2000-355 BUILDING PERMIT
Town of Queensbury, 742 Bay Road, Queensbury,NY 12804
County of Warren (518) 761-8256
VALUE $ 0 2000355
Building Permit No.
TAX MAP NO. 15 . -1-48
CLUNE, THOMAS & SUSANNE
Permission is hereby granted to
ROCKHURST RD.
Owner of property located at
in the Town of Queensbury, SEPTIC ALTERATION
to construct or place a
at the above location in accordance to application together with plot plans and other information hereto filed and
approved and in compliance with the NYS Uniform Building Codes and the Queensbury Zoning Ordinance.
Owner's Address:
24 ORCHARD DR.
QUEENSBURY, NY 12804
Contractor or Builder's Name:
HOWLAND, DEAN JR
Contractor or Builder's Address:
28 HUNTER LANE
QUEENSBURY, NY 12804
Electrical Inspection Agency:
Type of Construction: SEPTIC
Plans and Specifications:
Proposed Use:
SEPTIC ALTERATION
25 May 23 2002
$ PERMIT FEE PAID—THIS PERMIT EXPIRES
(If a longer period is required,an application for an extension must be made to the Code Enforcement
Officer of the Town of Queensbury before the expiration date.)
23 May 2000
Dated at the Town of Queensbury ' Day of
SIGNED Y for the Town of Queensbury
o nforcement cer
Application for Permit—Septic Disposal System
Town of Queensbury 742 Bay Road Queensbury,NY 12804 (518) 761-8256
1. OWNER INFORMATION:
Office Use
Location of installation: Ac, k,e676
File Permit No.c.„13bCD-3—C-5
Tax Map No. /5 1 / I. "fa o
//
• Fee Paid
Owner's Name: /loy ds 1 aaap
Address: Z ac%rna/
2. INSTALLER'S NAME : l- oZ4a/6 , {p,�, PHONE NO.
3. RESIDENCE INFORMATION: (circle year of dwelling, indicate#bedroom(s)and multiply# of
bedrooms with applicable gallons per bedroom to equal total daily flow)
Year of House: No. of Bedrooms x Computation = Total Daily Flow
1980 or older 2. x 150 gal/bdrm = 30a -3 63
1980— 1991 x 130 gal/bdrm = ciCEIVED
1991 —present x 110 gal/bdrm =
•
Garbage Grinder Installed yes I no X SAY 2000
ssuRY
Spa or Whirlpool Installed yes / nor TOW '" G DE
OF
�lJll_DI�G'p1�lU
4. PARCEL INFORMATION: (circle applicable information&indicate measurements)
Topography Soil Nature Ground Water Bedrock or Impervious Material Domestic Water Supply
Flat sand at what depth at what depth municipal
Rolling loam feet feet well
Steep slope clay if well; water supply
_%slope other from any septic-system
depth: absorption is ft.
other
Percolation Test: (To be completed by licensed professional engineer or architect)
Rate: minute per inch
5. PROPOSED SYSTEM: For New Construction: All individual sewage disposal systems must be designed by a licensed
professional engineer or architect(unless installed in a Planning Board approved subdivision). Add 250 gallons to the size
of the septic tank and leach field for each Garbage Grinder, Spa or Whirlpool Tuba
Septic Tank: gallon (min. size 1;000 gal)
Tile Field: each trench ft. Total System Length: ft.
Seepage Pit(s): number of size of each: ft, by ft.
Size of Stone to be used: # / depth or thickness feet
Bed System Size: x
• Alternative System: length and/or size
6. HOLDING TANK SYSTEM: (if required)
Number of tanks: 3 / Size of each: %O gallons /TOTAL Capacity;& ) gallons
Note: Alarm System and associated electrical work must be inspected by a Town approved
electrical inspection agency.
7. SIGNATURE &INFORMATION FOR RESPONSIBLE PERSON(please read)
For your protection,please note that pursuant to Section 136-29 of the Code of the Town
of Queensbury, any permit or approval granted which is based upon or is granted in
reliance upon any material misrepresentation 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 with respect to this application and agree to abide by these and all
requirements of the To of ueensbury Sanitary Sewage Disposal Ordinance.
e`" �/ fz� / 5-22
6nature of responsi le person Date
0 X.
TOWN OF QUEENSBOZY Office Stamp (received)
742 Bay Road , QUEENSBURY, N.Y. 12604-972-5 •
,
Ire% SEPTIC VARIANCE
° Application to be reviewed by Town Board. of Health,
0,EctIVED
1.. Applicant's Name: Ao,fr, eiv/ve 2 2000
SIM 2
Street Address : ?hi ,,/Vee EENsBUSY
City, State, Zip: 04.4041,54- ii041 /2E30+4 TOWN OF013
CODE
Telephone ,No. 793-85q/
2. Agent's Name: /14-ta.) ./24a.14tit4/42,05 ho..%.2%-v.
Street Address :
City, State, Zip: ' 43.4„e0.,0,5440,tv tAJfii2f3e,4
Telephone No. 793-6467
3. Owner' S Name: iDno (7444).C.
Street Address': 5400,4 eAtilaae.
City, State, Zip:
Telephone No.
4 . Location of property: AckLe.si •
, ,
5. Description Of, how to find the property: .C•4401421110-14-,41/ 10
iefek4)4624 41 -514 lava"' gm) .e41- 045,7( 10/hei1.4:)4
6. Tax Map Number: Section )5 Block 1 , Lot TR
7 . Lot size: .07 acres/Sq. ft.
8. Section of the Sanitary Sewage Ordinance from which you are
seeking this variance:
.#19as7 44-/J•e, 144•44 7171x..i.k5•
_
,04
•
9 . Distance from well on property to septic system (if
applicable) .
4)14
10 . Is it possible to' install a _conforming septic system on this
• property?
No •
if Yes, please explain and attach diagram.
•
I PAGE 1 I
• ; •
. .
11 . Does proposed system meet setback requirements for distance
from wells and septic systems on neighboring,: properties?
Yes XV. No -
if No, please explain:
4/ Br is -6'0 s aa?t ZG by l ,o 00,7044S. idiGL . 74/yl, 1.
. v sea--Beer. t�
12 . Is' proposed system to be installed under a parking area?
Yes x . :No V .
13 . List the names, addresses (including tax map. number) of all
adjoining property .:owners . You may obtain tax map numbers
from the Assessor's,'_Department as well as the names and
addresses of neighboring property owners .
•
Name. Cn3C,at 'A Sose F4 atePAO10
• Tax.Map # It..- 1-4.7
Address la 1 6gc-2pss NoPKINTONi 01-)ca
.0? ACRES . . .
- • 4ORTH �AK6 6EoRG€
Name: I Nanze:
Tax Map # 1S.-1-3 WIT -4 EAST Tax Map
Address PO QQK Q84 V Address • -
- - Cl-C.VOLSI AAI iasao SOUTH I -
.o Ac2ES V
Name:. ()cep .)} M%ci1AEL MA060,Rer • .
dos it�E 3Dt1N. - Tax:Map ,# %5:-1- .
AoR.K.1ef 0 Address L Q .RAf Mo N.Q:,R^t� -
Mtx!�AHA�•1{K1G4 AR
a t oR.Tr't G - si 'V V .6% Ads
1-uflsoN FA Q N`*1 i a83q .
.10 AC.R.a.
PAGE 2
Please; attach the following items to your application.
A. Location map showing the site within-the Town.
B. Plot plan showing existing and proposed'features of the property including:
I. lot dimensions
2. north arrow and scale
3. location and dimensions of existing and proposed buildings, showing
setback distances and uses
4. parking layout to scale, if applicable
S.' physical features (streets, steep slopes, lakes, wetlands,,etc.)
6. location of all wells and septic systems at neighboring properties
7. adjacent ownership
A•sample plot plan and location map are shown below.
„,. Y ir
c... 1' C }i a'''� E L_AMPLE "tt•'°w"......_
'
Vl67W III �pTG{• 1 H--. '4/ !hwy. „ FRANK LI
TQ U1§IN14 ••� r n OR
r 4
AN
yy t.i T�J qq 5 PAT VIEW
` 'F q QO N 'n(vo c e,rATlf
T»n •r
. 4. �u fa : CRpNMR00D
• llottat t 44. eR&M. I•Q •E - ' Qw °
tit 1,
1 gg�
Tl..,1L
�� : RII.w �i
J i 4 OtAcr 1 v.NN,K,lev L..' �
of
RUN < f
„„ter !p L.n�; 3 ti 7
'0/111.y y L.n i It' ''' 6J
Q
CIr n Q O$ -'Ci' >
LOCATION MAP
PAGE-3
APR 26 '00 14:41 FR PRU SECC ALBANY _ +16 4620517 TO 7610691 P.01/01
•
AUTHORIZATION.TO ACT :A►,S AGENT FOR
. 1, - /[orr;�`d,�� seller_`l owner EI of premises located at
Tax Map Number: - hereby
- designate / I J112 • to act as my agent regarding
an application for a septic variance at the above premises.
Applicants signature Date
4111i /
Applicant's agent signature M
r%..- .' . Date tao
STATEMENT
i, (we), f� e'?e ( . do hereby relieve the Town of
®ueensbury from any liabilities on the,plumbing and septic system located at:
I,, (we), realize that putting_the system iess'than the required _. feet from
the may Increase risk of pollution.,
in
Applicant's si nature - Date H./2ar/z
OFFICIAL COED.OF.MEETING MINUTES
"The parties hereto consent that-the"`proceedings which result from the within
applicat¢on may be tape recorded and transcribed by the Town Clerk or his
agent and that such minutes as may be transcribed shall constitute the official
record of all proceedings regarding this application, unless the same May vary
from the handwritten miriutes..taken by the Town Clerk; in vyhiph-event the
handwritten minutes as to such inconsistencies shall be deemed the official
record."
A licent'. signature "`�'`''""-- Date �( 41y°.
p p s s 9 n '�----� _.
Applicant's agent signature - _ .Date - - -
PAGE
RPR 26 '00 14:02 5167610691' PAGE,01
• ** TOTAL PAGE:01 **
NEIGHBOR OR TENANT RELEASE 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 system less than the required feet from
the may increase risk of pollution.
•
Neighbors Tenant [j Signature Date
NEIGHBOR OR TENANT RELEASE 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 system less than the required feet from
the may increase risk of pollution,
Neighbors Tenant j Signature Date
IL NOTICE
This form may be duplicated as required for further Neighbor or
Tenant Statements as required per the Town Board of Health. PAGE 4A
PROJ,EGT I.D.NUMBER 817.21 SEQR
Appendix C
' .State,Environmental Quaiity.Review •
SHORT"ENVIRONMENTAL ASSESSMENT FORM:
• For UNLISTED ACTIONS Only '
PART I—PROJECT INFORMATION (To be completed by Applicant or Prolect sponsor)
1. APPLICANT(SPONSOR T eAs) f( /.e ,- 1 2.- PROJECT NAME �,0�
3. PROJECT LOCATION: - /�� /,J l/J ��,��;;,,��
• Municipality ,2� ..),I) et �d4a'rosimee,. County ' 2.4
4. PRECISE LOCATION(Street address end road Intersections.prominent landmarks,etc.,or provide map) '
R d0,¢s74 — 1t4c r ' a o;v ,eid'hi•
5. IS PROPOSEDy ACTION: '
5 New ❑Expansion 0 Modification/alteration _, /7r�'�'r4
8. DESCRIBE PROJECT,BRIEFLY: . ' , V
ZYisi setorc T1s. */ 'Z ASO) Aeore rr- /hvs7-,A)s7m-
//CzaaGixs .
V
7. AMOUNT OF LAND AFFECTED:
Initially r 0TL. acres Ultimately . acres. V
8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING'LAND USE RESTRICTIONS?
❑Yes 154 No It No,describe briefly to/,.'s ,vaf G
V vOc17�!' A C°i9v,& w. i 'salet
,
9. W}H/g,T IS PRESENT LAND USE IN VICINITY OF PROJECT? . V '
LIST Residential• 0 Industrial 0 Commercial, D Agriculture 0 Park/Forest/Open space D Oilier
Describe:
10. DOES ACTION INVOLVE A PERMIT APPROVAL,OR FUNDING,NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY(FEDERAL,
STATE OR LOCAL)?V -
CI Yee :(No If yes, list-agency(s)and permHVapprovals '
1
11. DOES ANY ASPECT OF.-THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? - •
• ( ❑Yes 'No II yes,list agency name and permltlapproval •
'
• 12. AS A RESULT OF PROPOSED ACTION WILL,EXISTING PERMIT/APPROVAL REQUIRE MODIFICATION?
. ` ❑Yes PNo •
1 CERTIFY AT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE ''/ ./
Apptlesn115pensor name' / '. 1'•'"v' ��• - " Die: G1�(�
' Signature: , e"
i ' , • -
If the action Is In the Coastal Area, and-you are a state 'agency, complete the
Coastal Assessment Form before proceeding with this assessment
OVER'
•i '.-
• PAGES
RESOLUTION APPROVING SANITARY SEWAGE DISPOSAL
VARIANCES FOR THOMAS CLUNE
RESOLUTION NO.: 15,2000
INTRODUCED BY: Mr. Tim Brewer
WHO MOVED ITS ADOPTION
SECONDED BY: Mr. Daniel Stec
WHEREAS, Thomas Clune previously filed an application for three (3) variances from
provisions of the Town of Queensbury On-Site Sewage Disposal Ordinance as follows:
1. §136-11(B) of the Town Code requires an applicant to obtain a variance for all holding
tanks and Mr. Clune has requested a variance to allow a holding tank;
2. Mr. Clime has requested a variance to locate the proposed holding tank three feet, eight
inches(3'8") from the dwelling rather than the required ten feet(10') setback;
3. Mr. Clime has requested a variance to locate the proposed holding tank one foot(±) (1')
from the property line rather than the required ten feet(10') setback;
concerning his property located on Rockhurst Road on Lake George in the Town of Queensbury,
and
WHEREAS,the Town Clerk's Office published the Notice of Public Hearing in the Town's
official newspaper and the Local Board of Health conducted a public hearing concerning the
variance requests on May 15th,2000, and
WHEREAS, the Town Clerk's Office has advised that it duly notified all property owners
within 500 feet of the subject property,
NOW, THEREFORE,BE IT
RESOLVED,that
1. due to the nature of the variances, it is felt that the variances would not be materially
detrimental to the purposes and objectives of this Ordinance or other adjoining
properties nor otherwise conflict with the purpose and objectives of any Town plan or
policy; and
2. the Local Board of Health finds that the granting of the variances is necessary for the
reasonable use of the land and are the minimum variances which would alleviate the
specific unnecessary hardship found by the Local Board of Health to affect the
applicant; and
BE IT FURTHER,
RESOLVED, that the Local Board of Health hereby approves the application of Thomas
Clune for three(3)variances from the Sewage Disposal Ordinance to allow
1. Mr. Clune to have a holding tank;
2. Mr. Clime to locate the holding tank three feet, eight inches (3'8") from the dwelling
rather than the required ten feet(10') setback;
3. Mr. Clime to locate the holding tank one foot (±) (1') from the property line rather than
the required ten feet(10') setback;
4. To include water saving devices.
on property situated on Rockhurst Road on Lake George in the Town of Queensbury and bearing
Tax Map No.: 15-1-48.
Duly adopted this 15th day of May,2000,by the following vote:
AYES : Mr. Turner,Mr. Stec,Mr. Brewer,Mr. Martin,Mr.Brower
NOES: None
ABSENT: None
TOWN OF QUEENSBURY //A)
BUILDING & CODE ENFORCEMENT
742 Bay Road ( (
Queensbury NY 12804 • -%JUG,
(518) 761-8256
SEPTIC DISPOSAL SYSTEM INSPECTION
Name (,J1,e.
Location dG J, I
Date Permit # - _Ood- 35S
SOIL TYPE:/Sand-Loam-Clay-
Results of Percolation Test-
(if applicable) : .te-Minute/Inch
TYPE OF SYSTEM:
ABSORPTION FIE D: To -1 Length
Length of each trench
Depth of trenc es
Size of stone
SEEPAGE PITS: umber-
Size - f . x ft.
Stone size
PIPING: Size Type
Bldg. to Tank 41/"-
Tank to Dist. Box
Dist. Box to Field/Pit
Openings Sealed? Y- o Partial
LOCATION/SEPARATIONS:
Foundation to Tank feet
Foundation to Absorption . feet . .
Separation of Pits feet
Conforms as per Plot Plan , Yes No
LOCATION OF SYSTEM ON PROPE', :
(circle one)
Front - Rear - Left Side Righ , Side
Middle Front - Middle : -ar
COMMENTS: . .
(3) Io
a/ d/45
• fiece sec/ 4-(4.
iOr't SyJ%w.. AraTtcr
QJ ds J2
SYSTEM USE APPROVED: YES A-15-1
Arrived: /r110
Departed:
(.] )
Building I spector
Age
TOWN OF QUEENSBURY
BUILDING & CODE ENFORCEMENT
742 Bay Road
Queensbury NY 12804
(518) 761-8256
SEPTIC DISPOSAL SYSTEM INSPECTION
Name Q...\,01/f....„ 11\01M(1,5
Location
Date(Q`I5 yermi t #a
SOIL TYPE: Sand-Loam-Clay-
Results of Percolation es -
(if applicable) Rate- nute Inch
TYPE OF SYSTEM:
ABSORPTION FIELD: To al Length
_ Length of each •tren .
Depth of trenches /
Size of stone
SEEPAGE PITS Num•
l,'
Size - ft. ft.
Stone size.
PIPING: Size Type
Bldg. to Tank
Tank to Dist. Box '
Dist. Box to Field Pit
Openings Sealed? Yes No Partial
LOCATION/SEPARATII S:
Foundation to Tank'. feet
Foundation to 'Abso ption . feet
Separation of Pits feet
Conforms as per Plot Plan Yes No
LOCATION OF SYSTEM ON PROPERTY:
(circle one)
Front - Rear - Lef. Side - Right Side
Middle Front - Middle Rear
COMMENTS: :
y
• /S /nJ4l/ed
SYSTEM USE APPROVED: YES NO
Arrived: 9C3a
Departed:
Building Insp ctor
•
— Lake George ,,,,I0DO—a55
r4 A, I F
MAY 2 2 2000
TOWN OF QUEENSBURY alto;DEPARTMENTTOWN OF OUEENSBU RY
BUILDING AND CC7D
Based on our limited examination,
compliancevith our comments shalt
not be construed as indicating the
plans and specifications are in full
compliance with the codg,
Q TOWN OF QUEENSBURY
BUILDING-& • , d. ' ' PT.
REVIEWED BY rr
DATE S 3
,i_o" COPY
Two !Bedroom douse
36' x 20'
3 1000 gal tanks
4'3" xa'2" x61O"
4 ,
o O O 0
Rockhurst Road
SGALE: I" = IC'
"I have seen or observed,or believe$saw evidence of,
,Ii objects such as houses,wells,trees,fences,etc.,
own on this document I also represent that I have
sonally measured the distances set forth on the diagram:'
SIGNATURE DATE
. .
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