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WASTEWATER-SEWER\Set PH\Hampshire John-Holding Tank—12-21-2020
RESOLUTION SETTING PUBLIC HEARING ON SEWAGE DISPOSAL
VARIANCE APPLICATION OF JOHN HAMPSHIRE
RESOLUTION NO.: ,2020
INTRODUCED BY:
WHO MOVED ITS ADOPTION
SECONDED BY:
WHEREAS, the Queensbury Town Board serves as the Town's Local Board of Health and is
authorized by Town Code Chapter 136 to issue variances from the Town's On-Site Sewage Disposal
Ordinance, and
WHEREAS, John Hampshire (Applicant) has applied to the Local Board of Health for
variances from Chapter 136, §136-11, which requires applicants to obtain a variance for holding tanks
as the Applicant wishes to install a new 2,000 gallon septic holding tank in lieu of a sewage disposal
system on property situated at 62 Dream Lake Road in the Town of Queensbury,
NOW, THEREFORE, BE IT
RESOLVED, that the Town of Queensbury Local Board of Health will hold a public hearing
on Monday, January IIth, 2021 at 7:00 p.m. at the Queensbury Activities Center, 742 Bay Road,
Queensbury, to consider John Hampshire's sewage disposal variance application concerning property
located at 62 Dream Lake Road in the Town of Queensbury(Tax Map No.: 279.17-1-10) and at that
time all interested persons will be heard, and
BE IT FURTHER,
RESOLVED, that the Local Board of Health authorizes and directs the Queensbury Town
Clerk to publish the Notice of Public Hearing presented at this meeting and send a copy of the Notice
to neighbors located within 500 feet of the property as required by law.
Duly adopted this 21'day of December, 2020,by the following vote:
AYES
NOES
ABSENT:
SEPTIC VARIANCE Office Use Only
Received:
APPLICATION Permit#:
742 Bay Road,Queensbury,NY 12804 Permit Fee:
P:518-761-8256 www.gueensbury.net Invoice#:
U C 14 ,02 J Approvals:
Submittal: I (one) original & 8 copies of the completed application package
Property Owner(s):John Hampshire Owner's Agent:_ Arnica Septic Design & Installation
Address: 637 4th Street Address: 6049 Fish House Road
Troy, NY 12180 Galway, NY 1207
Phone#: 518-763-2964 Phone#: 518-882-5445
Site Address: 62 Dream Lake Road, Queensbury Tax ID#: 279.17-1-10
Directions to Site: Bay Rd to Sunnyside Rd North, left onto Dream Lake Rd south
Distance from well on property to septic system (if applicable) 71'+/- feet
Is it possible to install a conforming septic system on this property? Yes X No
If YES, please explain and attach a diagram:
Does the proposed system meet setback requirements for distance from wells&septic systems on neighboring
properties? X Yes No If NO, please explain:
Is the proposed system to be installed under a parking area? 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.):
Installation will be for a 2000 gallon holding tank with high water alarm sensor for pumping
Septic Variance Application February 2018
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 Barton
Address 60 Dream Lake Road
Tax Map ID 179.17-1-11
South Name Rivette
Address 64 Dream Lake Road
Tax Map ID 279.17-1-9
East Name N/A
Address
Tax Map ID
West Name N/A
Address
Tax Map ID
OWNER STATEMENT
I/We do hereby relieve the Town of Queensbury from any liabilities on the plumbing and septic system located at:
62 Dream Lake Road
I/We realize that putting the well,septic tank or leaching systemless than the required 100feet from the well
may increase the risk of pollution.
Owner—Print Name: John Hampshire Date: 11/19/20
Owner—Signature: Date: 11/19/20
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:
N/A
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: N/A Date:
Neighbor/Tenant-Signature: N/A Date:
Septic Variance Application February 2018
PLEASE ATTACH THE FOLLOWING TO YOUR APPLICATION:
1. A location map showing the site within the Town of Queensbury
2. A plot plan showing existing and proposed features of the property, including:
a. Lot dimensions
b. North arrow and scale: 1 inch=40 feet
c. Location & dimensions of existing and proposed buildings, showing setback distances and
uses
d. Parking layout to scale (if applicable)
e. Physical features (street, steep slopes, lakes,wetlands, etc.)
f. Location of all wells and septic systems on neighboring properties
g. Adjacent ownerships
h. All properties within 500 feet
A sample plot plan and location are shown below:
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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: John Hampshire
Designates: Dominick Arico c/o Arnica Septic Design as agent regarding the Septic Variance for
Tax Map#: 179.17-1-10
OWNER'S SIGNATURE: _ DATE: 11/19/20
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.
Official 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: John Hampshire
OWNER—SIGNATURE: DATE: 11/19/2020
AGENT—PRINT NAME: Dominick Arico
- % ____. 11/8/2020
AGENT—SIGNATURE: = DATE:
Septic Variance Application February 2018
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