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SEP-0570-2021 • - SEPTIC DISPOSAL PERMIT office Use only _ APPLICATION Permit#: 51&f d` ©" -20ZI Town ofCZaeensbw7 D E C E E Permit Fee:$ WSJ L`� AUGq Invoice#: 4kx^+- 742 Bay Road,Queensbury,NY 12804 AUG 2 5 2021 0 P:518-761-8256 www. ueensbur .n Septic Variance? N TOWN OF QUEENSBURY BUILDING&CODES Flood zone? Y 1 Wetlands? Y Reviewed By: Project Location: 91 �f z,!j .1 -&W r g- C)u-"OsbLw� , My 9Sbt/ Tax Map #: RESIDENCE INFORMATION: Year Built Gallons #of bedrooms: X gallons per =total daily flow per day bedroom Garbage Grinder Yes No 1980 or older 150 _ �v Installed? (choose one) ❑ 0 1981-1991 130 Spa or Hot Tub Yes No 1992-Present 110 Installed? (choose one) ❑ [�; PARCEL INFORMATION: Topography ❑ Flat Rolling ZLSteep Slope % Slope Soil Nature ❑ Sand ❑ Loam ❑ Clay ® Other, explain: ►7-oC-k Groundwater At what depth? A A Bedrock/Impervious material At what depth? /y zi Domestic Water Supply ❑ Municipal ❑ Well ®Lake (if well or lake, water supply from any septic system absorption is ft.) o" .'U r lc� '`/(a•s IC 7-2 nk 0-'-� Percolation Test Rate: v A per minute per inch (test to be completed by a licensed engineer/architect) PROPOSED SYSTEM INFORMATION: Tank size D Co f56vgallons (min. size 1,000 gallons, add 250 gallons for each garbage cylinder or spa/hot tub System Absorption field w/#2 stone Total length ft.; Each Trench ft. Seepage Pit w/#3 stone How many: ; Size: Alternative System Bed or other type: Holding Tank System Total required capacity? 3000 ; tank size /uraa # of tanks 4 Septic Application Revised April 2021 CONTACT INFORMATION: PLEASE PRINT LEGIBLY OR TYPE, PLEASE INCLUDE AN EMAIL • Applicant: Name(s): 2Qmr?�1 As C�.;f'C� 0.5C Mailing Address, C/S/Z: 2z P7"na&Vdk &,S4 6-f-ev6 _ -) Cell Phone: 5/8- 33+-Rj-+l Land Line: -15"/8 --33 -4 Email: Ceti 1dr6SCAc, 1+�C 14r . d 1". zcf,1 • Primary Owner(s): Name(s): + Ck.Jzrw-- aLc(rb5-C Mailing Address, C/S/Z: ,,1t urtdc-v .61 M. CAE4 6-1=cak6 1sk), A--``, laoo/' Cell Phone:_rj S -3 3 ::)- -11-7�1 Land Line: Email: t4VISC(o, fVV ca-le !'f. LOdI ❑ Check if all work will be performed by property owner only • Contractor: Contact Name(s): 6kri.s Ex-, /� Contractor Trade: 15zp- ;, r �- Mailing Address, C/S/Z: ) /©cm-v- &J VLv-reyi C i e.whury Cell Phone: S;3 -30/- ,WG5 Land Line: Ti R �1179 91 rr`l Email: **Workers' Comp documentation must be submitted with this application** • Engineer(s): Mailing Address, C/S/Z: /1& a n,6,L KX C4,s4 �,16" J-4033 Cell Phone: 5-fi Land Line: j) - Email: 6"n Contact Person for Compliance in regards to this project: .5-'e Cell Phone: :fjS 36:,5 &5:P,.�Z Land Line: . 5-/:R - 506::V-9 - -'Vol Email: ,$�-�I/�,:�: hoZ�"C� �i�a�/`e✓1�/r�-.eei^. �-v,., NOTES: 1. Alarm system and 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. 3. As- built drawings must be submitted prior to the inspection, if there has been a change to the submitted plans. 4. If, for any reason, the building permit application is withdrawn, 30% of the fee is retained by the Town of Queensbury. After 1 year from the initial application date, 100% of the fee is retained. 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. PRINT NAME: Daw&g SIGNATURE: �c DATE: -�/ Septic Application Revised April 2021 TOWN OF OUEENSBURY ,r 742 Bay Road, Queensbury, NY. 12804-5902 Sept-ic System Checklist Plan to scale oLA Received Deep hole perc test results from engineer/Architect if applicable(Town Approved Engineers and �Architects;June 30 to April 15 Town Engineer for unapproved Engineers and Architects) lv" All wells on property and adjacent properties shown �Zx &C !/►/GI- S��f�lia Water line shown Municipal or well 10'separation to any part of system (/ %-Setback to property lines show 10' or more for any part of system Ieptic tank and pump stations 10'from foundation 50'from any well/lake/wetland 10'from any waterline ti-*Septic tank to foundation crawl space/slab on grade,grade in crawl space must be above top of septic tank for 0',Separation required (field verification required) Sceptic tank sized for number of bedrooms and add 250 gals for Jacuzzi tubs/garbage grinder each rJ Leech Field 2U from foundation 100'from any-well 10'from water line Pi/&-Seepage pit 150'from well 50'from septic tank r� Seepage Pits 3-times diameter apart Septic tank and pump stations over 30 gallons 50'from watercourse or wetland r�distance from bottom of trench or system 24"to bedrock or mottling 36"within 1000' of Lake George 1OLLeech field 100'from watercourse or wetland Toe of mound or bottom of retaining wall 10'from property line 100' from well 20'from Foundation V�Provide Engineer/Architect stamp sys ems "JADepartment of Health Approval for all mobile home park new systems Flood Plain requirements 2' above established flood elevation to bottom of system All tanks anchored or 2' above flood elevation Revised 4/15/2021 Y . � SEPTIC VARIANCE Office Use Only z- �, Permit#: _ APPLICATION Permit Fee: (_wn of(_)wCmQ'111- Z Invoice#: %�' 7 742 Bay Road,Queensbury,NY 12804 P: 518-761-8256 www.gueensbury.net Approvals: Submittal: 1 (one) original & 8 copies of the completed application package Contact Information: PLEASE PRINT LEGIBLY OR TYPE, PLEAS OD Property Owner(s): Owner's Agent: �s - Ch,Cv� r-,v. C11i1�9�c�S<- AUG 0 2 2021 Address: Address: TOWN OF QUEENSBURY BUILDING& CODES Phone#: ! - 33� -� } � Phone#: Email: Email: Ch� ►�� �s�� E� N Site Information: RECEIVED .-,- Site Address: Tax ID#: rl'-zgzp 6��G� t�tA. G Ll l C✓)Si1�� y t O,UEENSBURY CLERKS OFFICE ",irectlons to Site: Clep/,eD AUG - Distance from well on property to septic system (if applicable) feet CQ�S3BU�Y Is it possible to install a conforming septic system on this property? ❑ Yes 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? XYes ❑ No If NO, please explain: Is the proposed system to be installed under a parking area? 2] Yes ❑ 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.): Se-e:IC in i vI k i r—,5 Cj'rdn�--)Er 'j�:)L.L„-(-Ps . �c .n-ce-4 Ste- 13->,ek- (-r-h Q.If- I,►�,ic � L, ill 164,- c P r r b Y, �--r i ►� av p vp S L�-evw- �a f �� b e �.P�rb�c. s.} ►n skEn�( I a r p t w p -L,,,,k.-,� i ri4'-ec,j a r 5 r r t4aUtn� b&+-le-s w Lq -r'b 6� 5 Septic Variance Application Revised January 2021 List Biel.-names, parcel addresses, and tax map numbers of all adjoining property owners. You may obtain this information from the Town of Queensbury's Assessor's Office: North Name Address Tax Map ID South Namea Address rn 3 FJ-2-&r k)c( Red_ Oiw_LnSticr, , JVU JQSC4 Tax Map ID aS'1 • 14 -. a-. - � � l_l - East Name m �U��,c-� •'' VF)sAv­� Address q Tax Map ID a`3(,. ' `� -.I - ��-� L West Name Q--?,NJvn 4- -3':L,,ruz, )U)W,Df-t. Address q 5 �1' ��i' lcQ 2cQ_ ► c�s��tyv.� {V\i /d�L�f Tax Map ID 5?9 • 14 ' x - �� �) 7 OWNER 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 well, septic tank or leaching system less than the required feet from the may increase the risk of pollution. Owner—Print Name: Owner—Signature: c/ lli Gc'c� �:� -� `��'�i,i� Date: S-� 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: I/We realize that putting the well, septic tank or leaching system less than the required feet from the may increase the risk of pollution. Neighbor/Tenant—Print Name: l f eighbor/Tenant-Signature: ' Date: Septic Variance Application Revised January 2021 ?0 21 RESOLUTION APPROVING DOUGLAS AND CHRISTINE CHILDROSE'S APPLICATION FOR SANITARY SEWAGE DISPOSAL VARIANCES RESOLUTION NO.:BOH 44,2021 INTRODUCED BY: Mr. George Ferone E G 0 V E WHO MOVED ITS ADOPTION D SECONDED BY: Mr. Timothy McNulty AUG 2 5 2021 TO N OF QUEENSBURY WHEREAS, Douglas and Christine Childrose (Applic ts) 'd D r variances from provisions of the Town of Queensbury On-Site Sewage Disposal Ordinance, Chapter 13.6, §136-11 which requires applicants to obtain a variance for holding tanks as the Applicants wish to replace their wastewater system by installing a holding tank system consisting of two (2)holding tanks each with a capacity of 1,500 gallons,thus meeting the required total capacity of 3,000 gallons, and WHEREAS, the Applicants have also applied for additional variances from Chapter 136 to allow placement of the: 1. Holding tank#1 - 3.6P from the property line in lieu of the required 10' setback; 2. Grinder pump system - approximately 5' from the property line in lieu of the required 10' setback; 3. Grinder pump system - 31.31' from Glen Lake in lieu of the required 50' setback; and 4. Holding tanks-45.64' from Glen Lake in lieu of the required 50' setback; on property located at 97 Fitzgerald Road 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 duly conducted a public hearing concerning the variance requests on Monday,August 23`d,2021, 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, the Local Board of Health determines 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 Applicants; and BE IT FURTHER, RESOLVED, that the Local Board of Health hereby approves the application of Douglas and Christine Childrose for variances from the Sewage Disposal Ordinance to allow installation of a holding tank system consisting of two (2) holding tanks each with a capacity of 1,500 gallons, thus meeting the required total capacity of 3,000 gallons and placement of the: 1. Holding tank#1 - 3.61' from the property line in lieu of the required 10' setback; 2. Grinder pump system - approximately 5' from the property line in lieu of the required 10' setback; 3. Grinder pump system - 31.31' from Glen Lake in lieu of the required 50' setback; and 4.. Holding tanks-45.64' from Glen Lake in lieu of the required 50' setback; f on property located at 97 Fitzgerald Road in the Town of Queensbury and bearing Tax Map No: 289.14-1-26. Duly adopted this 23rd day of August,2021,by the following vote: AYES : Mr. Freer,Mr. Ferone,Mr. McNulty,Mr. Strough NOES : None ABSENT: Mr. Metivier HART ENGINEERING RESIDEN'TIAL, COMMERCIAL&MUNICIPAL SITE DESIGN DEVELOPMENT 1969 FERNDALE ROAD CASTLETON,NY 12033 (518)479-40111 FAX(518)177-63-1-1 STEVEN P.HART,P.E. Town Of Queeftsbury October 15, 2021 742. $ay-Road:, Qtieeins'bury,New Y6rk 128.04 Attn: Mr.Mark'Smith, Code Efiforcernent,Officer Re: Childrose.Septic System Replacement 97 Fitzgerald Road-Town of QupensbUry -Dear Mr. Smith: With;* respept to tbe.::above replacement septic field installation,we offer you the following inf 1-1- AS Built drawing a provided by the:Owner, and S g 2. Material list-spec sheets as,provided by the Coritractar, Mr. Chn-i-s.B'6.11, With respect to the.-provided information as noted above, it appears th At..the holding tanks aiid-related:.apptitt&riabce8.were installed in substantial cbhforinance to the approved plans. Itis.-importnt.,to note that Hari Digftiecring did.not perform-any constructio n inspections during;or after;the constriction process. WeWerendtawarethat-thi§was a requirement and therefore did not perform these services. Out,conclusion of"substantial conformance"is based on conversations with the Contractor during construction and with the ownerfollowing construction. Should.you have any questions or-tequire additional informationfree to. please feel contact us. yory truly yours, Hdrt Engin - h t P. HArt�P.E. even P I . cc:File:childros6qucensbury2 I I