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WASTEWATER-SEWER\Set PFFBlack William—Replacement with Absorption Field Septic Tank To Dwellings and Lanes—ETU—In APA-2-12-2024
RESOLUTION SETTING PUBLIC HEARING ON SEWAGE DISPOSAL
VARIANCE APPLICATION OF BLACK FAMILY NOMINEE TRUST
RESOLUTION NO.: 92024
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, William Black, on behalf of the Black Family Nominee Trust, (Applicant) has
applied to the Local Board of Health for variances from Chapter 136 to install a replacement onsite
wastewater treatment system with certain of its components to be located:
1. absorption field 1' from the property line(E) in lieu of the required 10' setback;
2. absorption field 3' from the dwelling(guest house) in lieu of the required 20' setback;
3. septic tank 1' from the dwelling in lieu of the required 10' setback;
4. septic tank 1' from the property line(W) in lieu of the required 10' setback;
5. absorption field 8' from the property line(W) in lieu of the required 10' setback;
6. absorption field 4' from the dwelling (main house) in lieu of the required 20' setback;
and
7. absorption field 8' from the neighboring dwelling in lieu of the required 20' setback;
on property located at 13 Fielding Lane 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, March 4t", 2024 at 7:00 p.m. at the Queensbury Activities Center, 742 Bay Road,
Queensbury, to consider William Black, on behalf of the Black Family Nominee Trust's, sewage
disposal variance application concerning property located at 13 Fielding Lane in the Town of
Queensbury(Tax Map No.: 227.13-2-16) 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 12t'day of February, 2024,by the following vote:
AYES
NOES
ABSENT:
Office Use Only
SEPTIC VARIANCE
Permit #:
APPLICATION Permit Fee: $
Town of t4mvn,sbury Invoice #:
742 Bay Road, Queensbury, NY 12804 Approvals: —
P: 518-761-8256 www gueensbury.ne# T 8 to Y
r
Submittal: 1 (one) original & 8 copies of the completed applicatio ac
dry
FFi? - ^nq !
PLEASE PRINT LEGIBLY OR TYPE. PLEASE INCLUDE AN E11lL
Section 1• Y1r1
Contact Information:
Property f7wner(s) :
William Black Owner's Agent: Environmental Design Partnership
Address:
28 Birch Hill Rd. PO Box 17 Address: 900 Route 146
New Lebanon NY 12125 Clifton Park NY 12804
Phone #:
51 B-376-6462 Phone #: 518-371 -7621 x 138
Email-
bblack d-)sfli.net Email : cdemyer@edplfp.com
Section 2:
Site Information:
Site Address:
13 Fielding Lane Tax ID#: 227. 13-2-16
Directions to Site: From 9L, turn onto Cleverdale Rd, continue to Cleverdale, turn right onto Fielding Lane
Section 3•
Distance from well on property to septic system (if applicable)
nla (Lake Water Supply)feet
Section 4:
Is it possible to install a conforming septic system on this property? ❑ Yes FN'j 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? *Yes E] No If No, please explain:
Section 6•
Is the proposed system to be installed under a parking area? ❑ Yes [] No
Section 7:
V-1 .ABSORPTION FIELD TO PROPERTY LINE (E} - REQUESTING 1' IN LVE3 OF THE ol F REQUIREE
V-2:ABSORPTION FIELD TO DWELLING (GUEST HOUSE) - REQUESTING ' IN LIEU OF THE 20' REQUIRED
V-3:SEPTIC TANK TO DWELLING - REQUESTING i' IN LIEU OF THE 10' REQUIRED?
V-4:SEPTIC TANK TO PROPERTY LINE (W) - REQUESTING 1 ' IN LIEU OF THE 10' REQUIRED
V-5.ABSORPTION FIELD TO PROPERTY LINE (W) - REQUESTING 6' IN LIEU OF THE 10' REQUIRED
V-6:ABSORPTION FIELD TO DWELLING (MAIN HOUSE) - REQUESTING 4' IN LIEU OF THE 20' REQUIRED
V-7:ABSORPTION FIELD TO NEIGHBORING DWELLING - REQUESTING B' 4N LIEU OF THE 20' 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
Address
Tax Map ID
South Name STATE OF NEW YORK
Address Cleverdale Rd
Tax Map ID 227. 13-2-20
East Name Sherry M . Kearns
Address 15 Fielding Lane
Tax Map ID 221 ?. 13-2- 17
West Name The Van Schaick Lake HOUSe LLC
Address 11 Fielding Lane
Tax Map ID 1 17. 13-2-15
Section 9•
OWNER STATEMENT
I/We do hereby relieve the Town of Queensbury from e pum
any liabilities on the and septic system located at:
is Fielding Lane . I/We realize that putting the well, septic tank or leaching system less than the required feet
10120
from the dwelling/property line
may increase the risk of pollution .
Owner—Print Name: William Black
Owner—Signature: /S/ W'�1'Zr.cliru. l .Laok
Crate: 2/5/Z-o+
Section 10:
NEIGHBOR DR 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
Section W.
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
Address
Tax Map ID
South Name STATE OF NEW YORK
Address Cleverdale Rd
Tax Map ID 227. 13=2-20
East Name Sherry M. Kearns
Address 15 Fielding Lane
Tax Map ID 2217.13-2-17
West Name The Van Schalck Lake House LLC
Address 11 Fielding Lane
Tax Map ID 117. 13-2-15
Section 9s
OWNER STATEMENT
I/We do hereby relieve the Town of Queensbury from any Ilabilities on the plumbing and septic system located at:
1sing Lam
I/We realize that putting the well, septic tank or leaching system less than the required i°nO feet
from the dwelling/property line may increase the risk of pollution.
owner—Print Name: William Black
CJwner--Signature: Date: 2
Section 70:
NEIGHMM OR TENANT RELEASE STATEMENT I(f oPPNbable)
I/We do hereby relieve the Town of Queensbury from any liabilities on the plumbing, and septic system located at:
15 Fieldinq Lane . I/We realize that putting the well, septic tank or leaching system less than the required 8' feet
from the dweiiing ay increase the yisk of pollution.
Neighbor/Tenant—Print Narne: r'' '`r`"�`
Neighbor/Tenant-Signature: Date:
Septic Variance Appitcation j' Revised December 2021
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: William Black
The Black Residence
Environmental Design Partnership LLP as agent regarding the septic Variance for
Designates:
Site Address: 13 Fielding Lane
Tax Map #1: 227 . 13-2- 1 E
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
Board of Health, building and code
Owner, Applicant and his/her/their agent hereby authorize the Town
Enforcement Officers and Town Engineer to enter the subject properties for the purpose of reviewing the
application submitted.
Please Nate: 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: William Black 2/6i'2.4-
OWNER—SIGNATURE:
!s✓ w'i.4LEuvu. '�tGtclrl. DATE:
AGENT—PRINT NAME: Connor DeMyer (EDP)
.rdr - - DATE. 1 /15123
AGENT—SIGNATURE:
Revised December 2021
septic variance Application
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