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SEP-0147-2022 SEPTIC VARIANCE Office Use Only Permit#: a-T— ©Ar}-20fI2 APPLICATION Permit Fee:$ 110 5 Teruo of S Invoice#: znt?A'-�" 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 PLEASE PRINT LEGIBLY OR TYPE, PLEASE INCLUDE AN EMAIL Section 1: Contact Information: Property owner(s): Betty Spawn , �iA�Qr" ent: Hutchins Engineering PLLC �� Address: 33 Fletcher Road 169 Haviland Road MAR � ueensbury, NY 12804 .Albany, NY 12203 TOWN of QUCCNSIP,bMe#: 518-745-0307 Phone#: BUILDING a O®OCS Email: tim41153@gmail.com -Tim Spawn l: I dobie@hutchinsengineering.com Section 2: Site Information: Site Address: 26 Knox Road Tax ID#: 239.771-22 Directions to site: Assembly Point Road, Left onto Knox Rd house on right Section 3: Distance from well on property to septic system (if applicable) 73 feet Section 4: Is it possible to install a conforming septic system on this property? ElYes ■❑ No If YES, please explain and attach a diagram: Section 5: Does.the proposed system meet setback requirements for distance from wells&septic systems on neighboring properties? *Yes ❑ No If NO, please explain: Section 6: Is the proposed system to be installed under a parking area? ❑ Yes ■❑ No Section 7: 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 ioo ft.): Setbacks for new Absorption Field to Property Lines (1'&2')&on-site well (7 Septic Variance Application Revised December 2021 r Section 8: List the 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 Jean Wanamaker Address 30 Knox Road Lake George, NY 12845 Tax Map ID 239.7-1-43 South Name 15 Knox Road LLC Address 7 Berkery Place Alpine, NJ 07620 Tax Map ID 239.7-1-21.1 East Name John & Mary Virginia Harris Address 20 Knox Road Lake George NY 12845 Tax Map ID 239.7-1-23 West Name Jean Wanamaker Address 30 Knox Road Lake George, NY 12845 Tax Map ID 239.7-1-43 Section 9: OWNER STATEMENT I/We do hereby relieve the Town of Queensbury from any liabilities on the plumbing and septic system located at: 26 Knox Rd . I/We realize that putting the well, septic tank or leaching system less than the required 100 feet from the existing Well may increase the risk of pollution. Owner—Print Name: Betty Spawn s Owner—Signature. _07- r Date: o`- U Section 10: 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: Neighbor/Tenant-Signature: Date: Septic Variance Application Revised December 2021 r J Section 11: 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: Betty Spawn Designates: Hutchins Engineering PLLC as agent regarding the Septic Variance for �r. Site Address: 26 Knox Road Tax Map#: 239.7-1-22 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: Betty Spawn OWNER—SIGNATURE: . .2) DATE: AGENT—PRINT NAME: Lucas W. ®Obie, P.E. AGENT—SIGNATUR ___ _ _ — _�_ _ DATE: Septic Variance Application Revised December 2021 169 Haviland Road Queensbury, NY 12804 Hutchins Engineering PLLC Phone: (518)745-0307 Fax: (518)745-0308 April 11, 2022 &TOWN Town of Queensbury Local Board of Health742 Bay Road Queensbury NY 12804OF Re: Betty Spawn —26 Knox Road =Assembly Point `�� SBURY Septic Variances ®DES Tax Map ID: 239.7-1-22 Dear Supervisor Strough and Town Board Members: This office represents the Spawn family with respect to a new enhanced treatment on-site wastewater treatment system and associated septic variances for their home at 26 Knox Road on Assembly Point. On March 30, 2022i we made a variance submission to the Board in which we proposed a new Puraflo® Peat Biofilter on-site wastewater treatment system over the northeasterly portion of the parcel. Subsequently, the design has been revised to a Fujiclean Enhanced Treatment Unit with a shallow pipe-in-stone absorption bed. r Presently, the camp has an old wastewater system, which we understand is a metal septic tank with a drywell, situated close to the rear of the home, approximately 60 feet from the parcel's well. 'It is proposed to remove the existing system as part of the project and to install the new system. Given the site constraints and well location, it is not possible to install a compliant absorption field upon the parcel, therefore three variance requests to the Local Board of Health are requested for the project. These requests are itemized on Sheet S2 of the project plans and consist of: property lines setback relief for the Absorption field (toe of wall for fill) and well setback _relief for the Absorption Field. It is our opinion that this new enhanced treatment system will provide a vast improvement for the parcel and the neighborhood. Given the deficient setback to the existing well, our clients propose to install a UV disinfection system for their water supply. Enclosed please find 10 sets of updated project plans. We look forward to discussing the applicatign with the board at the April 18, 2022 meeting._ Please contact me with any questions that you may have or if you would like to perform a site visit. Thank you for.your assistance with the project. Best reg6rds 6�YA. VISED Lucas W. Dobie, P.E. ,4ssociate/Partner—Design Engineer Enclosures Hutchins Engineering PLLC C RESOLUTION APPROVING BETTY SPAWN'S APPLICATION FOR SANITARY SEWAGE DISPOSAL VARIANCES RESOLUTION NO.: BOH 34,2022 KTOWN C E EINTRODUCED BY: Mr. George FeroneWHO MOVED ITS ADOPTION AY 0 3 202?OF QUEEN �J�RYSECONDEDBY: Mr. Timothy McNulty DING ✓t.,�_,�, WHEREAS, Betty Spawn (Applicant) filed an application for variances from provisions of the Town of Queensbury On-Site Sewage Disposal Ordinance, Chapter 136 to install a new enhanced treatment on-site wastewater treatment system with certain components of it to be located as follows: 1. Absorption field toe of fill to be 2' from the northerly property line in lieu of the required 10' setback; 2. Absorption field toe of fill to be F from the easterly property line in lieu of the required 10' setback; and 3. Absorption field toe of fill to be 76' from the well and absorption bed to be 83.7' from the well in lieu of the required 100' setback(s); on property located at at 26 Knox 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,April 18", 2022, 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 R 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 fmds 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 Betty Spawn for variances from the Sewage Disposal Ordinance to install a new enhanced treatment on- site wastewater treatment system with certain components of it to be located as follows: 1. Absorption field toe of fill to be 2' from the northerly property line in lieu of the required 10' setback; 2. Absorption field toe of fill to be 1' from the easterly property line in lieu of the required 10' setback; and 3. Absorption field toe of fill to be 76' from the well and absorption bed to be 83.7' from the well in lieu of the required 100' setback(s); on property located at at 26 Knox Road in the Town of Queensbury and bearing Tax Map No: 239.7-1-22, and BE IT FURTHER, RESOLVED, that the Enhanced Treatment Unit (ETU) shall be maintained by the property owner in accordance with the manufacturer's recommendations for the life of the system, and r BE IT FURTHER, RESOLVED, that the Town Board authorizes and directs the Town Clerk to forward by certified mail a certified copy of this Resolution to the Adirondack Park Agency for its review,and BE IT FURTHER, RESOLVED, that this approval Resolution shall not be effective until 30 days after such notice to the Adirondack Park Agency and shall be subject to review by the Adirondack Park Agency during such period. Duly adopted this 18th day of April,2022,by the following vote: AYES Mr. Freer,Mr.Ferone,Mr. McNulty,Mr. Strough,Mr.Metivier NOES None ABSENT: None I, Caroline H. Barber, Town Clerk of the Town of Queensbury, Warren County, New York, do hereby certify that I have compared the foregoing with the original resolution as listed above adopted at a regular meeting of the Town Board of the Town of Queensbury held on the 18th day of April, 2022 at which a quorum was present and that the same is a correct transcript therefrom and of the whole original thereof to date. IN WITNESS THEREOF, I have hereto set my hand and the SEAL of said Town of Queensbury, this 19th day of April, 2022. SEAL SIGNED: Caroline H.Barber Town Clerk Town of Queensbury SEPTIC DISPOSAL PERMIT office Use only APPLICATION Permit#: roam ofQgeensbury eJ Permit Fee:$ Invoice#: 742 Bay Road,Queensbury,NY 12804 P:518 761-8256 www.aueensburv.net Septic Variance? © N Flood Zone? Y Wetlands? Y Reviewed By: Project Location: 26 Knox Road Tax Map #: 239.7-1-22 RESIDENCE INFORMATION: Year Built Gallons #of bedrooms: X gallons per =total daily flow per day bedroom Garbage Grinder Yes No 1980 or older 150 Installed? (choose one) ❑ 10 1981-1991 130 Spa or Hot Tub Yes No 1992-Present 110 3 110 Installed? (choose one) ❑ [� 330 PARCEL INFORMATION: Topography Flat Rolling ❑ Steep Slope % Slope Soil Nature Sand ❑ Loam V Clay ❑ Other, explain: Groundwater At what depth? L seasonal high groundwater) Bedrock/Impervious material At what depth? Domestic Water Supply ❑ Municipal Well ❑Lake (if well or lake, water supply from any septic system absorption is 76 ft.) Percolation Test Rate: 12:00 per minute per inch (test to be completed by a licensed engineer/architect) PROPOSED SYSTEM INFORMATION: Tank size ETU gallons (min. size 1,000 gallons, add 250 gallons for each garbage cylinder or spa/hot tub (500 GPD Fuji Clean ETU) 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: 15'x 25'stone absorption bed: Holding Tank System Total required capacity? ; tank size ; # of tanks Sentic Aoolication Revised Anril 2021 CONTACT INFORMATION: PLEASE PRINT LEGIBLY OR TYPE, PLEASE INCLUDE AN EMAIL • Applicant- Name(s): Betty Spawn Mailing Address,C/S/Z: 33 Fletcher Road Albany.NY_12203 Cell Phone: Land Line: Email: tim41153@gmaii.com-Tim Spawn • Primary Owner(s): Name(s): same as applicant Mailing Address,C/S/Z: Cell Phone: Land Line: Email: ❑Check if all work will be performed by property owner only • Contractor: Contact Name(s): Stevenson Excavating-Bruce Stevenson Contractor Trade: Excavation Mailing Address,C/S/Z: 51 Stevenson Way.Fort Ann.NY 12827 Cell Phone:(518)401-7659 Land Line: Email: "Workers' Comp documentation must be submitted with this application" • En ineer s : Name(s):_Hutchins Engineering PLLC Mailing Address,C/S/Z: im Haviland Road Queensbury,NY 12804 Cell Phone: Land Line: 518-745-0307 Email: Iwdobie hutchinsengineering.com Contact Person for Compliance in regards to this project: Lucas Dobie.P.E. Cell Phone: Land Line: 518-745-0307 Email: lwdobie @-hutchinsenaineerino,com 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: Bette Spawn :SIGNATURE: `'t� �C DATE: J f --- Septic Application Revised April 2021 TOWN OF QUEENSBURY 742 Bay Road, Queensbu-ry, NY. 12804-5902 Septic System Checklist � ) Plan to scale 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) fAll wells on property and adjacent properties shown 16' 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'2 �ASeptictank and pump stations 10'from foundation 50'from any well/lake/wetland 10' from any waterline 45eptic tank to foundation crawl space/slab on grade, grade in crawl space must be above top of septic tank riff for 0',Separation required (field verification required) IN_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 IL4-Seepage pit 150'from well 50'from septic tank N%Seepage Pits 3-times diameter apart Septic tank and pump stations over 30 gallons 50'from watercourse or wetland distance from bottom of trench or system 24"to bedrock or mottling 36"within 1000' of Lake George *Leech field 100'from watercourse or wetland W�Toe of mound or bottom of retaining wall 10'from property line 100'from well 20' from Foundation l,71z CV,,_ - 36provide Engineer/Architect stamp for bed or design systems Ck-Department of Health Approval for all mobile home park new systems Flood Plain requirements W� 2' above established flood elevation to bottom of system All tanks anchored or 2' above flood elevation r i SERVICE'CONTRACT FOR THE FUJI CLEAN TREATMENT TECHNOLOGY Ellsworth"&Son'Excavating,,Inc. has been contracted by Fuji Clean USA and their Authorized Distributor to provide you with the first two years of service,maintenance,and operation as well as any warranty service should it be required. I This contract'has been paid in full on your behalf. This contract is provided in accordance with applicable state and 4 local regulations. This contract,entered into between Ellsworth&Son Excavating,Inc_and; __:3` and BetfjiySp 1 �shall be binding upon both parties in accordance with the conditions and terms set forth below: If Contract Date: 1 /1120?2 I Tenn of Contract: 2 years location of Technology:.property address: 26 Knox Road,Assembly Point,NY 12845 I ' Model: Fujiclean CE5 Maintenance and Other Services shall consist ok a. Inspection,Maintenance,and Operation:Service Provider agrees to inspect,maintain and operate the Fuji Clean treatment system per the TN DEC and manufacturer's requirements.This Includes but Is not limited to the following: two service visits per year (6-month intervals). Service visits will include performance of ,operation and maintenance activities detailed in the Operation and Maintenance manual; check the sludge depth to determine the need for pumping; inspection of the final effluent to determine proper operational performance;and test the process parameters including but not fimited to DO,pH,and turbidity to maintain proper operation; b. Service Calls: Service Provider will provide services calls within two business days. Service Provider will apply a charge for labor;travel time and shipping for any necessary replacement parts unless covered by the manufacturers warranty. c. Completed inspection form will be submitted to local and state authorities as required. d. Contract is transferable in the event of sale of the home. The owner of the system agrees to use the system as outlined in the,owners manual.The owner also understands that any abuse of the system may void the manufacturers warranty. Owner acknowledges that the following items can overtax the.biological process of the system and shall avoid introducing dental floss,disposable diapers,'kitty fitter,sanitary napkins,tampons,cigarette butts,condoms and other Items of.similar nature.Owner acknowledges that the following can destroy the biological process and agrees to not introduce chemicals such as paints,varnishes,thinners,waste oils,photographic solutions,pesticides and excessive amounts of household chemicals into the system.The owner acknowledges that violation of these terms will void the manufacturers warranty and may be in violation of state law. Homeowner. e � Date f�) Service Provid Date262,2, d (Authorized gent) Please sign and return to the Service Provider whose name and address appear below: Ellsworth&Son Excavating, Inc 10302'State Route 149 IE 0 v Er Fort Ann,NY 12827 I OCT 2 6 € Town OF QU-ImNSBURY BUILDING & 000E_8 Inspector's No.: /1-1 2 2 '315 1 'oL COMMONWEALTH ELECTRICAL INSPECTION SERVICE, INC. (Consulting and Fire Inspection Services) (Incorporated in the states of New York, Pennsylvania, and West Virginia) ZE�(- D )ztq -2 2,2.- Desiring Certificate of Approval,application is made for inspection of electrical installation in the premises described below. On demand,applicant agrees to pay for inspection service in accord with schedule of charges. Owner: /� C;r-✓ Type Building:Dwelling Othef(please specify): C� n„ S,/ ( Job Location: Y x ,-, City: %T r' e-r, State: A-J N County: « ),�2n_r_,,_ Permit From: Permit# Swimming Pool: Inground: Aboveground: Bonding Date: Work—New Additional Bldg.— New Old Ready for Inspection Applicants Signature: License#: Please Print Name: /k ,,< < , Ar, Phone#: Applicants Address: Name of Utility: City: Office To Be State: Zip: Notified: Job#: SPACE BELOW FOR USE OF INSPECTORS ONLY Switches Water Heater Service Equipment Other list below Receptacles Paddle Fan/Light Control Service Equipment GFCI Rece t Paddle Fan Panel AMP Rece t Paddle Fan/Light Dryer Rec Lights Vent Fan Washer Rec Lights Air Conditioner Dishwasher Rec Smoke Detectors AFCI Breaker Microwave Rec Smoke/CO Detectors GFCI Breaker Garbage Disp Rec AFCVGFCI Breakers Refrigerator Receptacle Additional apparatus for certificate:(Not listed above) Inspector Job Notes: Gov MUAflKjOU EII sty Inspector OCT glens Falls, NY 128012022 515) 79E9-Ot305 U Y (aDE Installed By(if other than applicant): OFFICE USE ONLY Extra trip dates Ins ection Fee$ ,S v_o Ci Date Received: Service Date: 1 CASH Certificate No: R.W.Date: 2 Check No. Final Date: 3 Invoice Certificate Needed? 4 CC Date Sent: Inspector sign in r t Yes_Dup f next s ace Please print name Inspector: = Original Progress Final THIS APPLICATION EXPIRES ONE YEAR FROM DATE MAKE ALL FEES PAYABLE TO C.E.I.S.INC.