Jarrett Engineers.10.25.2010.SPDES Permit JARRE-17 Engineers, PLLC Civil&Environmental Engineeiiw
TRANSMITTAL
To: Michael Dauphinais,Jr.
NYS DEC --
232 Golf Course Road E C F. I!
PO Box 220 D
Warrensburg,NY 12885-0220
OCT z 5 zoo
Date: October 25, 2010
TOWN OF QUEENSBURY '�
Re: Durham's Bay Resort Wastewater BUILDING & CODES
JE 06-100.06
ITEMS TRANSMITTED
ouantity Description
I SPDES Permit—Applicalion Form "D"
11 by 17 draining entitled "Wastewater Management Dunham's Bay
I Resort"
Existing Wastewater Systems—Cl
Revision 2, dated 10/15/10
I Copy of Department of Health Approved plans—Coversheet only
COMMENTS:
If you have any questions, do not hesitate to contact me at(518) 792-2907.
Sincerely,
JARRT;i'r I L2gincua; PLLC
Plorene Thornton
Office Administrator
Enc.
CC: Alan Goldstein with enclosures via email
Michael O'Connor, Esq. with enclosures via email
Dave Hatin,Town of Queensbury Building & Codes with enclosures via email
Keith Oborne, Town of Queensbury Planning Dept. with enclosures via email
Mike Shaw,NYS Dept. of Health with enclosures via email
F.Wo(aPile12006 Projecls12006 ConnuerciaA06-100 Dunhonts Ray106-100.06 Lodge tYII SaGmissionsll'eudirig106100.06 101015 Rev 2 Permit&
const5ource h ilesI06100.06 101025 SPDES TransmNaLdoc
12 East Waslungton Strect 518 792--2907
Glens rails,NY 12801 Fax 518 798-1864
91-19-f(2/85)
NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION
APPLICATION FORM "Do'
for a State Pollutant Discharge Elimination System (SPDES) Permit 1,11111111W
(A SPDES Application When Signed by a Permit Issuing Official Becomes a SPDES Permit)
PLEASE PRINT OR TYPE
APPLICATION TYPE IF RE-ISSUANCE OR MODIFICATION,GIVE PREVIOUS NUMBER
❑New ❑Re4ssuance ®Modiflcavon NY-- 013-1601
OWNER'S NAME(Corporate,Partnership,Individual) TYPE OF OWNERSHIP
Capital Region Properties, LLC ®Corporate ❑Individual ❑Partnership ❑Public
OWNER'S MAILING ADDRESS ISbeet.Citv.State.Zia Codet
1754 Central Avenue, Albany, NY 12205
REFER ALL CORRESPONDENCE TO:(Name,Tine and Address) TELEPHONE NUMBER
Alan Goldstein, Owner, 1754 Central Ave. , Albany, NY 12205 (518) 785-4156
FACILITY NAMEBaT Or s Edge, L FACILITY LOCATION(Street or Rced) CITY,TOWN OR VILLAGE
d a: Dunham's Bay Resort 2999 State Route 9L Lake George
COUNTY GIVE EXPLICIT DIRECTIONS TO LOCATION
Warren Bay Road to Route 9L, property is on the right
NATURE OF BUSINESS OR FACILITY POPULATION SERVED(See Instructions))
Resort / Motel 599 Restaurant IS, 47 Roof s
FREQUENCY OF DISCHARGE
All Year? ®Yas ❑NO If No,Specify Number of Months All Week? ®Yes ❑NO "No,Specify Number of Days
DOES YOUR DISCHARGE CONTAIN OR IS IT POSSIBLE FOR YOUR DISCHARGE 7o CONTAIN ONE OR MORE OF THE FOLLOWING SUBSTANCES ADDED AS
A RESULT OR YOUR OPERATIONS,ACTIVITIES OR PROCESSES?
Please Check❑Aluminum ❑Ammmmia ❑BelyllWm ❑Cadmium ❑Chlorine ❑Chromlum ❑Copper ❑Cyanide
Grease [:]Lead ❑Mercury [-]Nickel ❑Oil ❑Phenols ❑selenium Zinc Nona of These
DISCHARGE DATA (Use additional forms.If necessary) (See Instructions)
OUTFALLNO. Proposed Replacement TYPE OF WASTE TYPE OF TREATMENT DESIGNFLOW 1920
001 Exlstin E ansion Sanitary e tic Tank & Leach System Gal[Da
SURFACE DISCHARGE If YES,Name of Receiving Waters Classincalion Waters Index Number
❑Yes Eallo
SUBSURFACE DISCHARGE If YES,Name of nearest surface waters Distance SO{{L TYPE Depth to Water Table
UYes ❑No Lake Geor a 690± Ft. 15 $d I unknown
OUTFALL NO. ®Proposed Replacement TYPE OF WASTE TYPE OF TREATMENT DESIGN FLOW 1200
002 Existing HE Sanitary Se tic Tank & Leaci S stem Galway
SURFACE DISCHARGE If YES,Name of Receiving Waters Classification Waters Index Number
❑Yee ®No
SUBSURFACE DISCHARGE If YES,Name of nearest surface waters Distance TjI TYPE DeDIhio Water Table
®Yes NO Lake Geor a 150± Ft. SSan y 36"
OUTFALL NO. Proposed Replacement TYPE OF WASTE TYPE OF TREATMENT DESIGN FLOW 4800
003 Existing Expansion Sanitary S ptic Tank & Leach ystem GayDay
SURFACE DISCHARGE If YES,Name of Receiving Waters Class ficalion Waters Index Number
❑Yea ®No
SUBSURFACE DISCHARGE I It YES,Name of nearest surface waters Distance SSO{L TYPE Depth to Water Table
Yes ❑Noeorge i Ft. 11 Y unknown
RAnd
1 hereby often under penally Of perjury that the information provided on this form and any attached supplemental forms Is true to the best of my knowledge and belief.
False statements made herein are punishable as a Class A misdemeanor pursuant to section 210.45 of the Penal Law.
L TS SI T aee nsl (ions) DATE PRINTED NAME TITLE
1'� r;2A /(l r f li'�Sr fryy7 6(embe'r
PERMIT VALIDATION SECTION APPLICATION NUMBER
(Department of Environmental Conservation Use Only) NY
This SPDES permit is Issued in compliance with Title 8 of Article 17 of the Environmental
Conservation Law of New York State and In compliance with the provisions of the Federal Water EFFECTIVE DATE EXPIRATION DATE
Pollution Control Act,as amended by the Federal Water Pollution Control Act Amendments of 1972.
P.L.92-500,October 1Q 1972(33 U.S.O.§1251 at. seq.) (hereinafter referred to as,the Act"),
and subject to the attached conditions. ATTACHMENTS:
sign oture m Perrot Issuing Avant Dale
CARD Type Type SIC CODE zeal Ols. CARD Region County Abpr Sub c=7CARD os. Longbud. CARD Llmlrd
QrnFoos Clasa Basin aesln Ara.ee 7o u m 3 yt z 4 a 9 sg 7 s7
NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION
APPLICATION FORM "D" da
for a State Pollutant Discharge Elimination System (SPDES) Permit VW
(A SPDES Application When Signed by a Permit Issuing Official Becomes a SPDES Permit)
PLEASE PRINT OR TYPE
APPLICATION TYPE IF RE-ISSUANCE OR MODIFICATION,GIVE PREVIOUS NUMBER
❑New [:]Rs-Issuance ®Mod9cellon NV-- CONTINUATION SHEET
OWNER'S NAME(Corporate,Partnership,Individual) TYPE OF OWNERSHIP
Capital Region Properties, LLCCorporate ❑Individual ❑ Pannershlp ❑Public
OWNER'S MAILING ADDRESS(Street CiN.State.ZIO Cadet
1754 Central Avenue Albany, NY 12205
REFER ALL CORRESPONDENCE TO:(Name,Title and Address) TELEPHONE NUMBER
Alan Goldstein, Owner, 1754 Central Ave. Alban NY 12205 I519 785-4156
FACILITY NAME 7Vl, FACILITY LOCATION(Sweet or Roadl CITY,TOWN OR VILLAGE
dba: Dunham's Bay Resort 1 2999 State Route 9L Lake George
COUNTY GIVE EXPLICIT DIRECTIONS TO LOCATION
Warren Bay Road to Route 9L property e riabt
LqJp E
NATURE OF BUSINESS OR FACILITY P LATIC7ENSSEa UD f ei InsDuctbns)
Resort / Motel Y i( L 8 L ❑
FREQUENCY OF DISCHARGE ��—
AIIYeaR E3Yes []NO ONO,Specify Number of Months AT Week? faYes ONO U No,Specify Number of Days
DOES YOUR DISCHARGE CONTAIN OR IS IT POSSIBLE FOR YOUR DISCHARGE TO CONTAIN ONE OR MORE OF THE FOLLOWING SUBSTANCES ADDED AS
A RESULT OR YOUR OPERATIONS,ACTIVITIES OR PROCESSES?
Please Check❑Aluminum ❑Ammonia ❑BeMtium ❑Cadmium ❑Chlorine []Chromium❑Copper ❑Cyanide
Grease []Lead ❑Mercury ❑Nlckel []Oil ❑Phenols ❑Selenium Zinc Noneor These
DISCHARGE DATA(Use additfonal forms.If necessary) (See Instructions)
OUTFALL NO. Proposed Replacement TYPE OF WASTE TYPEOFTREATMENT DESIGN FLOW 2500
004 Exlsflno Expansion eptic Rank & Leach System caws
SURFACE DISCHARGE If YES,Name of Receiving Waters ClasaHcation Waters Index Number
❑Yes ao
SUBSURFACE DISCHARGE OYES,Name of nearest surface waters Distance SOIL TYPE Depth to Water Table
®Yes ❑No Lake George 380t FL it Unknown
OUTFALLNO. ®Proposed HReplacement TYPE OF WASTE TYPEOFTREATMENT DESIGN FLOW
Existing Expansion Gel(Da
Y
SURFACE DISCHARGE If YES,Na of Receiving Welers Classification Wafers Index Number
❑Yes ❑No
SUBSURFACE DISCHARGE O YES,Name of nearest surface wafers Distance SOIL TYPE Depth to Water Table
Ely- No FL
OUTFALL NO. Proposed Replacement TYPE OF WASTE TYPEOFTREATMENT DESIGN FLOW
Existing H Expansion Gal(Dey
SURFACE DISCHARGE If YES,Name of Receiving Waters GlassOicatin Waters Index Number
❑Yea ❑No
SUBSURFACE DISCHARGE If YES,Name of nearest surface waters Distance SOIL TYPE Depth to Water Table
Yes ❑No Ft.
I hereby aMrm under penally of perjury that the information provided on this form and any attached supplemental forma is true to the best of my knowledge and belief.
False statements made herein are punishable as a Class A misdemeanor pursuent to section 21OA5 of the Penal Law.
LI TS S NAJU,E(see Instructions) GATE PRINTED NAME TITLE
\ N got %i0 /Cc >, .Js dc,n rrlh er2-
PERMIT VALIDATION SECTION APPLICATION NUMBER
(Department of Environmental Conservation Use Only) NY--
ThisSPOES permit Is Issued In compliance with Title 8 of Article 17 of the Environmental
Conservation Law of New York State and In compliance with the provisions of the Federal Water EFFECTIVE DATE EXPIRATION DATE
Pollution Control Act,as amended by the Federal Water Pollution Control Act Amendments of 1972,
P.L.92-500,October 18,1972(33 U.S.C.§1251 at. seq.) (hereinafter referred to as'the Act-), ATTACHMENTS:
and subject to the attached conditions.
8lgnaNreorPwntltluMrg 7peM Due
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