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BOTH-000090-2016 fes--050. 2x)wb tr,�ro►w to- Town of Queensbury- Building&Codes Enforcement Office■742 Bay Road- Queensbury,NY 12804 DEEP HOLE/PERC TEST Request for Town Engineer Review Property Owner: t'{ j VV0� kA014,�0 Phone: ���" ^V(7 PropertyeAddresss Location of Test: t MAN ,. Tax ID#: ( t l *Applicant's Engineer: 5wm-16�u,- Phone: XA Applicant's Agent: 74045 't!iNA - )� Phone: Additional Notes: 1.Reason for Request? [:] New Septic SystemR lacement Septic System El Failed Septic System Subdivision Site Plan Review 2.Are Wetlands present? F] YES NO UNKNOWN *Note: Applicant is required to encase an engineer for design and testing of the system. The Town Enaineer's responsibility is to witness stern testing only. PLOT PLAN: Plot plan,to scale, to be submitted with application FEE SCHEDULE: a. $200 Flat Fee Date Paid: ': '201 to Check No.: b. OR Fee to be determined during To Be Determined: Site Plan 1 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 APPLICANT: Date: #^ SIGNATURE OF AGENT: 4%/ Date:4174 Ijr Original (B&C File) Canary(Planning) Pink(Applicant) Gold (Town Clerk) f .. G r I 4 46 r I[S la Q � G t 2E _ 5 G+ Q O W !V 1 � 1 Y I 'I 111 t ...,..-. 11 _ . % ca " (n m cri (D C p 04 IL .r q � cu THE Cha North Country office Kqj375 Bay Road, Queensbury, NY 12804 P: (518) 812-0513 F: (518)812-2205 COMPAN I ES www.chazencompanies.com N Engineers Hudson Valley Office (845)454-3980 Environmental Professionals Capital District Office (518)273-0055 Land Surveyors Landscape Architects Planners February 25, 2016 ©I c)— 2,o Dave Hatin, Director, Building and Codes Town of Queensbury 742 Bay Road Queensbury,New York 12804 Re: Soil Testing Verification Building& Parking Lot Improvements—17 Main St. Queensbury, NY 12804 Chazen Project#:91600.15 Dear Mr. Hatin: As requested, Chazen has witnessed onsite soil testing forthe above referenced location on February 25, 2016. The purpose of this testing was to investigate subsurface soils conditions for septic systems associated with the proposed building and parking lot addition. The testing was performed by Ethan Hall of Rucinski Hall Architecture. One test pit was performed at approximately (43.302465°, -73.664921°) 250 feet north of Main St in the existing wooded area to the east of the existing dirt parking lot. The soil profile consists of the following: Test Pit#1: 0"-6" Topsoil 6"-65" Topsoil-fill. Fill consisted of topsoil, asphalt, concrete blocks and various rubbish (aluminum cans, automobile rear differential etc.) 65"-84" Brown sandy loam, relatively dry No mottling or groundwater was observed. If you have any questions or require additional information please do not hesitate to call me at(518) 824-1926. Sincerely, can M. Doty, P.E., LEAD A Associate Manager, Municipal Engineering Services Chazen Engineering, Land Surveying&Landscape Architecture Co..P.C. Chazen Environmental Services, Inc. The Chazen Companies, Inc.