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2024-0185 SEPTIC DISPOSAL PERMIT Submission Requirements: Town ofgy rn4micy 742 Bay Road,Queensbury,NY 12804 P:518-761-8256 www.queensbury.net 1. Completed Septic permit application (please print neatly or type) 2. Workers Compensation insurance information for ALL contractors involved in the project— this is REQUIRED EVEN FOR SOLE PROPRIETORS TWO (2) COPIES of the plot plan showing: a. The location of the proposed septic alterations b. The location of any existing structures c. All wells on the property and adjacent properties shown d. Distances from, if needed: a. Leech lines to foundation b. System to wells c. Any part of system to property lines d. Tank and pump stations to foundation and/or any water line e. Leech field to water/wetland Setback requirements: 1. Minimum setback for a septic system to any property line is 10 feet 2. Minimum setback for a leech field is 20 ft. from the foundation, 100 ft. from any well and 10 ft. from the water line *Final Inspection Information: 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 ADDITIONAL IMPORTANT INFORMATION: 1. Any changes to the approved plans prior to or during construction will require the submittal of amended plans, additional reviews and re-approval. 2. If,for any reason,the building permit application is withdrawn, 30%of the fee is retained by the Town of Queensbury.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. Septic Application Revised July 2022 SEPTIC DISPOSAL PERMIT Office Use Only ) APPLICATION Permit#: 2924--G f \Ci Town ofCJ`uccnsbury )� ./.-60 Permit Fee:$ l�0 Invoice#: 3 oa 742 Bay Road,Queensbury,NY 12804 it P:518-761-8256 www.queensbury.net Septic Varianc No AR 9 � � Flood Zone? No P I ----------�- ---�� --�� Wetlands? No Review y: TOM o;= oL"- .iosll�:Y I Project Location' 2663 State Route 9L 5,�Jl ��!�,J, .;CiDc Tax Map #: 240.-1-22 RESIDENCE INFORMATION: Commercial 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) ❑ 0 1981-1991 130 Spa or Hot Tub Yes No 1992-Present 110 330GPD Installed? (choose one) ❑ U PARCEL INFORMATION: Topography ❑■ Flat Rolling ❑ Steep Slope % Slope Soil Nature Sand ❑■ Loam ❑ Clay ❑ Other, explain: Groundwater At what depth? >60' Bedrock/Impervious material At what depth? Domestic Water Supply ❑ Municipal ❑■ Well ❑Lake (if well or lake, water supply from any septic system absorption is ft.) Percolation Test Rate: 6 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 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:ABSORPTION BED 15'X30' Holding Tank System Total required capacity? ; tank size ; # of tanks Septic Application Revised July 2022 CONTACT INFORMATION: PLEASE PRINT LEGIBLY OR TYPE, PLEASE INCLUDE AN EMAIL • Applicant: Name(s): North Queensbury Fire Co. Inc. Mailing Address, C/S/Z: P.O. Box 61 Cleverdale, NY 12820 Cell Phone: 518-796-1254(Pete Carr) Land Line: Email: • Primary Owner(s): Name(s): same as applicants 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): CRANDAL EXCAVATING Contractor Trade: Mailing Address, C/S/Z: 63 WOODCHUCK HILL RD, LAKE GEORGE, NY 12845 Cell Phone: 518-793-0431 Land Line: Email: **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: Pete Carr Cell Phone: 518-796-1254 Land Line: Email: 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 sposal Ordina PRINT NAME: — e �� u SIGNATURE: DATE: I I f Septic Application Revised July 2022 ..''w'' Q TOWN OF UEENSB URY � 0 742 Bay Road, Queensbury, NY. 12804-5902 Septic System Checklist V w(Plan to scale aCSReceived Deep hole perc test results from engineer/Architect if applicable(Town Approved Engineers and rchitects•June 30 to April 15 Town Engineer for unapproved Engineers and Architects) 445 All wells on property and adjacent properties shown 9,c1Water line shown Municipal or well 10'separation to any part of system (/,ei_s Setback to property lines show 10'or more for any part of system Septic tank and pump stations 10'from foundation,50'from any well/lake/wetland, 10'from any waterline ,J/ ,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) Ci Septic tank sized for number of bedrooms and add 250 gals for Jacuzzi tubs/garbage grinder each G(. / Leech Field 20'from foundation 100'from any well 10'from water line ,,,,J , Seepage pit 150'from well 50'from septic tank 14 Seepage Pits 3-times diameter apart Septic tank and pump stations over 30 gallons 50'from watercourse or wetland Cf-r-S Distance from bottom of trench or system 24"to bedrock or mottling 3366"within 1000'of Lake George 9.4Leech field 100'from watercourse or wetland (4-liToe 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 k VA Department of Health Approval falall mobile home park new systems Flood Plain requirements NP 2'above established flood elevation to bottom of system All tanks anchored or 2'above flood elevation a-4 l) G. TAA54 7 / <- l FILE COPY tTATEOF c Adirondack ij1j OPPORTUNITY- Park Agency J AUG z o 2024 -1 KATHY HOCHUL BARBARA RICE Governor Executive Director TOWN OF QUEENSBURY BUILDING 8,CODES August 20, 2024 G. Thomas Hutchins, P.E. —via email thutchns(c�hutchinsengineerin.com 169 Haviland Road Queensbury, NY 12804 RE: Jurisdictional Determination J2024-0571 Tax Map Parcel 240-1-22 Land Use Area: Moderate Intensity Use, Resource Management Town of Queensbury, Warren County Dear G. Thomas Hutchins, P.E.: Thank you for your Jurisdictional Inquiry Form, submitted on behalf of your client and received by the Agency on June 24, 2024. The zoning laws for the Town of Queensbury have been approved by the Adirondack Park Agency pursuant to § 807 of the Adirondack Park Agency Act. This means that certain permitting requirements of the Adirondack Park Agency Act are administered by the Town. The replacement of the on-site wastewater treatment system and replacement of the septic tanks and force main described in your submission and depicted on the map titled "Wastewater Treatment System Plan and Details" and dated January 31, 2024, does not require Agency approval; instead, review of this proposal will occur pursuant to the Town's zoning laws. Please be sure to contact the Code Enforcement Officer or Zoning Administrator for the Town of Queensbury to determine compliance with all requirements. This letter makes no representation as to the approvability of your project under the Town's laws. An Agency staff biologist confirmed wetlands on the property during a site visit on July 30, 2024 as being as shown on a plan provided with the application materials, and it was determined that the project as proposed will not affect these wetlands. This determination may be relied upon for a period of three years following issuance of this letter. Please see the attached Freshwater Wetlands flyer for additional information regarding wetlands in the Adirondack Park. Although your client's proposal does not require Agency approval, please help to prevent the spread of invasive species by ensuring all excavating tools, fill, and other P.O.Box 99.1133 NYS Route 86•Ray Brook,NY 12977•Tel:(518)891-4050•www.apa.ny.gov i 5 G. Thomas Hutchins August 20, 2024 Page 2 equipment are thoroughly cleaned and that all fill is free of invasive species prior to use on-site. If any portion of the site contains invasives, all construction equipment and vehicles should be thoroughly cleaned prior to moving to other areas. If the proposal will involve any plantings, care should be taken to avoid the introduction of invasive species. Additional information on how to prevent the spread of invasive species in the Adirondack Park can be found at www.adkinvasives.com. In addition, please be aware of the following information and requirements: 1. A permit is required for the installation of any new on-site wastewater treatment system within 100 feet of wetlands. The wastewater setback is measured horizontally along the shortest line between the closest point of any leaching component of the system and the edge of the wetland. This letter does not authorize the impairment of any easement, right, title, or interest in real or personal property, and shall not be construed to satisfy any legal obligations of the permittee to comply with all applicable laws and regulations or to obtain any governmental approval or permit from any entity other than the Agency, whether federal, State, regional or local. Again, we recommend that you check with Town authorities, to obtain all necessary approvals prior to commencing the project. Please do not hesitate to contact the Agency with any questions. Sincerely, /s/Tracy J. Darrah Tracy J. Darrah Project Administrator Attachments: Wetlands flyer cc: Town of Queensbury—via email 2 i 3 NEW YORK Adirondack STATE OF OPPORTUNITY_ Park Agency FRESHWATER WETLANDS This is a supplement to the Citizen's Guide,which provides basic information about Adirondack Park Agency regulations. Regulated Wetlands Defined in §802 of the Adirondack Park Agency Act, wetlands are "any land which is annually subject to periodic or continual inundation by water and commonly referred to as a bog, swamp or marsh which are either (a) one acre or more in size or (b) located adjacent to a body of water, including a permanent stream, with which there is free interchange of water at the surface, in which case there is no size limitation1." Section 578.3 of the Agency's regulations provides additional wetland information, and the criteria for identifying wetland areas are provided in the New York State Wetland Delineation Manual (available at http://www.apa.nv.gov). Wetland Permitting Under the Adirondack Park Agency Act and the Freshwater Wetlands Act, an Agency permit must be obtained for the following activities involving wetlands in the Adirondack Park: 1. Draining, dredging, or excavating2 a wetland; 2. Placing fill, including soil, stone, sand, gravel, mud, trash, structures, pilings, roads, or any other obstruction or substance3, into a wetland; 3. Clearcutting4 more than three acres; 4. Releasing any form of pollution into a wetland, including pesticides and sewage effluent or other liquid waste; Areas that are less than one acre in size and meet the New York State Wetland Delineation Manual criteria are considered wetlands for Agency purposes if: 1)the adjacent waterbody is at least 6.6 feet deep;2)the adjacent waterbody is at least one acre in surface area;3)the adjacent waterbody and the wetland together are at least one acre in surface area;or 4)the adjacent waterbody has a permanent surface water inlet or outlet. 2 With certain exceptions;see section 578.3(n)(4)of Agency regulations and the Agency's flyer titled"Hand Harvesting of Aquatic Plants"for additional information. 3 With certain exceptions;see section 578.3(n)(4)of Agency regulations for additional information. 4 For Agency purposes,a clearcut is generally defined as any cutting of trees over six inches in diameter at breast height over any 10-year cutting cycle,where the average residual basal area remaining is less than 30 square feet per acre within the area harvested. See sections 570.3(f)and 573.7 of Agency regulations for additional information. Page 1 of 4 Revised February 28, 2019 5. Installing any sewage drainage field or seepage pit or any sewer outfall in or within 100 feet of a wetland; 6. Undertaking any other activity within or outside of a wetland that substantially impairs the functions served by or the benefits derived from the wetland, including the diversion of surface or subsurface drainage or natural water flow that adversely affects the natural hydrological regime of or substantially increases erosion of or siltation or sedimentation into the wetland; or 7. Creating by subdivision any lot that contains wetlands and any lot adjoining a lot that contains wetlands, as well as all land use and development related to these subdivision lots, unless the Agency issues a letter finding that: • All lot boundaries will be located at least 200 feet from all wetlands; • All new roads providing access to more than one lot will be located at least 50 feet from all wetlands; • All non-wetland areas of the wetland subdivision lots will be accessible by road without crossing or causing adverse impacts to wetlands5; and • Any lot containing a lawfully existing principal building will also contain its associated water supply, wastewater treatment system, and an adequate replacement site for the on-site wastewater treatment system that is located at least 100 feet from all wetlands6. When a regulated activity is proposed, a wetland biologist will determine the value rating for the wetland. As described in §578.10 of Agency regulations, the standards for approval of activities involving wetlands depend on the value rating, with stricter standards for activities in high value wetlands. Please note that development is generally prohibited in wetlands with a value rating of"1." For specific locations, the Agency will determine whether wetlands are present and will delineate wetlands upon the request of any person having a legal interest in the property. These determinations involve examination of maps at Agency headquarters, interpretation of aerial photographs, and/or field visits by Agency wetland biologists. Please contact the Agency for additional information. WETLAND IDENTIFICATION AND IMPORTANCE Deep Water Marsh Areas of open water filled with plants that float freely or are rooted are called deep water marshes. The leaves of the rooted plants are either submerged or floating. Such plants as pondweeds, duckweeds, and wild celery are important food for waterfowl. The shallow waters of a deep water marsh and the protecting vegetation make them important areas for fish spawning and nurseries. 5 This requirement is generally applied to mean that access roads could be constructed at least 50 feet from wetlands to reach all non-wetland areas of the subdivision lots. 6 This requirement is generally applied to mean that the lot contains a potential replacement wastewater treatment system site that: 1)is at least 1,500 square feet in size;2)is no more than 60 feet in length;3)has slopes of 15%or less;and 4)and is located greater than 100 feet from all waterbodies. Page 2 of 4 Revised February 28, 2019 3 'S Deciduous Swamp These are wetlands where the covertype contains mostly live deciduous trees, twenty feet or more in height. The trees grow on hummocks or in seasonally or permanently flooded areas. Swamp maples and willows are evident in lowland deciduous swamps. These swamps are spotted with dead trees which are used by flying squirrels and chickadees. The swamps provide a habitat for nesting waterfowl and a great variety of birds and wildlife. Their soils are usually very fertile, promoting rapid plant growth and a wide diversity of plants and animals. Because these swamps filter great quantities of water, they play a very important role in purifying water and maintaining high water quality. Wet Meadows Wet meadows are wetlands where most of the cover is composed of sedges, rushes, and coarse grasses, most of which tend to grow in clumps. Groundwater is at or near the surface for much of the year, including significant parts of the growing season, creating saturated soils. These meadows are often found in the flood plains of lakes and rivers and in the areas once flooded by beaver dams or other impoundments. Their soils are mostly mineral in structure. Bog A bog is a closed wetland from which drainage is either extremely slow or absent and where the vegetation grows on a saturated mat of peat. The mat sometimes covers all of the surface of a shallow pond, sometimes it covers only a portion leaving open water. The peat is formed by species of sphagnum moss which die, but do not decay because of the acidity and low oxygen levels of the bog. All processes in a bog including nutrient recycling are slowed down by the stagnant acid water. This is why bogs are so sensitive. It takes centuries to recover from disturbance. Emergent Marsh Emergent marshes are shallow wetlands that are flooded with standing or running water much of the year. Their cover consists of such plants as cattails, bulrushes, pickerel weed, loosestrifes, and arrowheads. Emergent marshes have the most valuable covertype and one of the highest levels of productivity and habitat diversity. Not only • does the vegetation in these wetlands provide nesting habitat, food, and cover for many waterfowl and other wildlife, but it adds large quantities of nutrients to food chains. These marshes are attractive to muskrat, ducks and geese, herons, and egrets, mink and deer. Shrub Swamp Page 3 of 4 Revised February 28, 2019 A shrub swamp is a wetland where woody shrubs, less than twenty feet in height, make up most of the covertype. Shrub swamps are often found in floodplains, in frost pockets and other depressions, on the edges of ponds, lakes and bogs, along meandering streams, and in hillside drainages. These areas have two things in common: fresh water flowing through them and a high level of productivity. Alders, hollies and viburnums typify these swamps and have berries which are eaten by a wide variety of birds. The shrubs are the nesting habitat of such diverse species as the rose-breasted grosbeak and kingbirds, and game birds, including woodcock, pheasant and grouse. It is also the habitat of beaver and otter, and waters adjacent to shrub swamps are essential to spawning northern pike. Coniferous Swamp A coniferous swamp is a wetland where most of the plant cover consists of live coniferous trees over twenty feet in height. The trees often grow on hummocks in deep organic deposits with pockets of water or sphagnum moss between them. Coniferous swamps are most important because they give off large quantities of water over much of the year. In summer, this process helps keep surrounding soil temperatures low. This, combined with the cooling effects of the swamps' dense shade, helps maintain low water temperatures critical to the survival of cold water fish in streams running through these swamps. The shelter offered by coniferous swamps creates clear wintering fields so important to the survival of deer and other animals and birds. This flyer is intended to provide general information regarding Agency jurisdiction. Other provisions or restrictions may apply if an Agency permit or variance is required or if the property has previously been subject to Agency review. Please contact the Agency with any questions at 518-891-4050. For a binding written response as to whether a specific proposal requires Agency review, please submit a Jurisdictional Inquiry Form (JIF). The JIF form is available on the Agency website at www.apa.ny.00v/Forms/iiform.pdf. Page 4 of 4 Revised February 28, 2019 rif---tilJEWYOK Adirondack FILE COPY STATE OF OPPORTUNiTY Park Agency JURISDICTIONAL INQUIRY FORM Please submit by email to—apajifCa�apa.ny.gov A. INSTRUCTIONS Submit this form to obtain a written determination whether an Adirondack Park Agency permit or variance is needed for a proposed project. This form is not an application. If you know you need an Agency permit or variance you should not submit this form, but instead you should contact the Agency for the appropriate application form. Information about Agency jurisdiction can be found on the Agency's website (https://www.apa.ny.gov/) and in the Permit Checklist on pages 10 and 11 of the Agency's `Citizen Guide,' which is also available on the website. The Jurisdictional Inquiry Form must be signed by a person with a legal interest in the property; only owners, tenants, mortgagees, purchasers under an existing contract of sale, or their attorneys. Please note that if the person under contract to purchase the property signs this form, then a copy of the purchase agreement signed by both parties must be provided. The legal issues involved in determining jurisdiction are complicated. All of the information requested on this form is necessary in order for us to determine if the proposal requires an Agency permit or variance. The County Clerk's Office, Real Property Tax Services and/or the Town Office may be able to assist you in obtaining property information (i.e., tax map number, history, copies of deeds, etc.). Please include a copy of the current recorded deed, tax map number, a description of your proposal, including a sketch map, and the necessary signature(s). WE CANNOT RESPOND TO YOUR INQUIRY WITHOUT THIS INFORMATION S. GENERAL INFORMATION APPLICANT/REPRESENTATIVE: PROPERTY OWNER (if not applicant): Name G Thomas Hutchins, PE No. Queensbury Fire Co. Inc. Mailing 169 Haviland Road P.O. Box 61 Address Queensbury NY 12804 Cleverdale, NY 12820 Telephone 518.745.0307 518-796-1254 Email thutchins@hutchinsengineering.com Page 1 of 6 Revised April 4, 2022 PROPERTY LOCATION: Town/Village Queensbury County Warren Road/Highway 2663 State Route 9L Tax Map Number: (This can be found on your tax bill and it looks something like this... 89.12-1-1.4-three numbers separated by dashes, and there may not be decimals). Section 240. Block 1 Parcel/Lot 22 C. PROPERTY HISTORY Please include a copy of the current recorded deed for the property 1. Has the property been the subject of any previous Agency permit, variance, map amendment,jurisdictional determination, staff site visit, wetland site visit, or an enforcement action? 0 Yes ❑ No ❑ Don't Know If yes, please include the following information: File number Agency contact Wetland Delineation(1991-contact unknown) 2. What is the acreage or square footage of the property at this time? 27.81 acres 3. Please describe all structures which currently exist on the property (include type and use of structure, size and construction date of each —for example, confirm if the structure is a mobile home, single family dwelling, barn, storage building, etc.). If your project involves replacement of a structure, please provide its description, even if it has already been removed (and indicate its removal date). Structure/Use Size Construction Date Removal Date a. Fire Station 13,000 SF 1993 N/A b Rescue Squad Bldg 3,100 SF 1970, Addition 2000 N/A c. d. e. f. Page 2 of 6 Revised April 4, 2022 • D. PROJECT DESCRIPTION Please check all that apply and fill in the appropriate blanks: 1. ❑ Subdivision (a) Number of proposed lots (including any lots being retained). (b) What is the size of the smallest lot in acres or square feet? (c) What is the smallest shoreline lot width (if applicable)? (d) Are any of the proposed lots being conveyed by gift? ❑'Yes ❑ No If yes, what is the recipient's relationship to the person giving the lot? ❑ Construction of a single family dwelling. ❑ Installation of a mobile home. ❑ Construction of a multiple-residence building ( housing units). ❑ Construction of a commercial, industrial or public building resulting in square feet of building footprint and square feet of floor space (total of all floors). ❑ Expansion of the footprint of an existing square foot structure by additional square feet. For group camps and public buildings, please also provide expansion information for the total of all floor space. NOTE: If you are expanding a structure other than a single-family dwelling, also provide the total square footage of the structure as of May 22, 1973. ❑✓ Proposing to install; replace or expand a seepage pit, drainage field or other leaching facility. Will it be within 100 feet of the mean high water mark of any lake, pond, river or stream (including intermittent streams)? 0 Yes 0 No Will the new system serve an actual or potential occupancy increase of the shoreline structure served? 0 Yes ❑✓ No ❑ Replacement of an existing square-foot structure with a new square-foot structure. Confirm the existing and proposed use of the structure. ❑ Conveyance of entire ownership ❑ Other(describe) 2. Does the project involve establishment of a new business? 0 Yes El No If yes: (a) Will it be operated at your residential property? 0 Yes ❑ No (b) How many people will the business employ who do not live on the premises? (c) How many signs will the business have? Will they be lighted? 0 Yes 0 No What will be the combined square footage of the sign(s)? (d) Please describe the type of business. Page 3 of 6 Revised April 4, 2022 3. Provide the height of the proposed structure(s) (measuring from the highest point of a structure including chimney to the lowest point of natural or finished grade, whichever is lower.) N/A (If the structure is close to 40 feet in height, it will be necessary to provide building elevations [all sides] and a grading plan which shows existing and proposed grade to obtain a jurisdictional determination.) 4. Will the project result in the removal of sand, gravel, topsoil or minerals from the property? ❑ Yes 0 No 5. Will waste material, such as construction debris, be disposed on the property? (This does not include soil and land clearing debris generated from onsite construction activities.) ❑ Yes El No If yes, explain the type and volume of debris. 6. Does the property contain shoreline? ❑ Yes 0 No What will be the distance from the mean high water mark to the closest new structure or expansion? feet If an expansion, how far from the mean high water mark is the existing structure? feet Will the existing roof ridgeline height be increased by more than 2 feet? ❑Yes El No If yes, what is the proposed new ridgeline height in feet above the existing ridgeline height? feet 7. Will any vegetation be cut within 35 feet of a lake, pond, river or stream? ❑ Yes ID No Your sketch should show the size and type of vegetation to be removed relative to the size and type which will remain. 8. Does the proposal involve provision of any new or additional deeded or contractual access to the shoreline? ❑Yes 0 No If yes, provide the number of new or additional lots being provided access (identify by tax map designation) and the width of the access area. E. SKETCH MAP (For the purposes of this Inquiry the map does not need to be professionally prepared) On a separate sheet, provide a scaled sketch map of the property showing acreage, boundaries, and natural features and water bodies. Include the location of all existing and proposed development(including structures, on-site wastewater treatment system, water supply, driveways, roads, and areas of clearing etc.) It should be drawn at a scale which clearly shows the location of all proposed activity, with measurements labeled. For a shoreline parcel, show the lot width along the shoreline and indicate the setback distance from mean high water mark of any existing or proposed structure and sewage system. Also, provide the north arrow, the name of the map maker and date it was prepared. Page 4 of 6 Revised April 4,2022 , • l F. NARRATIVE (Please describe your proposal) Replace septic system serving the Rescue Squad building. G. CHECK LIST El Have you answered all of the questions? El Did you include a copy of the current recorded deed? O Did you include a sketch map? 0 Is the form signed by an authorized person? O Did you provide the tax map identification number? O Did you include your return mailing address and phone number? Page 5 of 6 Revised April 4, 2022 . H. SIGNATURE OF AUTHORIZED PERSON Note: This form must be signed by a person with a legal interest in the property; only owners, tenants, mortgagees, purchasers under an existing contract of sale, or their attorneys. The use of an electronic signature, by typing in your signature and checking below, shall have the same validity and effect as a handwritten signature. Please fill in the information below and check all applicable boxes. The above information is correct and accurate to the best of my knowledge. ;L� J$t - O it -ter✓�?( �&-v Signed (typed) 01)fl o1�IV Its LastName First Name Middle Initial /2ies',c4il . it)()A Ptiems-A/9'14 7014/o_v-b-ve Lehry itle (if ppli ble) 6 zj Dat By submitting this form, I hereby request the Adirondack Park Agency issue a written determination as to whether an Adirondack Park Agency permit or variance is needed for a proposed project. I attest that I am the person named above and that I am the: Check one: ❑ Owner of the property subject to this jurisdictional inquiry ❑ Attorney for owner of the property subject to this jurisdictional inquiry ® Purchaser of the property subject to this jurisdictional inquiry under an existing contract of sale (a copy of which is attached) ® Tenant of the property subject to this jurisdictional inquiry under an existing lease (a copy of which is attached) ® Mortgagee of the property subject to this jurisdictional inquiry (a copy of which mortgage is attached) If you wish to have another person, such as a contractor, process this inquiry on your behalf, please provide the name and address of that person on page one of this form as authorized representative. (initials) I authorize the representative listed on this form to act on my behalf for this inquiry. I. PLEASE SUBMIT BY EMAIL TO—apajif(a apa.ny.aov Page 6 of 6 Revised April 4, 2022 s s f r' Safely, New York /� ti q6'39 � ` N 32'� '' 1 ` s � � n ®Cali Before You Dig \ c \ /'' / '�' � � s ,a .'.�"� ,. / ✓`="� ��� " ' �/ ®Wait The Required Time ®Confirm Utility Response Respect The(Narks Dig With Care Rou 800.962-7962 _ g www.digsafely»ewyork.com Cc ` a -.a d a � C, /4 d EXISTING. °e WELL a A 4 a t o ° 4 • d SITE LOCATION LOCATION MAP GRASS i- Z ` , • d e a a ' i WASTEWATER SYSTEM DESIGN d a 2—BEDROOM 24—HR STAFFED RESCUE SQUAD BLDG (DESIGN TO a __ _50' WELL/ a 330 GPD) 3Aj w SEIL(lVK � q � �d � ' W Co ` .a "'_ a ° d. _ m DESIGN FLOW — 110 GPD/BEDROOM a a d f SYSTEM DESIGN FLOW — 330 GPD q �-' ��-. . . SEPTIC TANK — 1,250 GALLO E o 4 OOMMER 5 yONE PRECAST CONCRETE TANK — 1,500 GALLON TANK INSTALLED W j 4 aa: ` e OOO GR PUMP STATION — 1,000 GAL 7E V) be a $ 4 f A a DRN , *2 t� a< ' 6 <° '� d CON DESIGN APPLICA77ON RATE: .8 GPD/SF, BASED ON - a d a ° < d `a 6-7 MIN/IN PERCOLA77ON RATE PARKING d a �`` ° ..100' WELL °` .. W d .. .°.. ° dae ° i /// a a SETBACK ° d ABSORPTON BED AREA REQ'D = (330 GPD)/(.8 GPD/SF) �f a a $ A a ..!��.,�_e I ° 4 a a a. ° a 413 SF e ,a a s a a q ° .• R1 °:d -d6 �! as a , a e a d a • O'x4O' = 800 SF INSTALLED / LU A8S0RPAON BED AREA PROVIDED 2 a d POTABLE WATER SUPPLY IS TO BE ON—SITE WELL d 4 DRIVE . °q. A I `' A.d m �' a' '° I FIRE e PARKING MAINTAIN 50' MINIMUM SEPARA77ON BETWEEN a HOUSE d. and 4d 4 d SEP77C TANK & WELL "� d e. aa_ I 4, m °. F. ZONE LINE ,-.-="-`"�.`$� .�>'. g.�. MAINTAIN 100' MINIMUM SEPARA770N BETWEEN Z m a (}FFF e a a, g °. < .�.. EXISTING OX� p7E LOCATIO _ ..:� .° a_ e. ° ° .° < and. d :..�a. ABSORPTION FIELD & WELL WELL Ap R d Q 4 q a SITE SOILS DATA 4' .. �' db, ° GRAVEL 1 ✓ , ✓ ; d� q a ° TEST PIT 4° ° a TP-1 — 0411712024 BY TOM HUTCHINS P.E. - ram.✓ a. ° d J F .i ✓C.- 9i °° d ' 0-12" — DARK SANDY LOAM TOPSOIL FEW �. w e e a BOULDERS e a ° ° a a A " — g bn r fr a d 12-34 LIGHT BROWN FINE SAND COBBLES AND 0 WELL a q_ BOULDERS a.a �F e ad ad d : 9 i a d' °a d E ,.,y 4 .✓fi 6dc d 4 JJ Y a 0 A e ° SETK 1 °` 34-60 — LIGHT BROWN SILT LOAM A x ✓ t-/- ..-� y a r'..✓ 4 \ tr ROOTS ALL DEPTH 3. ✓ ✓ ` UNDERGROUND ELECTRICAL y STONE RETENTION ad v ,v v v v v v v d NO GROUNDWATER EVIDENT TO 60 i ° a TO BE LOCATED AND I �,V ,,> . AREA ,... , ✓ ,,, v v v v vv v v v v v vv v v FUTURE RESERVE a a a 4 (3" q $g PERCOLATION TEST d VERIFIED PRIOR TO r N AREA d ° �� � EXCAVATION t r \ \\ \ \\ \ \ \\ e PT-1 — 411712024 BY HUTCHINS ENGINEERING Cs a i NEW 1,000 GAL PRECAST d d CONCRETE PUMP STATION t \\ \ \\\ \\\\ \ \\\ \\\\ ° °a d <d STABILIZED PERCOLA71ON RATE: 6 MINUTE PER INCH g `` HELICOPTER d' A ; q- .-.�. r: f ti� \V AA VA VA VA r a < "a�.. ,'tlq', q � :: � °A a a Iq i PAD a a f mNE B N 8E wd EXISTING FIREHOUSE \ \�\ \\\ i\ \\\ \\\ \\ NEW 2OX40 �� OaB a 4 i w ABSORP77ON FIELD PER \\ \\ \\\ \\\ \\ \\\ \\\ I A SORPTIO D , LED 0 RECORD DRAWING DATED RISERS TO GRADE INSTAL N �� R WJN SEPTIC TANK AND PUMP �..,, 7/8194 \ \l \ \ \\ \\ \\\ \\ 1 a a �" STATION `"� NEW DISTRIBU77ON BOX a a ad 19. ( NEW 1,500 GAL PRECAST \\ \�\ \v \\� v °°a. "q ALTERATION OF THIS DOCUMENT EXCEPT BY CONCRETE SEPTIC TANK \ ��� ~`'`r.,, v i 4 �_ —J d � � .'Q a ada a a_ a d• e4. A LICENSED PROFESSIONAL ENGINEER IS A EXISTING RESCUE NEW ILDING SEWER `7 �O ��`^`''` wa w� wa °. RECORD DRAWING VIOLATION OF NYS EDUCATION LAW. d 1 4^ AB--13U1 II Q� � °o-..` l` "�y, • „e ,t„ w�,,,,,,,....w3�-�""' • INSTALLATION DATE: 912024 EXIS77NG BUJLITG y _ INSTALLED BY — CRANDALL EXCAVATING SEWER \ � TREE LINE HI,ItCh1nS ° Aa APRX a Engineering d NEW 2" PVC FORCE GRAVEL ° MAIN EXISTING RECORD DRAWING NOTE: PLLC ~` I WELL I VISITED THE S17E NUMEROUS 77MES DURING 169 Haviland Road --� CONSTRUC77ON AND IT IS MY OPINION THAT THE Queensbury, NY 12804 " ` — • ..... .. , , • SY57EM IS INSTALLED IN GENERAL CONFORMANCE WITH (518) 745-0307 Phone 77-1E APPROVED PLAN AND THIS RECORD DRAWING (518) 745-0308 Fax / FINAL SURFACE FINISHING AND TURF ESTABLISHMENT 1 w�(j IS ONGOING. TAX MAP # 240.-1-22 G. 7H0MAS HUTCHINS, P.E. 9/1s/2o24 �50' WELL _/ f WASTEWATER SETBACK _ SYSTEM PLAN & DETAILS for: MAP REFERENCE: prepared 1. BASE MAP INFORMA77ON FROM 'PLOT PLAN MADE FOR North Queensbu ' WETLAND AS FLAGGED BY APA NORTH QUEENSBURY VOLUNTEER FIRE COMPANY, Volunteer Fire PER MAP REFERENCE 3 INCORPORATION" BY DAVID J. BOLSTER, JANUARY 10. 2015. f 2. "A NEW FIREHOUSE FOR THE: NORTH QUEENSBURY Company, INC. VOLUNTEER FIRE COMPANY, INC" BY RICHARD E. JONES \ ASSOCIATES, JULY 2, 1993. 2663 State Route A \ 3. "TOPOGRAPHIC MAP OF A PORTION OF LANDS OF NORTH Town Of Cleverdale, WASTEWATER SYSTEM PLAN �� r QUEENSBURY VOLUNTEER FIRE CO. INC.' BY COULTER & MCCORMACK, JUNE 22, 1994. County Of Warren, SCALE: 1"=50' t� 4. "MAP MADE FOR NORTH QUEENSBURY VOLUNTEER RESCUE SQUAD, INC." BY VAN DUSEN & SIEVES LAND SURVEYORS, State 0f New York GRAPHIC SCALE �Q LLC, JUNE 6, 2000. 20 1... ,. ...` _ WASTEWATER SYSTEM SETBACK REQUIREMENTS Drawn: AYA Checked. LWD STREAM, LAKE, Scale. NOTED onto: 0113112024 PROPERTY LINE HOUSE WATERCOURSE, WELL � CONTRACTOR TO FIELD VERIFY LOCAITONS�At4� DISTANCES + WETLAND THIS IS NOT A FIELD SURVEY. �,.. J• f 1 SEPTIC TANK 10' 10' 50' 50' 292054-0 1 —S 1 ABS0RP710N FIELD 10' 1 20' 100' 100' yg DigI Safely. New ®York EXTERIOR WEATHERPROOF JUNCTION BOXT tt � TwE POLYETHYLENE EXTENSION ���`���`�� � � �� � � � " � ;;� Call Before you Dig APPROXIMATE POLYETHYLENE EXTENSION (IF NECESSARY). SEAL CONDUIT GAS TIGHT. �T � e Confirm UtilityIM Wait The Required Time s ,� � Utility Response TO GRADE WITH TAMPER RESISTANT FINISH GRADE TO GRADE WITH TAMPER RESISTANT INSTALL CONTROL PANEL IN HOUSE. ALL ELECTRICAL � � EM Respect The Marks �^FYa. > -x ti ACCESS COVER ACCESS COVER WORK TO BE INSPECTED BY A CERTIFIED ELECTRICAL €€ "4 � ���' /�,�� � �, ,�-� � �� � �� �� � ®Dig With Care INSPECTION AGENCY PRIOR TO START—UP OF PUMP STA PON. F800-962-7962 w� w �. �ifG3` z • t a a a§4 www.digsafelynewyork.com 12 MIN, INSTALL FLOAT TRANSITION TO 4 12 MIN. COVER COVER � �,�-�. s � �/� �fy ,��x � � SWITCHES TO OPERATE OUTSIDE OF DISTRIBUTION BOX � � �� PUMP AND MAINTAIN D—BOX K mot- er ° LEVELS AS INDICATED o N 4" PVC SDR-35 21j 1 j8 PER FOOT ° . SLOPE BAFFLE INLET MIN BALL VALVE 2" MIN. 4. LIQUID LEVEL OUTLET 4 PVC SDR-35 � � � r ' MiN. SLOPE USE SPEED LEVELERS TO 1 3 INSTALL VALVES AND UNIONS ASSURE ALL OUTLETS ARE AT , SUCH THAT EITHER PUMP CAN BE 1 4 EXACTLY THE SAME PER FOOT 2 MIN. DROP a 16" 4H x18W SLOT, T" 18" ISOLATED AND REMOVED WITHOUT ELEVATION BETWEEN INVERTS " ( }2 4" ELBOWS MIN. REQUIRING PIT ENTRY 4" PVC SDR-35 SOLID HEADER WATERTIGHT SLEEVE AND OR 6" ELBOW — SEAL (TYP) � °" � TO PERFORATED ABSORPTION ALARM 3 ABOVE PUMP ON BALL CHECK VALVE a TRENCH PIPING, 118" PER FOOT SITE LOCATION LOCATION A�IA/'� SEPTIC TANK NOTES W & LAG PUMP ON 1-112" HDPE MIN SLOPE L ti l 1�✓l Y /'/t'►r ALL UNITS SHALL COMPLY WITH THE REQUIREMENTS OF THE ©� 0 FLOAT SWITCHES — INSTALL INSIDE SDR-11 FORCEMAIN PUMP STATION NOTES NEW YORK STATE DEPARTMENT OF HEALTH AND SHALL BE OF 60-75% OF 25-40% OF ' w PUMP ON PUMP PIT IN LOCATION ACCESSIBLE PRECAST CONCRETE AS MANUFACTURED BY UTOPIA a TANK VOLUME TANK VOLUME a WITHOUT PIT ENTRY SEAL ALL TANK OPENINGS WATERTIGHT. 1-1 ENTERPRISES OR EQUIVALENT. /2" SGH-40 PVC PIPING ° INSIDE WET WELL THROUGH WALL PROVIDE AND INSTALL UL LISTED PACKAGED PUMP CONTROL PANEL WITH MINIMUM 2X WIDTH PUMP OFF VISUAL AND AUDIBLE ALARM. INSTALL SIMPLEX DEMAND DOSE CONTROL w va ALL STRUCTURES SHALL BE PLACED ON FIRM, COMPACT SAND UNION — LOCATE SUCH THAT OR GRAVEL BASE. WHERE EXISTING SOIL CONDITIONS ARE MAXIMUM 4X WIDTH PANEL INSIDE HOUSE IN ACCESSIBLE LOCATION. UNSUITABLE, 16" MIN. UNION CAN BE DISCONNECTED AND O CRUSHED STONE SHALL BE PLACED AS d d , ° PUMP REMOVED WITHOUT TANK o NECESSARY TO ACHIEVE A STABLE BASE. 4' INSTALL POWER & CONTROL WIRING TO CONTROLLER WITH ALARM IN c� 6 'd ° d ° e ° ENTRY HOUSE IN ACCORDANCE W17H MANUFACTURER'S INSTRUCTIONS AND Q 1,250 GALLON PRECAST CONCRETE SEPTIC TANK a SEPTIC TANKS INSTALLED IN TRAFFIC AREAS SHALL BE OF REDUCING TEE POINTED DOWNWARD NATIONAL ELECTRIC CODE (N.E.C.) REQUIREMENTS. EXTRA HEAVY CONSTRUC71ON DESIGNED FOR H-20 WHEEL ° 1,000 GALLON PRECAST CONCRETE PUMP STATION WITH 1 BALL VALVE THROTTLED TO PUMP CONTROL AND FLOAT LEVELS TO BE INSTALLED TO PROVIDE A 50 LOADING. ALLOW TRICKLE DRAIN BAC WETWELL LLON DOSE. ALL JOINTS MUST BE SEALED WITH BUTYL SEALANT. JOINTS RECORD DRAWING NOTE: BELOW THE LIQUID LEVEL MUST BE TESTED BEFORE SIMPLEX EFFLUENT PUMP DUPLEX GOULDS WE07H 0.75 HP, 230V INSTALLED FLUENT PUMPS TO BE GOULDS PUMPS WE SERIES, MODEL WE07H BACKFILLING. UBMERSIBLE EFFLUENT PUMP .75 HP, 230 VOLT, 1 PH VERIFY EXISTING ELECTRICAL SERVICE PRIOR TO PURCHASING PUMP. SEPTIC TANK AND PUMP STATION DETAIL ALL ELECTRICAL WORK TO BE INSPECTED BY A CERTIFIED ELECTRICAL SCALE: NTS LIMIT OF 15'x30' 4" PERFORATED PVC LATERALS INSPECTION AGENCY PRIOR TO START—UP OF PUMP STATION. STONE BED INSTALLED NEAR LEVEL IN BED CONFIGURATION PROPOSED _� DISTRIBUTION BOX O / f ✓ 3✓ 3✓y✓Y ✓ ✓ 3✓ r r ✓ ✓ ✓ ✓ ✓ ✓ 3 TRANSITION FORCE N o Z -� MAIN TO PVC OUTSIDE OF D-BOX 4 TOPSOIL COVER ABOVE 4 PVC PERFORATED LATERAL FILTER FABRIC ✓ ✓ >✓ 3 - ✓ ✓ ✓ ✓ ✓ r r ✓ "✓ r �✓ TOP OF STONE BED; INSTALLED LEVEL, IN BED MIRAFI 140N OR EQUAL < 4 z a Y a SEED & ESTABLISH TURF CONFIGURATION WITH MANtFOLDED ENDS 2.5' TO EDGE f ✓ 7✓ ✓ ✓ ✓ ' ' ' ✓ ✓ f 5' PIPE SPACING OF BED / / 1✓ ✓ r✓ '✓ ✓ ✓ ✓ r ✓ ✓ , f ✓ ✓ r ✓ ✓ ✓ / y 8-16n 6,11 COVER4. e .:: / r3 STONE . R 12 _ .r: ECORD DRAWING NOTE: .... COVER OVER _ . TOTAL SHALLOW BED FILL MATERIAL AS ". ., _STONE DEPTH­ SHALLOW r 7 PAP 20 x 40 ABSORPTION BED INSTALLED. SEE PLAN NEEDED TO ESTABLISH GRADES M... ,9., d .,. l" , � � .' �' . ?' " .,..._.. y.._. __... ,_.; r_.• F__.r r 'r'1..;/- i .y',3:✓ .✓ ✓-s✓ .✓ ,-f- ✓`.;_✓ -✓ :.J" ✓ >.f`*,✓,,.✓ ✓-w .y.✓ z APPROX. EXISTING GRADE 6" MtN STONE BELOW PIPE 3' MINIMUM r i - E 7 SEPARA770N BED WIDTH & GEOMETRY PER PLAN. _..._TOBOUNDARY' __...; ; :;, �✓ �✓ ✓ �:�� ✓s.� r:�s ✓, "✓ t✓,,.✓..., ✓ t .✓ ✓°; ;,:y✓-,F..r:r; CONDITION 30 0\ 314"-1-1/2" WASHED ABSORPTION BED PLAN I ` A� CRUSHED STONE ABSORPTION BED SECTION NTS 0a T_ RIP AND DECOMPACT 1'-6" INTO EXISTING COMPACTED NTS < SURFACE SOILS AND BLEND WITH GRANULAR FILL MATERIAL. e MECHANICALLY STABILIZE WITH TRACKED EQUIPMENTS, Oo787` E ; SYSTEM INSTALLATION NOTESx SYSTEM MATERIAL SPECIFICATIONS CONSTRUCTION SHALL BE AS SHOWN ON THIS DRAWING AND IN ACCORDANCE WITH THE N.Y.S. DEPARTMENT OF ABSORPTION BED AGGREGATE HEALTH INDIVIDUAL HOUSEHOLD SYSTEMS AND ASTM F481 INSTALLATION OF THERMOPLASTIC PIPE AND CORRUGATED ALTERATION OF THIS DOCUMENT EXCEPT TUBING IN SEPTIC TANK LEACH FIELDS. EFFLUENT IS TO BE 314" TO 1-112" WASHED CRUSHED STONE. A LICENSED PROFESSIONAL ENGINEER IS A A EFFLUENT SEWER PIPE VIOLATION OF NYS EDUCATION LAW. AFTER EXCAVATION OF 15' WIDE X 30' LONG ABSORPTION BED TO 774E DEPTH REQUIRED, THE WALLS AND FLOOR PIPING TO BE 4" SDR-35 OR SCHEDULE 40 PVC. INSTALL WITH 1 f8" PER FOOT MINIMUM SLOPE. SHALL BE CLEANED AND RAKED IN ORDER TO LOOSEN SMEARED AREAS OF SOIL. FILTER FABRIC FILTER FABRIC TO BE 4.8 OZjSY NON-WOVEN SEPARATION FABRIC, 7ENCATE M1RAF7 140N OR PLACEMENT OF CRUSHED STONE, PERFORATED PIPE AND FILTER FABRIC SHALL BE AS SHOWN, AND CARE SHALL BE EQUIVALENT. Hutchins EXERCISED TO AVOID INCLUSION OF FINE GRAINED SOILS AND WASTE MATERIAL IN THE STONE AND PIPE. FORCEMAIN PIPING TO BE 1-112" SDR-11 HDPE OR SDR21 PVC, PROVIDE POSITIVE DRAINBACK TO PUMP STATION. Engineering THE PIPE SHOULD BE LAID AT THE GRADES INDICATED MAINTAINING STRAIGHT CONTINUOUS GRADES WITHOUT SAGS HOUSE SEWER PIPE HUMPS, SEPARATED JOINTS, OR OTHER UNSUITABLE CONDITIONS. PIPE SHALL BE LAID WITH HOLES DOWN IN ALL PIPING TO BE 4" SDR-35 OR SCHEDULE 40 PVC. INSTALL WITH 114" PER FOOT MINIMUM SLOPE. PLLC CASES. SYSTEM FILL 169 Haviland Rood AS DESCRIBED IN FILL MATERIAL NOTES" Queensbury, NY 12804 ALL DISPOSAL FIELDS SHALL BE GRADED TO SHED RAINFALL AND DIVERT SURFACE RUNOFF AWAY FROM THE TOPSOIL (518) 745-0307 Phone DISPOSAL FIELD. PLACE 4" MINIMUM TOPSOIL OVER ENTIRE BACKFILL AREA. SEED, MULCH, AND ESTABLISH TURF. (518) 745-0308 Fax DO NOT USE HEAVY EQUIPMENT WITHIN THE ABSORPTION AREA AFTER PIPING HAS BEEN INSTALLED. WASTEWATER SYSTEM FILL TAX MAP # 240.-1-22 THE WASTEWATER TREATMENT SYSTEM IS DESIGNED AND APPROVED BASED UPON THE INSTALLATION OF WATER MATERIAL NOTES WASTEWATER CONSERVING FIXTURES AND A DESIGN FLOW OF 110 GPD PER BEDROOM. THE SYSTEM IS NOT DESIGNED TO AFTER REMOVING ORGANICS & TOPSOIL, PLACE SYSTEM FILL OVER THE ENTIRE AREA OF PROPOSED ACCOMMODATE EXTREME WATER USE FIXTURES, SUCH AS JACUZZI-TYPE SPA TUBS OR WATER TREATMENT ABSORPTION BED AND TAPER AREA. SYSTEM PLAN EQUIPMENT. THE INSTALLATION OF NON-CONSERVING WATER FIXTURES OR EXTREME WATER USE FIXTURES IS CONTRARY TO 774E APPROVAL OF THIS WASTEWATER TREATMENT SYSTEM. "ABSORPTION AREA SYSTEM FILL" MATERIAL SHALL BE CAREFULLY SELECTED SAND OR SANDY LOAM & DETAILS W1774 IN-PLACE PERCOLA77ON RATE OF 3-6 MIN/INCH AND NO ORGANICS OR OBJECTS OVER 3" IN ROOF, FOOTING, GARAGE, CELLAR AND SURFACE WATER DRAINAGE MUST BE EXCLUDED FROM THE WASTEWATER SIZE. LESS THAN 10% BY WEIGHT SHALL BE FINER THAN 0.05mm. AT LEAST 25% OF THE MATERIAL SYSTEM. BY WEIGHT SHALL BE IN 714E RANGE OF 0.50mm TO 2.0mm. LESS THAN 15% OF THE MATERIAL BY prepared for: WEIGHT SHALL BE LARGER THAN A l j2" SIEVE North QUeenSbUry CONSTRUCT DRAINAGE SCALE UPGRADE OF SYSTEM IN ORDER TO DIVERT SURFACE RUNOFF AROUND ABSORPTION FIELD. ABSORPTION AREA SYSTEM FILL MATERIAL SHALL BE INSTALLED TO PROVIDE MINIMUM OF 3-FEET Volunteer Fire BETWEEN SEASONAL HIGH GROUNDWATER (60" FROM NA71VE GRADE AT TP-1)) AND BOTTOM OF a COl7Iil INC. SEP77C TANK, PUMP STA77ON & ABSORPTION BED MUST BE INSPECTED BY LOCAL BUILDING DEPARTMENT AND ABSORPTION BED. ONLY SYSTEM FILL MATERIAL SHALL BE INSTALLED THROUGHOUT THE ABSORP77ON Company, DESIGN ENGINEER PRIOR TO BACKFILL AND FINAL GRADING. IT IS THE RESPONSIBILITY OF THE CONTRACTOR TO BED AREA AND TAPER AREAS 2663 State Route 9L IDENTIFY THE NECESSARY PAR77ES AND REQUEST INSPECTIONS ABSORP77ON AREA SYSTEM FILL MATERIAL IS TO BE MECHANICALLY STABILIZED IN 12" LIFTS WITH Town of Cleverdale, TRACKED EQUIPMENT PRIOR TO INSTALLATION OF ABSORPTION TRENCHES County of Warren, INSTALLER TO N017FY ENGINEER OF PROPOSED SOURCE OF SYSTEM FILL MATERIAL PRIOR TO State Of New York TRANSPORTING TO SITE WASTEWATER SYSTEM SETBACK REQUIREMENTS Drown: AVA Checked: LWD STREAM, LAKE, scale: NOTED Data: 0113112024 PROPERTY LINE HOUSE WATERCOURSE, WELL WEXAND SEPTIC TANK 10' 10, 50' 50, 292054-01 -S2 ABSORPTION FIELD 1 10' 1 20' 1 100' 1 100' i, '4 e <./ .; PARKING �00' WELL _, d .�. e d t.� 44' "d '�a' a'a a. _ ea . a d° " j . ° SETBACK • w ° : - i'ii I 1.. ' ° <d"°�a �, d�o° /•♦.n d.•° 'e °.ad.,.a• yee a ' e e....'.. 'a d•ae`e '9f e.6 es e 4e• a ae d.I�a/aa'yL^ d'4°d'•° :°a d° e, / -wI.:rr'`it�'„ .J.ae fi-t — • — e_a a.e.e+.°.L _ -•�: —'— ,° h-•..ii✓2Jf . C.:OTr"S'.k/r,ro„✓�✓..,j< -°"�a=.4y,,•a.J�3.4ee.d"d; 'mJ°d..ams rt.(e,r R.+✓ `✓`.�?i;-''.e�°'' '"- :'a--fe�ai/% d_c':.MrsrY'°."r yh '.~X#✓,ar.a ° z� C)rT_'"s.✓i.<ai_ -"1 . Si:.� :r°a . .i` srry'J �✓Ste ..",C.�✓Ya -4`e�a.rn . °�eSe'd-'x."" eqJ�,°rj-i '� 9/a sae''%a'j�✓ a ".rr-k °A`•-f"✓,s`,.�,' drrst x ,� � ;,./, ,s',`�a✓ . i,r .`"';/f'.d.,r.�.'" 7h-' ✓ -_�.r—syti'."s/�. `��._.`1,i_$�r _✓`l,...rr;,... sc - - `3 >"' . `. dd• e ,°:a ter° •• ' d•'4_d e•'.P.• : _a • R e IIe/ \ a` \a °\ \\\ \ \\i\ \ \ \\ \ 4\\ \\ \\°• \\ °\\\\d \\ \\ \\\ ` \\ d \\\ \ \` . \\\\ \\ \\\\ \� \\\\\\ \\R \\\ \a\ \ .\ `to 4 .a J'4 d d DRIVE PARKING .a FIRE d\\\\ \\\° HOUSE '*4s4 m LINE A. ZONE A. \ al d'd B° ° a EXISTING da WELL sQXI Cq e4 a a° d d, LC n/T e .. aa`d. ` a a .a FAURETUARE . R° •E:ng e 24 °.. . d 0 WELL . a IILRJEIw ykw d ,,Q ; ,I . p UNDERGROUND ELECTRICALLLJ STONE RETENTION oTO BE LOCATED AND AREASERVE VERIFIED PRIOR TO r EXCAVATION t " 4 \ 4 EXISTING FIREHOUSE EX/STING SEPTIC HOLDING d1.. ABSORPTION FIELD PERTANTO BE REMOVED — RECORD DRAWNG DATED o \ .e° ' .i• d°' ' '• m. °• a.d n:e e• 1 \ \ \ \ .4 < 8 "a E .. ed O.. {Nj �•'►e- �j �_ \ \\ \ \ \\ \\ \ \U , 1 g o A. .] 1. V I s. NEW 1,250 GAL PRECAST -a...._ \\ \ \ \v v a f CONCRETE SEPTIC TANK 100' WETLAND �.. �°d . ate.° a' �-- -- - . a :. K •., ,d, . a K7 d � — - NEW 1,000 GAL PRECAST ` EXISTING RESCUE- : CONCRETE PUMP STATION J EXWEL NG J. --,50' WELL / SETBACK f, Gyp NEW BUILDING SEWER ` _"'""'�- w� - nj EXISTING BUILDING SEWER ` APPR X. TREE LINE NEW FORCE MAIN I • ''1 f L50'LAND S�C -- 1 v o� 1 � 1 WETLAND AS FLAGGED BY APA �- PER MAP REFERENCE- 3 WASTEWATER SYSTEM PLAN SCALE: 1 "--50' GRAPHIC SCALE 2,5 10 20 ( IN FEET ) CONTRACTOR TO MELD VERIFY LOCATIONS AND DISTANCES. THIS IS NOT A FIELD SURVEY NEW DISTRIBUTION BOX NEW 15X30 ABSORPTION BED SYSTEM FILL AS NEEDED SITE LOCATION—` LOCATION MAP WASTEWATER SYSTEM DESIGN 2-BEDROOM 24-HR STAFFED RESCUE SQUAD BLDG (DESIGN TO 330 GPD) DESIGN FLOW - 110 GPD/BEDROOM a p SYSTEM DESIGN FLOW - 330 GPD o .� SEPTIC TANK - 1,250 GALLON DUAL COMPARTMENT, ONE PIECE PRECAST CONCRETE TANK j PUMP STATION - 1,000 GALLON, ONE PIECE PRECAST CONCRETE DESIGN APPLICATION RATE: .8 GPD/SF, BASED ON 6-7 MIN/IN PERCOLATION RATE ABSORPTION BED AREA REQ D = (330 GPD)/(.8 GPD/SF) = 413 SF POTABLE WATER SUPPLY IS TO BE ON -SITE WELL MAINTAIN 50' MINIMUM SEPARATION BETWEEN Z SEP77C TANK & WELL MAINTAIN 100' MINIMUM SEPARATION BETWEEN ABSORP77ON FIELD & WELL SITE SOILS DATA TEST PIT TP-1 - 0411712024 BY TOM HUTCHINS, P.E. 0-12" - DARK SANDY LOAM TOPSOIL FEW BOULDERS 12-34" - LIGHT BROWN FINE SAND, COBBLES AND BOULDERS 34-60" - LIGHT BROWN SILT LOAM ROOTS ALL DEPTH NO GROUNDWATER EVIDENT TO 60" PERCOLATION TEST PT-1 - 411712024 BY HUTCHINS ENGINEERING STABILIZED PERCOLA77ON RATE: 6 MINUTE PER INCH R_-,: Za �-'� '•�= B8 8:0 LL�0- 14g co 0 M ff o w=. 3 n A (DMN U') fD o M C C D Q rDD TI N ® N N co Ul TO'V'JN OF • w.. BUILDING& O Reviewed ' Q APR FILE cOPY MAP REFERENCE: 1. BASE MAP INFORMATION FROM "PLOT PLAN MADE FOR NORTH QUEENSBURY VOLUNTEER FIRE COMPANY, INCORPORATION" BY DAVID J. BOLSTER, JANUARY 10. 2015. 2. "A NEW FIREHOUSE FOR THE. NORTH QUEENSBURY VOLUNTEER FIRE COMPANY, INC" BY RICHARD E. JONES ASSOCIATES, JUL Y 2, 1993. 3. "TOPOGRAPHIC MAP OF A PORTION OF LANDS OF NORTH QUEENSBURY VOLUNTEER FIRE CO. INC." BY COULTER & MCCORMACK, JUNE 22, 1994. 4. "MAP MADE FOR NORTH QUEENSBURY VOLUNTEER RESCUE SQUAD, INC." BY VAN DUSEN & STEVES LAND SURVEYORS, LLC, JUNE 6, 2000. WASTEWATER SYSTEM SETBACK REQUIREMENTS STREAM, LAKE, PROPERTY LINE HOUSE WATERCOURSE, WELL WETLAND SEP71C TANK 10' 10' 50' 50' ABSORPTION FIELD 10' 20' T 100' 100' ALTERATION OF THIS DOCUMENT EXCEPT BY A LICENSED PROFESSIONAL ENGINEER IS A VIOLATION OF NYS EDUCATION LAW. Hutchins Engineering PLLC 169 HoAand Rood Queensbury, NY 12804 (518) 745-0307 Phone (518) 745-0308 Fax prepared for. North Queensbury Volunteer Fire Company, INC. 2663 State Route A Town of Cleverdale, County of Warren, State of New York Drawn: AVA Checked: LWD fta1e; NOTED Date_ 0113112024 299-054-01 -S1 Dig Safely, NeWPAYork 4" PVC SDR-35 F INLET MIN. SLOPE 1/4» PER FOOT d WATERTIGHT SLEEVE AND - SEAL (TYP) SEPTIC TANK NOTES ALL UNITS SHALL COMPLY WITH THE REQUIREMENTS OF THE NEW YORK STATE DEPARTMENT OF HEALTH AND SHALL BE OF PRECAST CONCRETE AS MANUFACTURED BY UTOPIA ENTERPRISES OR EQUIVALENT. 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 TANKS INSTALLED IN TRAFFIC AREAS SHALL BE OF EXTRA HEAVY CONSTRUC7ION DESIGNED FOR H-20 WHEEL LOADING. ALL JOINTS MUST BE SEALED WITH BUM SEALANT. JOINTS BELOW THE LIQUID LEVEL MUST BE TESTED BEFORE BACKFILLING. POLYETHYLENE EXTENSION TO GRADE WITH TAMPER RESISTANT ACCESS COVER 12" MIN. COVER a r 2" LIQUID LEVEL 16" 47H x18"W SLOT—,,18" (2) 4" ELBOWS MIN. OR 6" ELBOW — z o � o 0 60-75% OF 25-40% OF o `� `D TANK VOLUME TANK VOLUME MINIMUM 2X WIDTH MAXIMUM 4X WIDTH 1,250 GALLON PRECAST CONCRETE SEPTIC TANK 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. AFTER EXCAVA77ON OF 15' IMOE X 30' LONG ABSORP77ON BED TO THE DEPTH REQUIRED, THE WALLS AND FLOOR SHALL BE CLEANED AND RAKED IN ORDER TO LOOSEN SMEARED AREAS OF SOIL, PLACEMENT OF CRUSHED STONE, PERFORATED PIPE AND FILTER FABRIC SHALL BE AS SHOWN, AND CARE SHALL BE EXERCISED TO AVOID INCLUSION OF F7NE GRAINED SOILS AND WASTE MATERIAL IN THE STONE AND PIPE. THE PIPE SHOULD BE LAID AT THE GRADES INDICATED, MAINTAINING STRAIGHT CONTINUOUS GRADES WITHOUT SAGS, HUMPS, SEPARATED JOINTS, OR OTHER UNSUITABLE CONDITIONS. PIPE SHALL BE LAID WITH HOLES DOWN IN ALL CASES. 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 PIPING HAS BEEN INSTALLED. THE WASTEWATER TREATMENT SYSTEM IS DESIGNED AND APPROVED BASED UPON THE INSTALLA77ON OF WATER CONSERVING FIXTURES AND A DESIGN FLOW OF 110 GPD PER BEDROOM. THE SYSTEM IS NOT DESIGNED TO ACCOMMODATE EXTREME WATER USE FIXTURES, SUCH AS JACUZZI—TYPE SPA TUBS OR WATER TREATMENT EQUIPMENT. THE INSTALLATION OF NON —CONSERVING WATER FIXTURES OR EXTREME WATER USE FIXTURES IS CONTRARY TO THE APPROVAL OF THIS WASTEWATER TREATMENT SYSTEM. ROOF, FOOTING, GARAGE, CELLAR AND SURFACE WATER DRAINAGE MUST BE EXCLUDED FROM THE WASTEWATER SYSTEM. CONSTRUCT DRAINAGE SCALE UPGRADE OF SYSTEM IN ORDER TO DIVERT SURFACE RUNOFF AROUND ABSORPTION FIELD. SEP77C TANK, PUMP STATION & ABSORP77ON BED MUST BE INSPECTED BY LOCAL BUILDING DEPARTMENT AND DESIGN ENGINEER PRIOR TO BACKFILL AND FINAL GRADING. IT 1S THE RESPONSIBILITY OF THE CONTRACTOR TO IDEN71FY THE NECESSARY PARTIES AND REQUEST INSPECTIONS. APPROXIMATE FINISH GRADE ME 1/8" PER FOOT MIN. SLOPE am- 4" PVC SDR 35 ALARM 3" ABOVE 'PUMP ON' & LAG PUMP ON PUMP ON PUMP OFF SEPTIC TANK AND PUMP STATION DETAIL SCALE: NTS POLYETHYLENE EXTENSION TO GRADE WITH TAMPER RESISTANT ACCESS COVER EXTERIOR WE ATHERPROOF JUNCTION BOX (IF NECESSARY). SEAL CONDUIT GAS TIGHT INSTALL CONTROL PANEL IN HOUSE. ALL ELECTRICAL WORK TO BE INSPECTED BY A CERTIFIED ELECTRICAL INSPECTION AGENCY PRIOR TO START-UP OF PUMP STATION. 1 INSTALL FLOAT TRANSITION TO 4",12" MIN. COVER SWITCHES TO OPERATE OUTSIDE OF DISTRIBUTION BOX PUMP AND MAINTAIN D-BOX LEVELS AS INDICATED as BAFFLE BALL VALVE USE SPEED LEVELERS TO-11 INSTALL VALVES AND UNIONS ASSURE ALL OUTLETS ARE AT SUCH THAT EITHER PUMP CAN BE EXACTLY THE SAME ISOLATED AND REMOVED WITHOUT ELEVATION REQUIRING PIT ENTRY 4" PVC SDR-35 SOLID HEADER BALL CHECK VALVE TO PERFORATED ABSORPTION TRENCH PIPING, 118" PER FOOT 1-112" HDPE MIN SLOPE FLOAT SWITCHES - INSTALL INSIDE SDR-11 FORCEMAIN PUMP PIT IN LOCATION ACCESSIBLE WITHOUT PIT ENTRY 1-1/2" SCH-40 PVC PIPING INSIDE WET WELL THROUGH WALL UNION - LOCATE SUCH THAT 16" MIN. UNION CAN BE DISCONNECTED AND PUMP REMOVED WITHOUT TANK a ENTRY a a REDUCING TEE POINTED DOWNWARD 1,000 GALLON PRECAST CONCRETE PUMP STATION WITH 1" BALL VALVE THROTTLED TO ALLOW TRICKLE DRAIN BACK INTO WETWELL SIMPLEX EFFLUENT PUMP SYSTEM MATERIAL SPECIFICATIONS ABSORPTION BED AGGREGATE STONE IS TO BE 3/4" TO 1-1/2" WASHED CRUSHED STONE. EFFLUENT SEWER PIPE PIPING TO BE 4" SDR-35 OR SCHEDULE 40 PVC. INSTALL WITH 118" PER FOOT MINIMUM SLOPE. FILTER FABRIC FILTER FABRIC TO BE 4.8 OZ/SY NON —WOVEN SEPARATION FABRIC, TENCATE MIRAFI 140N OR EQUIVALENT. FORCEMAIN PIPING TO BE 1-1/2" SDR-11 HOPE OR SDR21 PVC, PROVIDE POSITIVE DRAINBACK TO PUMP STATION. HOUSE SEWER PIPE PIPING TO BE 4" SDR-35 OR SCHEDULE 40 PVC. INSTALL WITH 1/4" PER FOOT MINIMUM SLOPE. SYSTEM FILL AS DESCRIBED IN "FILL MATERIAL NOTES." TOPSOIL PLACE 4" MINIMUM TOPSOIL OVER ENTIRE BACKFILL AREA. SEED, MULCH, AND ESTABLISH TURF. WASTEWATER SYSTEM FILL MATERIAL NOTES AFTER REMOVING ORGANICS & TOPSOIL, PLACE SYSTEM FILL OVER THE EN77RE AREA OF PROPOSED ABSORP77ON BED AND TAPER AREA. "ABSORPTION AREA SYSTEM FILL" MATERIAL SHALL BE CAREFULLY SELECTED SAND OR SANDY LOAM WITH IN —PLACE PERCOLA77ON RATE OF 3-6 MIN/INCH AND NO ORGANICS OR OBJECTS OVER 3". IN SIZE. LESS THAN 107 BY WEIGHT SHALL BE FINER THAN 0.05mm. AT LEAST 257. OF THE MATERIAL BY WEIGHT SHALL BE IN THE RANGE OF 0.50mm TO 2.Omm. LESS THAN 157. OF THE MATERIAL BY WEIGHT SHALL BE LARGER THAN A 1/2" SIEVE ABSORPTION AREA SYSTEM FILL MATERIAL SHALL BE INSTALLED TO PROVIDE MINIMUM OF 3—FEET BETWEEN SEASONAL HIGH GROUNDWATER (60" FROM NA77VE GRADE AT TP-1)) AND BOTTOM OF ABSORP77ON BED. ONLY SYSTEM FILL MATERIAL SHALL BE INSTALLED THROUGHOUT THE ABSORPTION BED AREA AND TAPER AREAS. ABSORPTION AREA SYSTEM FILL MATERIAL IS TO BE MECHANICALLY STABILIZED IN 12" LIFTS WITH TRACKED EQUIPMENT PRIOR TO INSTALLATION OF ABSORPTION TRENCHES, INSTALLER TO N077FY 7RANSPOR71NG TO SITE ENGINEER OF pROPOSo SOURCE OF SYSTEM Flit MATERIAL PRIOR TO LIMIT ' 15' L 2" MIN. 2" MIN. DROP BETWEEN INVERTS SITE LOCATION LOCATION MAP PUMP STATION NOTES SEAL ALL TANK OPENINGS WATERTIGHT. PROVIDE AND INSTALL UL LISTED PACKAGED PUMP CONTROL PANEL WITH VISUAL AND AUDIBLE ALARM. INSTALL SIMPLEX, DEMAND DOSE CONTROL PANEL INSIDE HOUSE IN ACCESSIBLE LOCATION. INSTALL POWER & CONTROL WIRING TO CONTROLLER WITH ALARM IN HOUSE IN ACCORDANCE WITH MANUFACTURER'S INSTRUC77ONS AND NA77ONAL ELECTRIC CODE (N.EC.) REQUIREMENTS. PUMP CONTROL AND FLOAT LEVELS TO BE INSTALLED TO PROVIDE A 50 GALLON DOSE. EFFLUENT PUMPS TO BE GOULDS PUMPS WE SERIES, MODEL WE05H SUBMERSIBLE EFFLUENT PUMP .5 HP, 230 VOLT, 1PH VERIFY EXISTING ELECTRICAL SERVICE PRIOR TO PURCHASING PUMP. ALL ELECTRICAL WORK TO BE INSPECTED BY A CERTIFIED ELECTRICAL N AGENCY PRIOR TO START—UP OF PUMP STA770N. ' 30' Inu ABSORPTION BED PLAN NTS )POSED TRIBU77ON BOX TRANSITION FORCE MAIN TO 4" PVC OUTSIDE OF D—BOX S Call Before You Dig IN Wait The Required Time Confirm Utility Response Respect The Marks IM Dig With Care 800-962.7962 www.digsafelynewyork.com rr o N 0 d- O o , o N ALTERATION OF THIS DOCUMENT EXCEPT BY A LICENSED PROFESSIONAL ENGINEER IS A VIOLATION OF NYS EDUCATION LAW. Hutchins Engineering PLLC 169 HoAand Road Queensbury, NY 12804 (518) 745-0307 Phone (518) 745-0308 Fax TAX MAP # 240. -1-22 WASTEWATER S YS TEM PLAN & DETAILS prepared for. North Queensbury Volunteer Fire Company, INC. 2663 State Route A Town of Cleverdale, County of Warren, State of New York WASTEWATER SYSTEM SETBACK REQUIREMENTS Drawn: AVA Checked: LWD STREAM, LAKE, Scale: DOTED Date: 01/31/2024 PROPERTY UNE HOUSE WATERCOURSE, WELL KTLA"D 02054-01 -S2 SEPTIC TANK 10' 10' 50' 50' 2 4 ABSORPTION FIELD 10' 20' 100 100'