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SEP-0035-2020 c °' 1` SEPTIC DISPOSAL PERMIT APPLICATION Office Use Only r ,;,,,-Ow n;hvr 742 Bay Road,Queensbury, NY 12804 P: 518-761-8256F n,e,r_ e >�;,;,_�,.r 8- Permit#: " (} �-- Z0� Tax Map ID#: I2 Uok ^b —I- Permit Fee: $ }t ; Invoice#:2.,- .1 2— Project Location: e-2--3 Ca LA G,Oro Septic Variance? Yes No Primary Owner(s) (A,k� r, l Mailing Address Kth CA VUu 1S 1/VrA Qui.. ,,,N AtAr-1 Phone & Email S I —LI 6 l -Q 1 1 i Installer/Builder � q Oil 5 S'erpi- �Mailing Address --1- ` r r ��P`��T T Phone & Email 5 , 0 -) - KM `-��J �� �, c R. Engineer ��11 ` I - � �1 Mailing Address C`Ar. A ` - ` , i APR 15 2023 Ill) 1 Phone &Email 5 _. J� _ 6� I 0 a Ot�1 N OF�^t.�tb-i'�caa�J `1 Contact Person for Building&Coden Compliance: , r� Phone: ,�; ;7 1 N23 0`� 'Kb RESIDENCE INFORMATION: Year Built Gallons #of bedrooms X gallons per =total daily flow per day bedroom Garbage Grinder Yes o 1980 or older 150 Installed? (circle one) 1981-1991 130 Spa or Hot Tub Yes No 1992-Present 110 Installed? (circle one) PARCEL INFORMATION: Topography 1.- \Loiiing Steep Slope %Slope Soil Nature Sand Loam Clay Other Groundwater At what depth? Bedrock/Impervious r t_eriai �4t y hat depth? Domestic Water Supp9y-v�` fV(Municipal _Well (if well, water supply from any septic system absorption is ft.) Percolation Test vV Rate: per minute per inch (test to be completed by licensed engineer/architect) PROPOSED YSTEM FOR Tank sizPhni 10n0 gallons (min. size 1,000 gallons, add 250 gallons for each garbage cylinder or spa/hot g Y _ tub System Absorption field with#2 stone Total length I ni- ft.; Each Trench T S- ft. Seepage Pit with #3 stone How many: ; Size: Alternative System Bed or other type: Holding Tank System Total required capacity? ;tank size ;#of tanks NOTES: 1. Alarm system &associated electrical work must be inspected by a Town approved electrical inspection agency; 2.We will no longer allow systems to be covered until such time as an as-built plan is received and approved. The installed system must match the septic layout on file—no exceptions. Declaration:Any permit or approval granted which is based upon or is granted in reliance upon any material representation or failure to make a material fact or circumstance known by or on behalf of an applicant,shall be void. I have read the regulations and agree to abide by these and all requirements of the Town of Queensbury Sanitary Sewage Disposal Ordinance. krPRINT NAME: C y 9 e61(,),„(, DATE: 14%4 SIGNATURE: -.(.---) I DATE: (4„(5 ,0 Town of Queensbury Building&Code Enforcement Revised March 2018 NORTH COUNTRY OFFICE 20 Elm Street, Suite 110 Glens Falls, NY 12801 P: 518.812.0513 or 888.539.9073 www.chazencompanies.com HUDSON VALLEY • CAPITAL DISTRICT • NORTH COUNTRY • WESTCHESTER • TENNESSEE Chazen Engineering, Land Surveying & Landscape Architecture Co., D.P.C. (New York) Chazen Engineering Consultants, LLC (Tennessee) February 14, 2020 Dave Hatin Director, Building and Codes Town of Queensbury 742 Bay Road Queensbury, New York 12804 Re: Soil Testing Verification 23 Cayuga Drive Town of Queensbury, Warren County, New York 92000.05 Dear Mr. Hatin: As requested, Chazen has witnessed onsite soil testing for the above referenced location on February 14, 2020. The purpose of this testing was to investigate subsurface soil conditions for a proposed wastewater system design. The system is proposed as a replacement to an existing system. The testing was performed by MacKenzie Pelton, E.I.T. of Rucinski Hall Architecture. One soil test was performed in the general area of the proposed septic system adsorption area. TP1 0” – 14” Medium Brown Silty Loam 14” – 33” Medium Clay with Gravel 33” – 52” Fractured Shale, Some Cobbles Roots encountered 0” – 22” Ledge at 52” No mottling encountered 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 Principal, Director Municipal Engineering Services RESOLUTION GRANTING THE DENISE L. CLAIRMONT TRUST AN EXTENSION OF TIME TO INSTALL NEW LEACH FIELD ON PROPERTY LOCATED AT 23 CAYUGA DRIVE, CLEVERDALE RESOLUTION NO.: BOH 14, 2020 INTRODUCED BY: Mr. Anthony Metivier WHO MOVED ITS ADOPTION SECONDED BY: Mr. George Ferone WHEREAS, by Resolution No. 380,2018, the Queensbury Town Board adopted Local Law 2 of 2018 entitled “Septic Inspection Upon Property Transfer” which is set forth at Queensbury Town Code Chapter 137 (Chapter 137), and WHEREAS, by Resolution No.: 176,2019, the Town Board adopted Local Law 5 of 2019 and by Resolution No. 47,2020, adopted Local Law 1 of 2020 to make additional minor modifications to Chapter 137, and WHEREAS, Chapter 137 requires inspection of Onsite Wastewater Treatment Systems (OWTS) prior to the sale of certain real property, and WHEREAS, the Director of Building and Codes Enforcement has advised that the Denise L. Clairmont Trust, owner of property located at 23 Cayuga Drive, Cleverdale in the Town of Queensbury (Tax Map No: 239.8-1-33) could not comply with a violation notice to complete a property transfer inspection and install a new septic tank and leach field on the property within six (6) months, and WHEREAS, the Denise L. Clairmont Trust (Applicant) by application dated January 29, 2020 has applied for a timeline extension or until June 1, 2020 to install the new septic tank and leach field on such property due to winter weather conditions, NOW, THEREFORE, BE IT , RESOLVED that the Queensbury Town Board, as the Town’s Local Board of Health, st hereby authorizes and grants the Denise L. Clairmont Trust additional time or until June 1, 2020 to obtain a certificate of compliance from the Town’s Building and Codes Enforcement Office as set forth in Chapter 137 for installation of a new septic tank and leach field on property located at 23 Cayuga Drive, Cleverdale and authorizes and directs the Town Supervisor and/or Director of Building and Codes Enforcement to and take any and all action necessary to effectuate all terms of this Resolution. th Duly adopted this 10 day of February, 2020, by the following vote: AYES: Mr. Metivier, Mr. Freer, Mr. Ferone, Mr. Strough NOES: None ABSENT :Mrs. Switzer REP -0028- DEEP HOLE/PERC TEST 2005 een scenbery REQUEST FOR TOWN ENGINEER REVIEW Building and Code Enforcement IIs 172 ay Rood,Queensbury,NY 12804 ©)JAN 31 2020 PSUR 7GL256 woe qveansburst ih Property Owner(s):KEITH ARNOLD Phone #:(518 )A(ol=0111 Mailing Address (c/s/2:—)PAULS WAY QUEENSBURY NY 12604 Location oftest:_22 CAYUGA DRIVE tax io #:230.B-|-3% *Applicant’s Engineer: QUOINSHHALL ARUN TECURE Phone +:AB)TAl-0208—Applicant’Agent: RUCANSEtHAULPRCHI TECTURE prone x:(5!Tal02108AdditionalNotes: 1,Reason for request?New Septic System x Replacement Septic System Failed Septic System CJ Subdivision C1 site Plan Review 2.Are wetlands present?X ves no (C_UNKNOWN “Applicant is required to engage an engineer for design and testing of the system.The Town Engineer's respons to witness system testing only. PLOT PLAN:plot plan,to scale,must be submitted with application. ol B/[200 2.OR fee to be determined during to be determined: site plan/subdivision review process FEE SCHEDULE: 1.$200 flat fee 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 |have thoroughly read and understand the instructions,agree to the submission requirements and have completed the application.|also fully understand that additional engineering fees may be necessary per Town of Queensbury Local Law 136-14 D. SIGNATURE OF APPLICANT:DAT! SIGNATURE OF AGENT:pate:Blow Zao COriginal (BEC File)Canary (Planning)Pink Applicant)Gold (Town Clerk). Deep Hole/Pere Test App Updated August 2017 , -- 00 "-ZOZU RUCINSKI HALL ARCHITECTURE e,`'cx, Ronald Richard-Rucinski �.�J� Ethan Peter Hall G`�co G 134 Dix Avenue �J c Glens Falls NY 12801 P Voice 518 741 0268 Fax 518 741 0274 Email ephall@nycap.rr.com Keith Arnold-23.Cayuga Drive 6 October 2020 John O'Brien Town of.Queensbu y Building Department 742 Bay Road. . Queensbury NY 12804 Re: Installation of Replacement Sewage Disposal System At the above referenced project location this office observed the installation of the new pump station, distribution box and gravity absorption bed prior to backfill. These installations are acceptable to this office. If there are any questions please contact our office to discuss. . 9 a Re r• ". 7, a) * 1 ,/ali,,,;/fi c- i� �.4.A`,,lip Ethan Peter Hall• ' "' r Architect tjw& iv`; _>,'4 1y, .i � � AS BUILT r s G' a ‘1 .. 11 1ace ®6 2Tao QuEENsBuIN -To\NN of G&coos 6thom I