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1.11.1 SETPH.VAR \Shearer — New On Site Disposal — Leach Bed and Mound to Property Line & Mound Fill Side Slope — 5 -16 -16 RESOLUTION SETTING PUBLIC HEARING ON SEWAGE DISPOSAL VARIANCE APPLICATION OF MICHAEL SHEARER RESOLUTION NO.: ___92016 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, Michael Shearer has applied to the Local Board of Health for variances from Chapter 136 to install a new on site disposal system as follows: 1. Leach Bed to be 5'9" from the property line instead of the required 10' setback; 2. Mound/Basil limit will be 1'4" from the property line instead of the required 10' setback; and 3. Mound/System fill side slope will be 1:2 instead of the required 1:3; on property located at 52 Russell Harris Road, Queensbury, NOW, THEREFORE, BE IT RESOLVED, that the Town of Queensbury's Local Board of Health will hold a public hearing on Monday, June 6r'', 2016 at 7:00 p.m. at the Queensbury Activities Center, 742 Bay Road, Queensbury, to consider Michael Shearer's sewage disposal variance application concerning property located at 52 Russell Harris Road, Queensbury (Tax Map No.: 240.5 -1 -6) 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 16"' day of May, 2016, by the following vote: AYES NOES ABSENT: Town of Queensbury Building & Codes Office Use Only SEPTIC VARIANCE APPLI ?2� Received: Tax Map ID: Submittal: 1 original & 8 copies of the comple tcatiop package Permit No.: Permit Fee: Approvals: �i�► RY w co `. Q3E0111,oka— i I Owner Michael Shearer G1RKS Owner's ent Jarrett Engineers, PLLC Address 6051 Greens Corne Xd. yr Galway, NY 12074 Phone (518)656-3513 Phone Directions to Site: 52 Russell Harris Rd. 12 E. Washington St. Glens Falls, NY 12801 (518) 792 -2907 Distance from well on property to septic system (if applicable) SEE PLANS feet Is it possible to install a conforming septic system on this property? Yes x No If YES, please explain and attach diagram: Does proposed system meet setback requirements for distance from wells & septic systems on neighboring properties? x Yes _ No If NO, please explain: Is proposed system to be installed over a parking area? Yes x 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): 1. Leach bed will be 519 "± from property line in lieu of 10, required. 2. Mound /basil limit will be 114" from property ling in lieu of 10, required. 3. Mound /system fill side slope will be 1:2 in lieu of 1:3 required. Town of Queensbury Building & Codes Septic Variance Application 518 - 761 -8256 djolning PrOPCFtY owners. YOu III":ly Obtain tax Map IlUilibers List the names, parcel addresses,, and tax Map numbers Of all a from the Assessors Office as well as the names and caddresses: Taflan. 1-kidi Worth Name 5() Russell Harris Rd. Addr(,,s,-- 0. 4 _5 -5 fax iVlap ID 2. (aeasiran, Mchael South Name: 52 lj2 Russell Harris Rd. Address Ta x NI a p ID 4240. 5-1-7 East Nairle: Bette Dual ified Per Trust #1, Lisa K Address 34 Boat house Road 240..S-1-2.1 Tax Map ID Nance: Lake (korizlc IfYost Address Tax Map ID QWN E R !Lf AT E M � Kf relieve tlle,i,n and septic system located at: 1, we do hereby � �,,jn of Queensbury from any liabilities oil the plumbing 52 Russell Harris Road i, we realize that putting the well, septic tank, or leaching systern less than the required -,.10' feet from the __p�Eqpe,rty line Illay increase risk of pollution. Owner-Print Name: \V Owner- Signature: Date: ... k?AA tLEt(� �j3q Al of applicable) 1, we do hereby relieve the Town of Queensbury frolil any liabilities on the plumbing and septic system located 1, via realize that putting the septic tank or leaching system less than the required.,-. ------- _ feet from the may increase risk of pollution. Neighbor or *tenant -Print Name: Neighbor or 'Fenant-Sig nature: Tovai of Queonsbury Building & Cc&s Septic Variance Application Date: Short Environmental Assessment Form Part 1 - Project Information Instructions for Completing Part 1 - 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 Michael Shearer Name of Action or Project: Shearer Wastewater Project Location (describe, and attach a location map): 52 Russell Harris Road Brief Description of Proposed Action: Construction of new on site disposal system Name of Applicant or Sponsor: elephone: (518)656 -3513 Michael Shearer kE-Mail: shearem @gmail.com Address: 6051 Greens Corner Rd. City/PO: State: Zip Code: Galway NY 12074 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 V may be affected in the municipality and proceed to Part 2. If no, continue to question 2. 2. Does the proposed action require a pennit, approval or funding from any other governmental Agency? NO YES ❑✓ ❑ If Yes, list agency(s) name and permit or approval: 3.a. Total acreage of the site of the proposed action? 0.27± acres b. Total acreage to be physically disturbed? 0.03± acres c. Total acreage (project site and any contiguous properties) owned or controlled by the applicant or project sponsor? 0.27± acres 4. Check all land uses that occur on, adjoining and near the proposed action. ❑ Urban m Rural (non- agriculture) [—]Industrial ❑ Commercial m Residential (suburban) ❑Forest ❑Agriculture [1 Aquatic ❑Other (specify): ❑Parkland Page 1 of 3 Np YES I N/A 5. Is the proposed action, regulations? a. A permitted use under the zoning re g b. Consistent with the adopted comprehensive plan? 6. Is the proposed action consistent with the predominant character of the existing built or natural landscape? al 7. Is the site of the proposed action located in, or does it adjoin, a state listed CLake George Park commission, If Yes, identify: Namelake George, ReasonTrotect the resources of the park, Ag y: 8. a. Will the proposed action result in a substantial increase in traffic above present levels? b. Are public transportation service(s) available at or near the site of the proposed action? odations or bicycle routes available on or near site of the proposed action? c. Are any pedestrian accomm 9. Does the proposed action meet or exceed the state energy code requirements? If the proposed action will exceed requirements, describe design features and technologies: 10. Will the proposed action connect to an existing public /private water supply? If No, describe method for providing potable water: 11. Will the proposed action connect to existing wastewater utilities? 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 Places? b. Is the proposed action located in an archeological sensitive area? 13. a. Does any portion e °vaterbodies regu t d by a federal estate or local agency�roposed action, contain wetlands or oth 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: NO I YES NO YES ❑ W3 Nn YES T N ✓❑ ❑ NO I YES NO I YES 179AN 14. Identify the typical habitat types that occur on, or are likely to be found on the project site. Check all that apply: 0 Shoreline ❑ Forest ❑ Agricultural/grasslands ❑ Early mid - successional ❑ Wetland ❑Urban C] 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? 17. Will the proposed action create storm water discharge, either from point or non -point sources? If Yes, a. Will storm water discharges now to adjacent properties? ❑ NO ❑YES b. Will storm water discharges be directed to established conveyance systems (runolff and storm drains)? If Yes, briefly describe: LJ Page 2 of 3 IOC Elm ME 1 k. Does the proposed action include construction or other activities that result in the impoundment of NO YES `? a water or other liquids (e.g. retention pond, waste lagoon, dam) If Yes, explain purpose and Sit I6. Has the site of the proposed cation or an adjoining property been the location of an actn a or closed —m - ? O YES solid waste management facility =? If Yes, describe: [� a n �. _ �m .� �. ._.. _ _ , m_ E , .i 11 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: I AFFIRM THAT THE INFORMATION PROVIDED ABOVE IS TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE rlpplicant°sponsor name: �kk CAA(: U. yT•n1(�T - -: _ _ Datc:,_y QZt A Z0tS Signature:,.__.,___ T FORM Page 3 of 3 EAF Mapper Summary Report 244:5 -1,77' / 244.5 --1�8 /24 ©:5 -1- 92.40 5 244.5 -1 -11 44.5 -1 -12 244.5 -1-2.1 244.5 -1 -1 Monday, October 26, 2015 10:52 AM Disclaimer: The EAF Mapper is a screening tool intended to assist project sponsors and reviewing agencies in preparing an environmental assessment form (EAF). Not all questions asked in the EAF are answered by the EAF Mapper. Additional information on any EAF question can be obtained by consulting the EAF Workbooks. Although the EAF Mapper provides the most up -to -date digital data available to DEC, you may also need to contact local or other data sources in order to obtain data not provided by the Mapper. Digital data is not a substitute for agency determinations. ott'W'+ Montreal ! ii ,trt f.�i .Aug' ensbul e -- ' Ta onto { ti C. - Concord - ? 244.9 -1 - r Boston t 244.9 -1 -16.12 Detroit Buttalo' Albap�' - prvyidence 2-44.9 -1 -4 = _ _'— = Cleveland Harttc.d Zs!rCF_': Esri, HERE. DeLtrme..}� 1f:.11 " 5curs;;`�;riYl�'ERE, )ntermap, inuement F CcfP., tdF C f�, l sn , Tr,�on t' �e tS Int+ssrnap, i4an,MET1. EsriChina lHong Kong),Eki Pittsburgh Harrisburgina �P�p.. tJRCFtJ, IThmilsnd), MaPmylndis, @ 0 Pen Steettvl�p_= -- mbu < y�< r4 japan, r�AETI, Esri China orntnbutors, and the 015 Usa CCmmrvs irtyl_g ovhington� Es_ Part 1 / Question 7 [Critical Environmental Area] Part 1 / Question 7 [Critical Environmental Area - Identify] Part 1 / Question 12a [National Register of Historic Places] Part 1 / Question 12b [Archeological Sites] Part 1 / Question 13a [Wetlands or Other Regulated Waterbodies] Part 1 / Question 15 [Threatened or Endangered Animal] Part 1 / Question 16 [100 Year Flood Plain] Part 1 / Question 20 [Remediation Site] Short Environmental Assess Yes Name:Lake George, Reason-.Protect the resources of the park, Agency:Lake George Park Commission, Date: 11-16-88 No Yes Yes - Digital mapping information on local and federal wetlands and waterbodies is known to be incomplete. Refer to EAF Workbook. Yes Digital mapping data are not available or are incomplete. Refer to EAF Workbook. No ment Form - EAF Mapper Summary Report I Agency Use Only [If applicable] Project: F--- Date: Short Environmental Assessment Form Part 2 - Impact Assessment Part 2 is to be completed by the Lead Agency. Answer all of the following questions in Part 2 using 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 ?" PRINT FORM Pagel of 2 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 ❑ 1:1 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 El 1:1 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 El ❑ reasonably available energy conservation or renewable energy opportunities? 7. Will the proposed action impact existing: 11 11 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, El ❑ 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)? 10. Will the proposed action result in an increase in the potential for erosion, flooding or drainage El ❑ problems? 11. Will the proposed action create a hazard to environmental resources or human health? ❑ ❑ PRINT FORM Pagel of 2 Agency Use only lit applicabtel Project: Date: Short Environmental Assessment Form Part 3 Determination of Significance For every question in Part 2 that was answered rmVOd not result in a impact may significant adverse environmental impacteplea please a particular element of the proposed action may complete Part 3. Part 3 should, in sufficient sponsor to identify reducimpacts. Part 3 should measures so explain how the lead agency have been included by the project its sett determined that the impact may or will versibilislgn geographic scope and magnitude. Al o consider the potential for short- term, probability of occurring, duration, irreversibility, g term, long -term and cumulative impacts. Check this box if you have determined, based on the information and analysis above, and any supporting documentation, 0 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 an d analysis above, and any supporting documentation, 0 that the proposed action will not result in any significant adverse environmental impacts. Date Name of Lead Agency 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) PRINT FORM Page 2 of 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: Michael Shearer Designates: Jarrett Engineers, PLLC as agent regarding Septic Variance for Tax Map ID: 240.5 -1 -6 OWNER'S SIGNATURE: - Date: 4 tit 61 Engineering Fee Disclosure: Applications may be referred to the Town consulting engineer for review of septic design, storm drainage, etc. as determined by the Town Board of Health. Fees for engineering review services will be charged directly to the applicant. Authorization for Site Visits: By signing this page and submitting the application materials attached, herein, the Owner, Applicant and his /her /their agent hereby authorize the Town Board of Health, building and code Enforcement Officers and 'town Engineer to enter the subject properties for the purpose of reviewing the application submitted. Please Note: Other permits may be required for construction or alteration activity subsequent to approval by the Town Board of Health. It is the applicant's responsibility to obtain any additional permits. Official Meeting Minutes Disclosure: It is the practice of the Town Board of Health to have a designated stenographer tape record the proceedings of the meetings resulting from 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. -'I, the undersigned, have thoroughly read and understand the instructions for submission; agree to the submission requirements and completed the checklist. PRINT NAME OF OWNER: Michael Shearer SIGNATURE OF OWNER: Y — DATE: 4 (11 ( Z(-) l(� PRINT NAME OF AGENT: Robert U. Holmes II, P.E. SIGNATURE OF �f� 7 AGENT: DATE: Town of Queensbury Building & Codes Septic Variance Application 518 -761 -8256