SEP-0074-2018 .*P ' 4--(71. /.5'
flow DEEP HOLE/PERC TEST
Town of Queensbury REQUEST FOR TOWN ENGINE R)R
Building and Code Enforcement FE 2 1 201.
742 Bay Road,Queensbury,NY 12804 (M � ee
P:518-761-8256 www.queensburv.net TOWN OF QUEEN BURY
COMMUNITY DEVELOPMENT
Property Owner(s): /vim v 'ile 6 y /i.71 Phone# V )76 OSZ
Mailing Address (c/s/z): �/6-{ 21y ��' L/4.ale 7 /( ' /z831
Location of test: o q ?jot )rs ok Tax ID #: /'z / / /
ry
*Applicant's Engineer: Phone#: ) 7‘ldt22
Applicant's Agent: ✓a++"+ �Cvcd/,G/� v� .« -L�' Phone#: 29 ) 7o'®J 2�✓
Additional Notes: Q ft(2,wr { tic, v0v6 5 .kn Y.z.,r,n- Se, x,vv\
1. Reason for request? ❑ ew Septic System ❑ Replacement Septic System
❑ Failed Septic System ❑ Subdivision ❑ Site Plan Review
2. Are wetlands present? ❑ YES❑ NO ❑ UNKNOWN
*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, must be submitted with application.
FEE SCHEDULE:
1. $200 flat fee date paid: 1j /��� _
check#:
2. OR fee to be determined during to be determined:
site plan/subdivision review process
PLEASE READ BEFORE SIGNING:
In carrying out the provisions of Article IV,the Local Board of Health or the enforcement office 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$1500 without proper written notice to the party to be changed the 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 understa that additional engineering fees may
be necessary per Town of Queensbury Local Law 136-14 D.
SIGNATURE OF APPLICANT: DATE: /9
SIGNATURE OF AGENT: DATE:
Original(B&C File) Canary(Plan ng) Pink(Applicant) Gold(Town Clerk)
Deep Hole/Pert Test App Updated August 2017
THE
North Country Office
375 Bay Road, Queensbury, NY 12804
P: (518) 812-0513 F: (518) 812-2205
COMPANIESwww.chazencompanies.com
Engineers Hudson Valley Office (845)454-3980
Environmental Professionals Capital District Office (518)273-0055
Land Surveyors
Landscape Architects
Planners
February 19, 2018
Dave Hatin, Director, Building and Codes E (i M f�
Town of Queensbury j51 t5 v
742 Bay Road
Queensbury, New York 12804 11 FEB 2 0 2018
Re: Soil Testing Verification TOWN OF QUEENSBURY
89 Pilot Knob Road BUILDING&CODES
Town of Queensbury, Warren County NY
91800.11
Dear Mr. Hatin:
As requested, Chazen has witnessed onsite soil testing for the above referenced location on February
19, 2018.The purpose of this testing was to investigate subsurface soils conditions for an existing septic
system design. Please note, the Owner's Engineer was not on site for the testing.
One soil test was performed. It was conducted on the northern side of the house, approximately 8ft
from the edge of the deck and 40ft from the edge of the road.
Test Pit 1
0"-4"Topsoil
4"-12" Light brawn sandy loam (Appears to be Fill)
12"-96" Medium brown sandy loam.
96"-108" Medium brown wet silty clay.
Mottling encountered at 96".
Roots encountered at 16"-24".
No groundwater encountered.
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, CPMSM
Director,
Municipal Engineering Services
Chazen Engineering, Land Surveying&Landscape Architecture Co.,P.C.
Chazen Environmental Services, Inc.
The Chazen Companies, Inc.