1.3 1.3
SETPHNAMTobin-Replacement WasteNvater System to Well-10-19-15
RESOLUTION SETTING PUBLIC HEARING ON SEWAGE DISPOSAL
VARIANCE APPLICATION OF JAMES TOBIN
RESOLUTION NO.: ,2015
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, James Tobin has applied to the Local Board of Health for variances from Chapter
136 to install a replacement on-site subsurface wastewater treatment system with the absorption
trenches to be located ±88' and ±90' from the well on the property in lieu of the required 100'
distance(s) on property located at 15 Dark Bay Lane, Queensbury,
NOW, THEREFORE, BE IT
RESOLVED, that the Town of Queensbury's Local Board of Health will hold a public hearing
on Monday, November 2nd, 2015 at 7:00 p.m. at the Queensbury Activities Center, 742 Bay Road,
Queensbury, to consider James Tobin's sewage disposal variance application concerning property
located at 15 Dark Bay Lane, Queensbury (Tax Map No.: 239.18-1-34) 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' of the applicant's property as required by law.
Duly adopted this 19t`day of November, 2015, by the following vote:
AYES
NOES
ABSENT:
•
8 g, Evergreen Professional Park
SCHODER R/VERS ;�� - -`1( 453 Dixon Road, Suite 7, Bldg. 3
ASSOCIATES 4 u Queensbury, NY 12804
Consulting Engineers, P.C. ,y L. Tel. (518) 761 -0417
•
OCT $ 2�,5 �L Fax (518) 761 -0513
0 •
QUEENSBURY `'-
Town of Queensbury CLERK'S OFFICE .. J October 6, 2015
742 Bay Road SRA 15-949
Queensbury, NY 12804 i�j-1
Z
ATTN: Dave Hatin, Director of Building &Code Enforcement
RE: Wastewater System Replacement Variance Application for Tobin Residence, 15 Dark Bay Lane,
Town of Queensbury, NY
Dear Mr. Hatin:
We have been retained by James Tobin, the owner of the existing residence at 15 Dark Bay Lane,
Queensbury, NY, to complete the design for a replacement on-site subsurface wastewater treatment
system.
The recent failure of the existing system servicing the residence prompted a site investigation by Schoder
Rivers Associates (SRA)to determine the feasability of replacing the system. The extent of the existing
treatment system consists of a metal septic tank and single forty foot long perforated PVC lateral
discharging directly from the tank. The absorption field was noted to no longer be infiltrating effluent during
the site investigation.
The owner anticipates replacing the existing deficient wastewater treatment system at this time. Due to the
location of the residence, the magnitude of existing slopes and the overall lot size,the only location for a
replacement subsurface treatment system was determined to be in an area of 10-12% existing site slopes
west of the residence. The available site area will require a well separation variance from the Town of
Queensbury Sewers and Sewage Disposal Ordinance as follows:
• Chapter 136 Article II. Section 136-9.D - Horizontal separation from wastewater disposal system to
potable water well: 100 ft. required-88 ft. and 90 ft. proposed.
As a mitigative measure in support of this variance request, we are proposing to utilize Advanced Enviro-
Septic®(AES) as manufactured by Presby Environmental, Inc. as an enhanced subsurface wastewater
disposal treatment system for the replacement absorption trenches.
We assume that, as a part of the variance application process, the proposed design must be reviewed by
the Town Engineer. To that end, we have enclosed the following information for review:
• Nine (9) copies- Septic Variance Application and, SEQRA Short Environmental Assessment Form.
• Nine (9) prints each -Drawings C-1 and C-2, all Revision 0 dated 10/6/15-site plans and details for
the wastewater system replacement project.
Please contact our office at any time if additional information is required.
Sincerely,
Matthew Huntington, PE
Project Engineer
cc: James Tobin, Owner-w/attachments
Town of Queensbury Building & Codes Office Use Only
SEPTIC VARIANCE APPLICATION Received:
Tax Map ID:
Submittal: 1 original &8 copies of the completed application package Permit No.:
Permit Fee: $
Approvals:
Owner jaif?G4 /d6/f1 Owner's Agent AAA/ #444/4 felok/4wf^�
/ gar/< , 4G s" . f 14 c
Address � �y � Address y � /�irah �i', � Z g/o�.
au s6kry, 4 Gray Q ee /y, 49 fa_ov
Phone S-//-A.‘fl-- Jh*f Phone .S-/t- 7//O'f/ ev.
Directions to Site: 4/0/14 an C/4, 44,4 fL. A PP m- q»14/5 im ,P' '71 '74 /4se44°rI/
Lef on Oa// 4 7 £ . 14
614/1.1.0. a. Alff./8_-/-N
Distance from well on property to septic system(if applicable) F r feet
Is it possible to install a conforming septic system on this property? Yes VNo
If YES, please explain and attach diagram:
Does proposed system meet setback requirements for distance from wells &septic systems on neighboring properties?
V Yes No If NO, please explain:
Is proposed system to be installed over a parking area? Yes r/No
Section of the Sanitary Sewage Ordinance from which you are seeking the variance: (example: leaching system will be 89 ft.
from well in lieu of required 100 ft. separate distance):
5ti
(df/r,/gam ,415-a//0/,..an r/efrie A eS w//( le !'fr/Y. 9 V 7f.
f;„4.7 ,ve f/ 00/ ,/o/De., / s'4 I'eu o/ /er 6f,'/eal 0:a as SGLD rn f'O1/2
'S 'arse e• . ,4 . ,.,.,.. /.9-4.1;v1 .rlecl f s7e 4 rG- "/oleos,4 44
E'rii4,'IGeo7 sg/ /1 6 wg sit 4/4"✓ 144/0/0/7T sy r7 (,44rn /
bl i//70 - 'elt,7/C. r/re as "f4,14/7664ted A/ 451,/ bi4i-gri An&4.4/... e )
,Ge- ar,/'zes/ / 71.1G adso/Peofri f/tichG j .
Town of Queensbury Building&Codes Septic Variance Application 518-761-8256
List the names, parcel addresses,and tax map numbers of all adjoining property owners. You may obtain tax map numbers
from the Assessor's Office as well as the names and addresses:
North Name .ar1/4 /4/D
Address 3?' 4/l /3a Z.vi&
Tax Map ID 239•/$ -/-3$
South Name: OG, 4/0,1 AS564/4/eS
Address c/afe ■f /& 9L
Tax Map ID 25f /-35
East Name: Amhi4 L7oic/— 4#9,6/
Address /7 42,4 4a7 L4iiC
Tax Map ID 259 /" - / -39 1
West Name: t✓oe ate/ 67044 s G,*v/),15 z ST Z /CGi? 441 " r
Address /7 t 4// /4/44e o�
Tax Map ID ;5f /r-/-502,
OWNER STATEMENT
1,we do herby reliev the Town of Queensbury from any liabilities on the plumbing and septic system located at:
1_< L4/(� 64y !writ
I, w re lize tha putting the will,septic tank,or.leaching system less than the required /OD feet from the
a`e *4/e/ we// may increase risk of pollution.
Owner-Print Name:
Owner Signature: / , Date:
NEIGHBOR OR TENANT RELEASE STATEMENT(if applicable)
I,we do hereby relieve the To n of Queensbury from any liabilities on the plumbing and septic system located at:
I,we realize that puttin th septic tank or leaching system less than the required feet from the
may increase risk of pollution.
Neighbor or Tenant-Print Name:
Neighbor or Tenant-Signature: Date:
Town of Queensbury Building&Codes Septic Variance Application 518-761-8256
PLEASE ATTACH THE FOLLOWING TO YOUR APPLICATION:
1. Location map showing the site within the Town of Queensbury;
2. 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(streets, steep slopes, lakes,wetlands, etc.)
f) Location of all wells and septic systems on neighboring properties
g) Adjacent ownership
h) All properties within 500 feet.
A sample plot plan and location are shown below
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Town of Queensbury Building&Codes Septic Variance Application 518-761-8256
617.20
Appendix B
Short Environmental Assessment Form
Instructions for Completing
Part l -Project Information. The applicant or project sponsor is responsible for the completion of Part 1. Responses
become part of the application for approval or funding,are subject to public review,and may be subject to further verification.
Complete Part 1 based on information currently available. If additional research or investigation would be needed to fully
respond to any item,please answer as thoroughly as possible based on current information.
Complete all items in Part 1. You may also provide any additional information which you believe will be needed by or useful
to the lead agency;attach additional pages as necessary to supplement any item.
Part 1 -Project and Sponsor Information
Name of Action or Project: �� t 5 7066;4 As,det1 Gtr /'4 e Ki-r/e✓ f a f/
sysIe.ri Pep/44esi eel 71
Project Location(describe,and attach a location map):
is' 4,/ BA7 /44e, queens 6"y, ' /;e0'
Brief pDescri��'tion of Proposed Action: Adel �qs�e wg kl' °4p c 1 f syf kit'J ferdi 6/'45
it e la6e art ex,s/,..11 A i
a /Are. 4eo'roarrt /5/c MC1 w,'M 4 4tI4/ a4-s,'/ w W4fe.'
4/ 9/54°1•
Name of Applicant or Sponsor: Telephone: , /�g_..w9
Uayy/G S oi,n E-Mail:j,07� /44 ay: f"?f44er:GO,'I
Address:
'c' Der/ 4, 444e.
City/PO: State: Zip Code:
&yee4114//1 fr/' a Ali G/
1.Does the proposed action only involve the legislative adoption of a plan,local law,ordinance, NO YES
administrative rule,or regulation?
If Yes,attach a narrative description of the intent of the proposed action and the environmental resources that \,
may be affected in the municipality and proceed to Part 2. If no,continue to question 2.
2. Does the proposed action require a permit,approval or funding from any other governmental Agency? NO YES
If Yes,list agency(s)name and permit or approval:
7:214/A/ 04. Queee, ,-6trry se/94c rte,V ,
3.a.Total acreage of the site of the proposed action? r/, ya acres
b.Total acreage to be physically disturbed? a 0q acres
c.Total acreage(project site and any contiguous properties)owned
or controlled by the applicant or project sponsor? a.. 142 acres
4. Check all land uses that occur on,adjoining and near the proposed action.
❑Urban ❑Rural(non-agriculture) ❑Industrial ❑Commercial %Residential(suburban)
❑Forest ❑Agriculture ❑Aquatic ❑Other(specify):
❑Parkland
Page 1 of 4
5. Is the proposed action, NO YES N/A
a.A permitted use under the zoning regulations?
b.Consistent with the adopted comprehensive plan?
6. Is the proposed action consistent with the predominant character of the existing built or natural NO YES
landscape? 2
7. Is the site of the proposed action locate in,op does it adjoi a state listed Critical Environmental Area? NO YES
If Yes,identify: W4 k15 4� �(/4/1°t S 2( b' Gaye'
8. a.Will the proposed action result in a substantial increase in traffic above present levels? NO YES
x
b.Are public transportation service(s)available at or near the site of the proposed action? �>
c.Are any pedestrian accommodations or bicycle routes available on or near site of the proposed action?
9.Does the proposed action meet or exceed the state energy code requirements? NO YES
If the proposed a tion will a ceed a irements,describe design features and technologies:
of , PP2 ?
10. Will the proposed action connect to an existing public/private water supply? NO YES
If Yes,does the existing system have capacity to provide service? ❑NO❑YES
If No,describe method for providing potable water: X
11.Will the P roposed action connect to existing wastewater utilities? NO YES
If Yes,does the existing system have capacity to provide service? ❑NO❑YES
If No,describe method for providing wastewater treatment:
12. a.Does the site contain a structure that is listed on either the State or National Register of Historic NO YES
Places?
b.Is the proposed action located in an archeological sensitive area?
13.a.Does any portion of the site of the proposed action,or lands adjoining the proposed action,contain NO YES
wetlands or other waterbodies regulated by a federal,state or local agency? /1
b.Would the proposed action physically alter,or encroach into,any existing wetland or waterbody?
If Yes,identify the wetland or waterbody and extent of alterations in square feet or acres:
14. Identify the typical h bitat types that occur on,or are likely to be found on the project site. Check all that apply:
❑Shoreline Forest ❑Agricultural/grasslands ❑Early mid-successional
❑ Wetland ❑Urban )4 Suburban
15.Does the site of the proposed action contain any species of animal,or associated habitats,listed NO YES
by the State or Federal government as threatened or endangered?
16.Is the project site located in the 100 year flood plain? NO YES
17.Will the proposed action create storm water discharge,either from point or non-point sources? NO YES
If Yes,
a.Will storm water discharges flow to adjacent properties? ❑NO 0 YES
b.Will storm water discharges be directed to established conveyance systems(runoff and storm drains)?
If Yes,briefly describe: ❑NO❑YES
Page 2 of 4
18.Does the proposed action include construction or other activities that result in the impoundment of NO YES
water or other liquids(e.g.retention pond,waste lagoon,darn)?
If Yes,explain purpose and size:
19.Has the site of the proposed action or an adjoining property been the location of an active or closed NO YES
solid waste management facility?
If Yes,describe: f
20.Has the site of the proposed action or an adjoining property been the subject of remediation(ongoing or NO YES
completed)for hazardous waste?
If Yes,describe:
1
I AFFIRM THAT THE INFORMATION PROVIDED ABOVE IS TRUE AND ACCURATE TO THE BEST OF MY
KNOWLEDGE '
Applicant/sponsor . - /' s'A\w T B 10 Date: OGT� �, ?.c)I r
i
Signature: ���.,
1 \
Part 2-Impact Assessment. The Lead Agency is responsible for the completion of Part 2. Answer all of the following
questions in Part 2 usipg the information contained in Part 1 and other materials submitted by the project sponsor or
otherwise available to the reviewer. When answering the questions the reviewer should be guided by the concept"Have my
responses been reasonable considering the scale and context of the proposed action?"
,j
No,or Moderate
small to large
impact impact
may may
occur occur
1. Will the proposed action create a material conflict with an adopted land use plan or zoning
regulations?
2. Will the proposed action result in a change in the use or intensity of use of land?
3. Will the proposed action impair the character or quality of the existing community?
4. Will the proposed action have an impact on the environmental characteristics that caused the
establishment of a Critical Environmental Area(CEA)?
5. Will the proposed action result in an adverse change in the existing level of traffic or
affect existing infrastructure for mass transit,biking or walkway?
6. Will the proposed action cause an increase in the use of energy and it fails to incorporate
reasonably available energy conservation or renewable energy opportunities?
7. Will the proposed action impact existing:
a.public/private water supplies?
b.public/private wastewater treatment utilities?
8. Will the proposed action impair the character or quality of important historic,archaeological,
architectural or aesthetic resources?
9. Will the proposed action result in an adverse change to natural resources(e.g.,wetlands,
waterbodies,groundwater,air quality,flora and fauna)?
Page 3 of 4
•
No,or Moderate
small to large
impact impact
may may
occur occur
I0. Will the proposed action result in an increase in the potential for erosion,flooding or drainage
problems?
11. Will the proposed action create a hazard to environmental resources or human health?
Part 3-Determination of significance. The Lead Agency is responsible for the completion of Part 3. For every
question in Part 2 that was answered"moderate to large impact may occur",or if there is a need to explain why a particular
element of the proposed action may or will not result in a significant adverse environmental impact,please complete Part 3.
Part 3 should,in sufficient detail,identify the impact,including any measures or design elements that have been included by
the project sponsor to avoid or reduce impacts. Part 3 should also explain how the lead agency determined that the impact
may or will not be significant.Each potential impact should be assessed considering its setting,probability of occurring,
duration,irreversibility,geographic scope and magnitude. Also consider the potential for short-term,long-term and
cumulative impacts.
❑ Check this box if you have determined,based on the information and analysis above,and any supporting documentation,
that the proposed action may result in one or more potentially large or significant adverse impacts and an
environmental impact statement is required.
❑ Check this box if you have determined,based on the information and analysis above,and any supporting documentation,
that the proposed action will not result in any significant adverse environmental impacts.
Name of Lead Agency Date
Print or Type Name of Responsible Officer in Lead Agency Title of Responsible Officer
Signature of Responsible Officer in Lead Agency Signature of Preparer(if different from Responsible Officer)
Page 4 of 4
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: k.);0,05 706ij'I
Designates: /i7VAC4/ 4 /iSm IV Pat/ ' vt/S Ai#c %41 ,)as agent regarding Septic Variance for
Tax Map ID: 0139./f /J 'la''
OWNER'S SIGNATURE: \.A f Date: OGT ?, 2,C)1
C
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 Viiity 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 application, and that 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.
11, the undersigned, have thoroughly read and understand the instructions for submission; agree to the submission
requirements and completed the checklist.
PRINT NAME OF OWNER:
SIGNATURE OF OWNER: �"
DATE: F"'�T.
PRINT NAME OF AGENT: n7 6N/ /%,1i7 / e
.X1-7
SIGNATURE OF AGENT:
DATE: /c / '/y
Town of Queensbury Building&Codes Septic Variance Application 518-761-8256