Application Town of Queensbury■ Building&Codes Enforcement Office■742 Bay Roads Queensbury,NY 12804
2�' -2DZ(� DEEP HOLE/PERC 'EST C��`Joy,
c Request f®.r Town Engineer Review - -b
74A2—
Property Owner: A S r>ro lj 0.--�'C,�2 t � Phone:
Property Owner's
Address:
Location of Test: l �— ��� �v��� Q� S i® 3-C) a —Is Q
*Applicant's Engineer: N g O Phone: --- "' 1�a j7
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Applicant's Agent: Phone: IK
Additional Notes:
1.Reason for Request? New Septic System Replacement Septic System ElFalled Septic System
❑ Subdivision 0 Site Plan Review
i
2.Are Wetlands present? YES ff'-'NO (UNKNOWN
*Note: Applicant is reguired to engage an engineer for design and testing of the system The Town
Engineer's responsibility is to witness system testing only.
B n
PLOT PLAID: Plot plan, to scale,to be submitted with application 1
C: U-;
FEE SCHEDULE: r�
a. $200 Flat Fee V__� Date Paid: / 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: _4 � /QGa 6
SIGNATURE OF AGENT: path:
Original(B&C File) Canary(Planning) Pink(Applicant) Gold(Town Clerk)
THE NORTH COUNTRY OFFICE
ChCivil
/� Engineers 20 Elm Street,Suite 110
//�/ (/`r(/ Land Surveyors
— Planners Glens Falls, NY 12801
COMPAN I ESO Environmental&Safety Professionals P:518.812.0513 or 888.539.9073
Landscape Architects
Proud to he Employee Owned TransportationPlanners&Engineers www.chazencompanies.com
September 8,2020
Dave Hatin _ o52� -W 20
Director, Building and Codes `
Town of Queensbury i t^ t
742 Bay Road '®
Queensbury, New York 12804
Re: Soil Testing Verification
11 Lynn Ave � !�EI61~Xr� Cfri�Y
Town of Queensbury, Warren County, New York
92000.29
Dear Mr. Hatin:
As requested,Chazen has witnessed onsite soil testing for the above referenced location on September 8tn,
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 cesspool system.The testing was
performed by MarkJ. Buckley, P.E.
One soil test was performed in the general area of the proposed septic system adsorption area.
TP1
0"—5" Dark Loam Topsoil
5"—28" Medium/Fine Sand,some Gravel
28"—51" Medium/Fine Sand,some Cobble
Mottling at 26"
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
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)