DISTRIBUTION BOX NOTES
USE SPEED LEVELERS TO " PIPE JOINTS TO BE SEALED WITH ASPHALTIC
ASSURE ALL OUTLETS ARE AT MATERIAL OR EQUIVALENT.
EXACTLY THE SAME ELEVATION • INVERT ELEVATIONS OF ALL OUTLET PIPES
4" PVC SDR-35 SOLID HEADER MUST BE EQUAL, USE SPEED LEVELERS
• D-BOX TO BE INSTALLED IN CONFORMANCE
TO PERFORATED TRENCH PIPING, ,
1/8" PER FOOT MIN SLOPE W17H MANUFACTURERS INSTRUC710NS
SEPTIC TANK NOTES
MINIMUM 2X WIDTH ALL UNITS SHALL COMPLY WITH THE REQUIREMENTS OF THE NEW YORK STATE
MAXIMUM 4)( WID DEPARTMENT OF HEALTH APPENDIX 75—A AND SHALL BE OF PRECAST
CONCRETE AS MANUFACTURED BY UTOPIA ENTERPRISES OR EQUAL.
ALL STRUCTURES SHALL BE PLACED ON FIRM, COMPACT SAND OR GRAVEL
BASE. WHERE EXISTING SOIL CONDITIONS ARE UNSUITABLE, CRUSHED STONE
SHALL BE PLACED AS NECESSARY TO ACHIEVE A STABLE BASE.
SEPTIC TANK DETAIL SEPTIC TANKS INSTALLED IN TRAFFIC AREAS SHALL BE OF EXTRA HEAVY
SCALE. NTS CONSTRUCTION DESIGNED FOR H-20 .WHEEL LOADING.
ALL JOINTS MUST BE SEALED WITH BUM SEALANT. JOINTS BELOW THE LIQUID
LEVEL MUST BE TESTED BEFORE BACKFILLING.
_LIQUID LEVEL
T
1/3
DEPTH
18"
OF OUTLET
MIN..
INVERT
—k-
25-40% OF
TANK VOLUME
SITE LOCATION LOCATION MAP
SYSTEM INSTALLATION NOTES
CONSTRUCTION SHALL BE AS SHOWN ON THIS DRAWING AND IN ACCORDANCE WITH THE N.Y.S. DEPARTMENT OF
HEALTH INDIVIDUAL HOUSEHOLD SYSTEMS AND ASTM F481 INSTALLATION OF THERMOPLASTIC PIPE AND
CORRUGATED TUBING IN SEPTIC TANK LEACH FIELDS
ALL DISPOSAL FIELDS SHALL BE GRADED TO SHED RAINFALL AND DIVERT SURFACE RUNOFF AWAY FROM THE
DISPOSAL FIELD.
DO NOT USE HEAVY EQUIPMENT WITHIN THE ABSORPTION AREA AFTER IN -DRAIN UNITS HAVE BEEN INSTALLED.
ABSORPTION TRENCH NOTES
THIS DESIGN UTILIZES ELJEN CORPORATION TYPE B IN -DRAIN GE07EX71LE SAND FILTER UNITS INSTALLED IN
SHALLOW CONFIGURATION. REMOVE EXISTING ORGANIC MATERIAL FROM SURFACE AND GRADE AREA PRIOR TO
PLACING FILL. USE TRACKED EQUIPMENT FOR ALL WORK IN ABSORPTION FIELD AREA. BOTTOM OF TRENCH
(BOTTOM OF CONCRETE SAND) TO BE INSTALLED AT 12" INTO HIGHEST POINT OF EXISTING GRADE, (CLOSEST TO
ROAD).
IA/A[ 'rr'1A1ATCn ["\/["TCAA AAATCnTA1 rnCY`TCT/^ATTr1A11r
ASTM C33 SAND
PRESBY SYSTEM SAND TO BE ASTM C33 WASHED CONCRETE SAND. SEE "ASTM C33 SAND GRADATION" FOR
SPECIFICATIONS.
EFFLUENT SEWER PIPE
PIPING TO BE 4" SDR-35 OR SCHEDULE 40 PVC. INSTALL WITH 1/8" PER FOOT MINIMUM SLOPE
FILTER FABRIC
FILTER FABRIC TO BE 4.8 OZ/SY NON -WOVEN SEPARATION FABRIC, TENCATE MIRAFI 140N OR EQUIVALENT.
HOUSE SEWER PIPE
PIPING TO BE 4" SDR-35 OR SCHEDULE 40 PVC. INSTALL WITH 1/4" PER FOOT MINIMUM SLOPE.
TOPSOIL
PLACE 4" MINIMUM TOPSOIL OVER ENTIRE ABSORPTION FIELD AREA. SEED, MULCH AND ESTABLISH TURF.
4" MINIMUM TOPSOIL ON
ENTIRE BACKFILL AREA;
SEED AND ESTABLISH TURF
4' SLOPE---�
TAX MAP # 226.12-1-56
Dig IlSafely,
NewPYork
■ Call Before You Dig
® Waft The Required Time
■ Confirm Utility Response
0 Respect The Marks
■ Dig With Care
800-962■7962 0 ISSUED FOR VARIANCE REQUEST 3/29/2023
www.digonfelymwyork.com
No. Revisions...... _Date
WASTEWATER SYSTEM PLAN & DETAILS
prepared for.
Jeanne L. Rollins Revocable Trust
377 Cleverdale Road
Town of Queensbury, County of Warren, State of New York
Drawn: JRS/WGC Checked: GTH Scale. NOTED Date: 312412023
169 HaWland Road
ALTERATION OF THIS DOCUMENT EXCEPT BY Queensbury, NY 12804 292123-01
A LICENSED PROFESSIONAL ENGINEER IS A (518) 745-0307 Phone
VIOLATION OF NYS EDUCATION LAW. Hutchins Engineering PLLC (518) 745-0308 Fax