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Town of Queensbury• Building&Codes Enforcement Office■742 Bay Road• Queensbury,N '
DEEP HOLE/PERC TEST
Request for Town Engineer Review
Property Owner: '5�u., T M%'10� Phone: C? ^��,�•"W f. �+�P
Property Owner's
Address:
Location of Test: Tax ID#:
*Applicant's Engineer: ! •�L�t1b F-t7-�1-�/ Phone:
Applicant's Agent: PU 6 -1-446W 14" Phone:
Additional Notes:
1.Reason for Request? D New Septic System Replacement Septic System ❑ Failed Septic System
❑ Subdivision F-� Site Plan Review
2.Are Wetlands present? U YES F—] NO ❑ UNKNOWN
*Note: Applicant is required to engage an engineer for design and testingof f the s}Lstem. The Town
Engineer's responsibility is to witness system testing only,
PLOT PLAN: Plot plan, to scale, to be submitted with application
FEE SCHEDULE:
a. $200 Flat Fee Date Paid: 2- 2-3 Zit b
Check No.:
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 Ark 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: Aq Date:
SIGNATURE OF AGENT: IVDate: rW ;4W&
Original(B&C File) Canary(Planning) Pink(Applicant) Gold (Town Clerk)
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THE
North Country Office
Cha ,
DSI/] 375 Bay Road, Queensbury, NY 12804
----- P: (518)812-0513 F: (518) 812-2205
COMPAN I ES www.chazencompanies.com
H
Engineers Hudson Valley Office (845)454-3980
Environmental Professionals Capital District Office (518)273-0055
Land Surveyors
Landscape Architects
Planners
February 25, 2016
Dave Hatin, Director, Building and Codes
Town of Queensbury
742 Bay Road
Queensbury, New York 12804
Re: Soil Testing Verification
Existing Residence—33 Country Club Road.
Queensbury, NY 12804
Chazen Project#!:91600.14
Dear Mr. Hatin:
As requested,Chazen has witnessed onsite soil testing for the above referenced location on February 25,
2016. The purpose of this testing was to investigate subsurface soils conditions for septic systems
associated with the existing residence. The testing was performed by Ethan Hall of Rucinski Hall
Architecture.
One test pit was performed at approximately (43.337211°, -73.663055°) 175 feet west of Country Club
Road in the existing wooded area to the south-east of the residence. The soil profile consists of the
following:
Test Pit#1
0"-3" Topsoil
3"-16" Wet light brown sandy loam
16"-28" Wet brown-red sandy loam
28"- Clay
Mottling at 28"
Flowing Groundwater at 18"-20"
If you have any questions or require additional information please do not hesitate to call me at(518)
824-1926.
Sincerely,
y
can M. Doty, P.E., LEED A
Associate
Manager, Municipal Engineering Services
Chazen Engineering, Lancs Surveying&Landscape Architecture Co. P.C.
Chazen Environmental Services, Inc.
The Chazen Companies. Inc.