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variance submission l SEPTIC VARIANCE Office Use Only 0A Received: ar�n q APPLICATION Permit#: c� Tossm of Qirccnsbury Permit Fee: -Do 742 Bay Road,Queensbury,NY 12804 P:518-761-8256 www.gueensbury.net Invoice#: Z�jrJ� Approvals: Submittal: I (one) original &8 copies of the completed application package Property Owner(s): Lee&Chris Kruger Owner's Agent: Dennis MacElroy Address: 32 Sandy Pines Blvd Address: EDP—900 Rt. 146 Hopewell Junction, NY 12533 Clifton Park, NY 12065 Phone#:845 489-2477 Phone#:518 376-4485 Site Address: 6 Morton Rd. Tax ID#: 239.12-2-82 Directions to Site:Assembly Pt. Rd.to Brayton Ln.to Bradley Way to Morton Rd. Distance from well on property to septic system (if applicable) NA feet Is it possible to install a conforming septic system on this property? ❑ Yes © No If YES, please explain and attach a diagram:Click or tap here to enter text. Does the proposed system meet setback requirements for distance from wells&septic systems on neighboring properties? ❑ Yes © No If NO, please explain:Click or tap here to enter text. Separation ' as approved by varianre granted by BOH in April 2018 Is the proposed system to be installed under a parking area? I] Yes x❑ No Section of the Sanitary Sewage Ordinance from which you are seeking the variance (i.e. leaching system will be 89 ft. from well in lieu of required 100 ft.): Chapter 136-91):Table 1 V-1 Pump Tank to be 45'to the lake vs.50' required. V-2 Pump Tank to be 4'to the dwelling vs. 10' required n E CO fE 9 W LJ OFL FL F FEB 0 4 2020 g 13 IIL-D[N'!: UEER 8,C`0D2S Septic Variance Application Revised February 2019 List the names, parcel addresses,and tax map numbers of all adjoining property owners. You may obtain tax map numbers from the Assessor's Office as well as the names and addresses: North Name Address Tax Map ID South Name ova Address 3a �AVT*4%Lvl ANE. 'i}1 Y -omAR �-wo m& nP Tax Map ID ' ii.AALI-40^011IC-a�It'iC+tUX= t&>EYe' e.,S7Dy East Name A.A 'L Cagpr-&� Address Tax Map ID West Name Address sit �%XR Tax Map ID 7-311.1 Z—Z—8CS OWNER STATEMENT I/We do hereby relieve the Town of Queensbury from any liabilities on the plumbing and septic system located at: I/We realize that putting the well,[epic or leaching system less than the required 54 feet from the L,s� may increase the risk of pollution. ,! Owner—Print Name: L�� CIF-yc--.0 Date: Owner---Signature: - Date: NEIGHBOR OR TENANT RELEASE STATEMENT(if applicable) I/We do hereby relieve the Town of Queensbury from any liabilities on the plumbing and septic system located at: I/We realize that putting the septic tank or leaching system less than the required feet from the may increase the risk of pollution. Neighbor/Tenant—Print Name: Date: Neighbor/Tenant-Signature: _ Date: Septic Variance Application February 2018 AUTHORIZATION AND SIGNATURE PAGE This page includes the Authorization to Act as Agent form,engineering fee disclosure, authorization for site visits,other permit responsibilities and agreement to provide documentation required. - Complete the following if the OWNER is using an Agent: Owner's Name: LEE KywxaER. Designates: ' lit yo as agent regarding the Septic Variance for Tax Map#: Z'69 VZ-'Z — SZ OWNER'S SIGNATURE: DATE:Z-3-Zb Engineering Fee Disclosure:Applications may be referred to the Town consulting engineer for review of septic design, storm drainage,etc.as determined by the Town Board of Health. Fees for engineering review services will be charged directly to the applicant. Authorization for Site Visits: By signing this page and submitting the application materials attached herein,the Owner,Applicant and his/her/their agent hereby authorize the Town Board of Health,building and code Enforcement Officers and Town Engineer to enter the subject properties for the purpose of reviewing the application submitted. Please Note:Other permits may be required for construction or alteration activity subsequent to approval by the Town Board of Health. It is the applicant's responsibility to obtain any additional permits. Officiatial Meeting Minutes Disclosure: It is the practice of the Town Board of Health to have a designated stenographer tape record the proceedings of the meetings resulting from the application,and that the minutes transcribed from those tapes constitute the official record of all proceedings. If there is a discrepancy between such record and the handwritten minutes taken by the designated stenographer,the handwritten minutes shall be deemed the official record. I,the undersigned, have thoroughly read and understand the instructions for submission;agree to the submission requirements and completed checklist: OWNER—PRINT NAME: K -�►Ez OWNER—SIGNATURE: DATE: AGENT—PRINT NAME: t 5;P k 'Pots-( AGENT—SIGNATURE: t DATE:: Septic Variance Application February 2018 ENVIRONMENTAL DESIGN PARTNERSHIP, LLP 900 Route 146 Clifton Park,NY 12065 (P)518.371.7621 (F)518.371.9540 edpllp.com Shaping the physical environment February 3, 2020 Town of Queensbury Board of Health 742 Bay Road Queensbury, NY 12804 Attn: John Strough,Supervisor Qu'FN 4?020 80 =� 4 P FRf� i�y Re: Kruger Wastewater—6 Morton Drive a� Modified BOH Variance Requests Ja Dear John: Submitted for your distribution and review are nine sets of a Board of Health wastewater system variance application for a single-family residence located at 6 Morton Drive. The Board had previously issued variances for the proposed system on April 16, 2018. The project received a septic disposal system permit from the Building Department in September 2019 and the system was constructed. Only during the construction phase was it determined that the presence of significant ledge conditions suggested the relocation of the pump tank. The revised location of the pump tank necessitates two additional variances but actually eliminates a variance previously issued. The application documents.include the following: • Replacement Wastewater System For The Kruger Residence-6 Morton Drive Sheet 1-Variance Plan Dated 2-3-20 • Queensbury Town Board of Health Application for Septic Variance • Application Fee-$150 check Please note that the Contractor proceeded with the installation of the pump tank in the modified location at my direction only after I had discussions with the Building Department representatives. It was understood that we would have to follow up with the additional variance application. As we were in the middle of installation and the modification made practical sense in an effort to avoid blasting near the foundation the installation was completed. We now seek the required the additional variance approval. I am available to meet with you and/or other Board members to'further discuss this proposal prior to the public hearing. Thank you for your consideration of this request. Sincerely, Dennis MacElroy, PE Environmental Design Partnership ��� FEB 0 4 2020 Attachment I111 'row"�F GUE�� � suit.La�i�a7 �S Cc: Dave Hatin Lee&Chris Kruger