BOTH-000008-2016 Town of Queensbury. Building&Codes Enforcement Office,742 Bay Road• Queensbury.NY 12804
DEEP HOLE/PERC TESTY1V0 ! CiZ, I
Request for Town Engineer Review
bTp-"- Oct -3z l 10
Property Owner: Aim Ila, jjL��L�� Phone:
Property Owner`s
Address:
Location of Test: '{�} Tax ID#: � =
*Applicant's Engineer: F 1<r r.l (1 Phone: 7
Applicant's Agent: Phone:
Additional Notes:
1. Reason for Request? New Septic System Replacement Septic System Failed Septic System
Subdivision ❑ Site Plan Review
2.Are Wetlands present? 7 YES El NO F-1 UNKNOWN
*Note: Applicant is required to engage an engineer for design and testing of the system. The Town
Engineer's s responslbility Is to wetness system only.
PLOT PLAN: Plot plan, to scale, to be submitted with application
FEE SCHEDULE:
a. $ 200 Flat Fee Date Paid: , ��ZOl (p
Check No.: 7ot
b. OR Fee to be determined during To Be Determined:
Site Plan /Subdivision review process
SIGNATURE:
In carrying out the provisions of Article IV, the Local Board of Health or the enforcement officer may
engage the services of a qualified professional consultant for expert review and recommendation arising
from the carrying out of the provisions of Art. IV, including but not limited to the review of plans,
specifications and reports, attendance at inspections, dye tests, deep hole test pits, septic related deep
hole and percolation tests, system installations, and any other aspect of any matter contained in this Art.
IV, and any costs incurred in such review shall be paid to the Town by the owner of the property before
any approval can be granted under this Art. IV shall become effective within 30 days of presentment of an
invoice for same, whichever is sooner. Such costs shall not exceed $1,500 without prior written notice to
the party to be charged with same.
My signature below indicates I have thoroughly read and understand the instructions, agree to the
submission requirements and have completed the application. I also fully understand that additional
engineering fees may be necessary per Town of Queensbury Local Law 136-14D.
SIGNATURE OF APPLICA : Date.
SIGNATURE OF AGENT: Date: >
r
Original (8&C File) Canary (Planning) Pink(Applicant) Gold (Town Clerk)
TH
E
North Country Office
375 Bay Road,Queensbury,NY 12804
P:(518)812-0513 F:(518)812-2205
COMPAN I ES www.chazencompanies.com
Engineers Hudson Valley Office (845)454-3980
Environmental Professionals Capital District Office (518)273-0055
Land Surveyors
Landscape Architects
Planners
January 13,2016
Dave Hatin,Director,Building and Codes
Town of Queensbury
742 Bay Road
Queensbury,New York 12804
Re: Soil Testing Verification
268 Lockhart Mountain Road
Queensbury, NY 12804
Dear Mr.Hatin:
As requested,Chazen has witnessed onsite soil testing for the above referenced location on January 11,
2016. The purpose of this testing was to investigate subsurface soils conditions for a proposed septic
system design. The system is proposed as a replacement for an existing system. The testing was
performed by Tom Hutchins of Hutchins Engineering.
One soil test was performed approximately 110 feet north of the main house on the parcel. The soil
profile consists of the following:
0"-7" Dark topsoil
7"-23" Medium brown silty loam
23"-36" Reddish brown fine silty loam
Mottling/Seasonally high water table at 27"
Groundwater at 35"
If you have any questions or require additional information please do not hesitate to call me at(518)
824-1926.
Sincerely,
.4��
Sean M.Doty,P.E.,LEED AP
Associate
Manager,Municipal Engineering Services
cc: File
Chazen Engineering,Land Surveying&Landscape Architecture Co.,P.C.
Chazen Environmental Services,Inc.
The Chazen Companies,Inc.
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' .` • - 169 Havaland Road v p(�q .. . ' ,Town of ®ueensburp Y�arien Couratp Nem' `York
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