BOTH-000652-2016 Town of Queensbury• Building&Codes Enforcement Office•742 Bay Road• Queensbury,NY 12804
DEEP HOLE/PERC TEST
Request for Town Engineer Review
Property Owner. MMCF el M 6&;S4l2_ Phone:
Property Owner's
dr s:
Addrei t�j�
ss: , ,.y
Location of Test: J �tpt1 `{�� Tax ID#: 1�'
"Applicant's Engineer: ` uI Phone: —7,�{1 —VL,8;,
Applicant's Agent: tm�`Arj aALt, Phone: :�41 —
Additional Notes:
1. Reason for Request? ❑ New Septic System ❑✓ Replacement Septic System ❑ Failed Septic System
❑ Subdivision ❑ Site Plan Review
2.Are Wetlands present? ❑ YES z NO ❑ UNKNOWN
'Note: Applicant is required to engage an engineer for design and testing of the system. 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: I cSC-d - ZDI(a
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 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: Date: 2? / -Zj16
Original (B &C File) Canary (Planning) Pink (Applicant) Gold (Town Clerk)
THE North Country Office
Cha
�p/I� 375 Bay Road,Queensbury, NY 12804
/��V{ [ P: (518)812-0513 F:(518) 812-2205
COMPANIES www•chazencompanies.com
Engineers Hudson Valley Office (845)454-3980
Environmental Professionals Capital District Office (518)273-0055
Land surveyors
Landscape Architects
Planners
October 12,2016 D lYt1s b D
Dave Hatin, Director, Building and Codes
Town of Queensbury
742 Bay Road
Queensbury,New York 12804
OCT 13 2016
Re: Soil Testing Verification
5 Ripley PI
Queensbury, NY 12804
Dear Mr. Hatin:
As requested,Chazen has witnessed onsite soil testing for the above referenced location on September
27,2016.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 Ethan Hall of Rucinski Hall Architecture.
Only one soil test was performed in the back of the house,near the southwest corner of the property.
The soil profile consists of the following:
0"-7"Topsoil,dark brown.
7"-17" Medium sand, light brown
17"-34"Course sand, light brown
34-48" Dark Brown Loam
48-66" Red-Brown Loamy Sand
No mottling
No Groundwater
Roots to 60"
If you have any questions or require additional information please do not hesitate to call me at(518)
824-1926.
Sincerely,
,<
Sean M. Doty, P.E.,LEED AP
Associate
Manager, Municipal Engineering Services
Chazen Engineering, Land Surveying 8 Landscape Architecture Co.,P.C.
Chazen Environmental Services,Inc.
The Chazen Companies, Inc.
HP / ,
x
■