SEP-0863-2021 SEPTIC DISPOSAL PERMIT Permit Fee:$
APPLICATION Invoice#:
Tni,-ii ud lgcnx%� w; Septic Variance-&N
Flood Zone?Y N
742 Bay Road,Queensbury,NY 12804 Wetlands?`Reviewed By: 6
P:518-761-8256 www.aueensbury.net
Office Use Only p O/ E C E 9 W E
Permit#: 5�1 ' (�O,(�J c�(ja,� D L5
Project Location: NY 128040 APR 14 2022
16 Genista Lane, Queensbury TOWN OF QUEENSBURY
523400 BUILDING c CODES
289.10-1-38 _ -- �"
Tax Map M
1992-Presen 110
RESIDENCE INFORMATION: t
Year Built Gallons #of bedrooms: X gallons
perday per
bedroom Garbage Grinder Yes No
1980 or 150 3 Installed? (choose one)
older Spa or Hot Tub Yes No
1981-1991 130 Installed? (choose one)
PARCEL INFORMATION:
Topography Flat Rolling Steep Slope % Slope
Soil Nature Sand Loam Clay Other, explain: GRAVEL
Groundwater. At what depth? NO GROUND WATER
Bedrock/Impervious material At what depth? NONE
Domestic Water Supply Municipal Well Lake THIS IS LAKE WATER OVER 100 FEET
(if well or lake, water supply from any septic system absorption
is ft.)
Percolation Test Rate: per minute per inch (test to be completed by a
licensed engineer/architect) 5MINUTES
PROPOSED SYSTEM INFORMATION:
TOWN OF QUEENSBURY
742 Bay Road, Queensbury, NY. 12804-5902
Septic System Checklist
Plan to scale
Vrchi
Received Deep hole perttest results from engineer/Architect if applicable(Town Approved Engineers and
tects;June 30 to April 15 Town En ineerfor unapproved Engineers a nd Architects)
All wells on property and adjacent properties shown �61 ke ( �
WJ 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 Var l Wv j 0"IVy CZ;%-tA
Septic tank and pump stations 10'from f undation 50'from any well/lake/ etland 10' from any waterline
va
4kSeptic tank to foundation crawl space/slab on grade,grade in crawl space must be above top of septic tank
for0',Separation required (field verification required)
v'�C-J—Septic tank sized for number of bedrooms and add 250 gals for Jacuzzi tubs/garbage grinder each
Leech Field 20'from foundation 100'from any well 10' from water line
-JJ Seepage pit 150'from well 50'from septic tank
A4eepage Pits 3-times diameter apart
Septic tank and pump stations over 30 gallons 50'from watercourse or wetland
l v $ istance from bottom of trench or system 24"to bedrock or mottling 36"within 1000' of Lake George
�LJ Leech field 100'from watercourse or wetland
4' Toe of mound or bottom of retaining wall 10'from property line 100'from well 20'from
p Foundation
Provide Engineer/Architect stamp for bed or design systems
Department of Health Approval for all mobile home park new systems Flood Plain requirements
2' above established flood elevation to bottom of system
46 All tanks anchored or 2' above flood elevation
Revised 4/15/2021
Tank size gallons (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. SEE FIGURE 2 ATTACHED
ENGINEERING DRAWING
Seepage Pit w/#3 stone How many: ; Size: SEE FIGURE 2 ATTACHED
ENGINEERING DRAWING
N/A
Alternative System Bed or other type: BED
Holding Tank System Total required capacity? ; tank size ; # of tanks
N/A, SEE FIGURE 2 ATTACH ED.ENGINEERING
DRAWING
Septic Application Revised April 2021
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EEM 2021-007
DATE
pROFE5S40N� 1"=20' 8 22 2022
FIGURE NO.
2A
.5GP- 5$b3 - 2021
RESOLUTION SETTING PUBLIC HEARING ON SEWAGE DISPOSAL
VARIANCE APPLICATION OF FRANK C. COTTONE
RESOLUTION NO.: BOH 5,2022 D. IE C� F 0 M LE
INTRODUCED BY: Mr. George Ferone JAN 2 5 2022
WHO MOVED ITS ADOPTION
TOWN OF QUEENSBURY
SECONDED BY: Mr.Anthony Metivier BUILDING& CODES
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, Frank C. Cotton has applied to the Local Board of Health for variances from
Chapter 136 to install a replacement wastewater treatment system with its components proposed to
be located as follows:
1. dispersal system to be 3.2' from the property line in lieu of the required 10' setback;
2. septic tank to be 7.2' from the property line in lieu of the required 10' setback; and
3. pumping station to be 4' from the dwelling in lieu of the required 10' setback;
on property located at 16 Genista Lane 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,February 14t', 2022 at 7:00 p.m. at the Queensbury Activities Center, 742 Bay
Road, Queensbury,to consider Frank C. Cotton's sewage disposal variance application concerning
property located at 16 Genista Lane in the Town of Queensbury (Tax Map No.: 289.10-1-38) 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 24t'day of January,2022,by the following vote:
AYES: 'Mr.Ferone,Mr.McNulty,Mr. Strough,Mr. Metivier,Mr.Freer
NOES: None
ABSENT:None
SEPTIC VARIANCE ffice Use Only
Received:
_ APPLICATION Permit* — 086-2n,-2024
TCMU ofQ{rcrn. Ury Permit Fee:
742 Bay Road,Queensbury,NY 12804
P:518-761-8256 www.aueensbury.net Invoice#: �4 Z-
Approvals:
Submittal: I (one) original &8 copies of the completed
application package
Property Owner(s): Frank C Cottone Owner's Agent: Eric Murdock, P.E.
Address: 123 Port Monmouth Rd, Keansburg NJ 07734 Address: PO Box 6265,Syracuse, NY 13217
Phone#:732-784-4264. Phone#:315-254-6891
Site Address: 16 Genista Lane,Queensbury NY 12804 Tax ID#: 289.10-1-38
Directions to Site:Turn off of Glen Lake Road
Distance from well on property to septic system (if applicable)_NO Well_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? ❑ Yes X❑ No If NO, please explain:Tank is less than 10'from property line.
Is the proposed system to be installed under a parking area? X❑ 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.):
1. Dispersal system is 3.2'from the property line instead of 10'
2.Septic tank is 7.2'from the Property line instead of 10'
3. Pumping station is 4'from the dwelling instead of 10'
_ D [ECEBY �
C� E 0 V LE DEC 0 7 2021
JAN 13 2022 TOWN OF QUEENSBURY
BUILDING&CODES
TOWN OF QUEENSBURY
BUILDING& CODES
eptic Variance Application REVISED Revised February 2019
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 James V Keller
Address 15 Fernw ood Road
Tax Map ID 289.10-1-34.1
South Name Glen Lake
Address
Tax Map ID
East Name Stephen Mackey
Address 14 Genista Lane
Tax Map ID 289.10-1-37
West Name James V Keller
Address 17 Fernwood Road
I
Tax Map ID 289-10-1-39
OWNER STATEMENT
I/We do hereby relieve the Town of Queensbury from any liabilities on the plumbing and septic system located at:
16 Genista Lane,Queensbury,NY '
i
I/We realize that putting the well,septic tank or leaching system less than the required 10'feet from the may increase
the risk of pollution. j
i
Owner—Print Name:Fr k Cottone Date:Oct 6,2021 Owner.
Signature: i Date: Oct 6 2021
I
NEIGHBOR OR TENANT RELEASE&T
UEMENT iff applicable)
I/We do hereby relieve the Town of Queenstyury from any iabilities on the plumbing and septic system located at: 16
Genista Lane,Queensbury,NY. j
I/We realize that putting the septic tank or leaching system less than the required 10 feet from the property line may
increase the risk of pollution.
Neighbor/Tenant—Print Name: Stephen Mac iey Date: Uld��
Neighbor/Tenant-Signature: Date: 11�aZ
f
eptic Variance Application Revised February 2019
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: Frank Cottone
Designates: Eric Murdock, PE as agent regarding the Septic Variance for
Tax Map#: 289.10-1-38
OWNER'S SIGNATURE: `a *� DATE: Nov. 20, 2021
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: Frank Cottone .
OWNER—SIGNATURE: DATE: Nov. 20, 2021
AGENT—PRINT NAME: Eric Murdock, PE
AGENT—SIGNATURE: _Ve55E_ DATE:
eptic Variance Application Revised February 2019