SEP-0041-2022 SEPTIC DISPOSAL PERMIT office use only
APPLICATION Permit#: tep-- .1-2027
Town of Quccnsbury 8 r
Permit Fee:$
i
Invoice#:
742 Bay Road,Queensbury,NY 12804 �
P:518-761-8256 Www.gueensbury.net Septic Variance? \v N .60 kA— 14 2-0 2Z
Flood Zone? Y N _y .�—
Wetlands? Y ed-By:arrf
Project Location: 390C1everdale Road
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Tax Map #: 226.8-1-7 r
TOWN Or L 'ODES Y
RESIDENCE INFORMATION: 61ji`01N ,
-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) ❑ ❑
1981-1991 130 Spa or Hot Tub Yes No
1992-Present 110 3 110 330 Installed? (choose one) ❑
PARCEL INFORMATION:
Topography ❑ Flat Rolling ❑ Steep Slope 10 % Slope
Soil Nature 0 Sand ❑ Loam ❑ Clay ❑ Other, explain:
Groundwater At what depth? >5,
Bedrock/Impervious material At what depth? >5-
Domestic Water Supply ❑ Municipal ❑ Well Lake
(if well or lake, water supply from any septic system absorption is
53'
Percolation Test Rate:. 8 per minute per inch (test to be completed by a
licensed engineer/architect)
PROPOSED SYSTEM INFORMATION:
Tank size gallons (min. size 1,000 gallons, add 250 gallons for each garbage cylinder or
:spa/hot tub *FUII Clean CE5
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 t InfiltratorH-20GravellessOpen-Bottom
y type: Chamber Enhanced Treatment Unit
Holding Tank System Total required capacity? ; tank size ;
# of tanks
Septic Application Revised April 2021
TOWN OF Q L' EENSB URY
742 Bay Road, Queensbury, NY. 12804-5902
Septic System Checklist
VI Plan to scale /C? j���/.� Q,,
q
�Received Deep hole pert test results from engineer/Architect if applicable(Town Approved Engineers and
Architects;June 30 to April 15 Town Engineer for unapproved Engineers and Architects)
1'-� All wells on property and adjacent properties shown �� �I,C.t, ZIP
Water line shown Municipal or well 10'separation to any part of system - (,✓G✓�-camv�,�
%, ,
Setback to property lines show 10'or more for any part of system (/(V4ti '
Septic tank and pump stations 10'from foundation 50'from,any well/lake/wetland 10'from any waterline
(J 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)
Septic tank sized for number of bedrooms and add 250 gals for Jacuzzi tubs/garbage grinder_eaeh__�
Leech Field 20'from foundation 100'from any well 10' from water line
Seepage pit 150'from well 50'from septic tank Ucr)c—
!✓Seepage Pits 3-times diameter apart
A/d/ Septic tank and pump stations over 30 gallons 50'from watercourse or wetland
[ istance from bottom of trench or system 24"to bedrock or mottling 36"within 1000' of Lake George
!" Leech field 100' from watercourse or wetland va rmj%C�I A, rff
41 '�
rToe of mound or bottom of retaining wall 10'from property line 100'from well 20' from
Foundation
v/ Provide Engineer/Architect stamp for bed or design systems
AllADepartment of Health Approval for all mobile home park new systems Flood Plain requirements
/" O 2' above established flood elevation to bottom of system
�A All tanks anchored or 2' above flood elevation
Revi.-ed 4/15/2021
VOTAL FtA
Dsass cr,ecuti ��I .! Cs
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only has 06en
visually inspedted and certified as of
this date pursuant to aliplicable •+
codm
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Date
554845Q.f�.1 Inspector
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s ¢csnrnie yi(e�s. Usv 1Vub%tx NR np wic,110 s;l(na�Rvvenmea+ent ralirtg aS:
tin er +.�+e:TF+�r bo�egn ei utiq undm fay i.res::at�vl lvi t�nduel anlrp»td,°^'��F 59sarrj tram�Wu;;t Contiu;t must tnaitrllun_
Let me know if you need anything else from me.
Thank you
Pete Carr
Sent from my Whone
2
ENVIRONMENTAL DESIGN
PARTNERSHIP, LLP. 900 Route 146 Clifton Park,NY 12065
(P)518.371.7621 (F)518.371.9540 edpllp.com
Shaping the physical environment
November 22,2022
Town of Queensbury Building&Codes
742 Bay Road
Queensbury, NY 12804 NOV 2 2 2022
Attn: John O'Brien, Director
TOWN OF QUEENSBURY
Re: Hole-390 Cleverdale Road BUILDING&CODES
Replacement Wastewater System
cz>e? - o 04k - 20 zZ
Dear John:
In compliance with application approvals granted by the Town of Queensbury I offer the following
regarding the referenced project.
The design plans, prepared by this office,reviewed and approved by the Town as associated with
the wastewater system application,are as follows:
Wastewater Improvements For Hole Residence
Applicant: Jeff Hole
390 Cleverdale Road Town of Queensbury
March 29,2022 E:MjEu:1-L
• Sheet 1 Cover Sheet
• . Sheet 2 Existing Conditions
• Sheet 3 Site Plan
• Sheet 4 Wastewater Variance Plan
• Sheet 5 Site Details
• Sheet 6 Enhanced Treatment Details
During the course of construction I was on the job site to observe key components of the system
installation. The field location of the pretreatment tank(Fuji Clean), pump tank tank and absorption
field have been installed in compliance with the approved design plan. The absorption field has
been constructed with an area as required of the design (three bedroom flowrate). I have provided
an 'as-built' plan which indicates those component locations. Part of the site improvements
included a catch basin capturing stormwater runoff with discharge to a down gradient rain garden.
Those components have been moved slightly in location. All other aspects of the work were
constructed as designed and using the materials as specified. The pump system and Fuji Clean
unit were set up for operation and tested/inspected on November 22th .
Based on my inspection of the system installation it is my opinion that the wastewater system is in
compliance with the intent of the approved design plan and is ready-for operation.
Sincerely,
t�19-LL��jy �-�a�
ennis MacElroy, PE
Attachment'
Cc:Jeff Hole
12-6-22
Office Use Only
-� SEPTIC VARIANCE
` Permit#: 'D&iP" O 0�,\ "20 Z2_
APPLICATION Permit Fee: $ �e5
Town of(Lixcnsbury
Invoice#: "f
742 Bay Road,Queerisbury,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): Jeff Hole Owner's Agent: Environmental Design Partnership LLP
Address: 13 Magnolia Drive,Saratoga Springs Address: 900 Route 146 Clifton Park NY 12026
NY 12866
Phone#: 201-246-6404 Phone#: 518-371-7621
Email: jdhole@gmail.com Email: dmacelroy@edpllp.com,cdemyer@edpllp.com
Section 2:
Site Information:
Site Address: ,390 Cleverdale Road Tax ID#: 226.8-1-7
Directions to Site: From 9L turn onto Cleverdale Road,Continue towards the end of Cleverdale,Site on East side
Section 3:
Distance from well on property to septic system (if applicable) N/A feet
Section 4•
Is it possible to install a conforming septic system on this property? ❑Yes M 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? ❑X Yes ❑ No If NO, please explain:
Section 6:
Is the proposed system to.be installed Under a parking area? n Yes n No
SECTION:7
Section of the Sanitary Sewage Ordinance from Which you are seeking the variance ry
V-1:ABSORPTION BED TO LAKE GEORGE-53'REQUESTED VS THE 100''REQUIRRn D v
V-2:PUMP TANK TO LAKE GEORGE-30'REQUESTED VS THE SU REQUIRED
V-3:ETU TANK TO LAKE GEORGE-32'REQUESTED VS THE 5Y REQUIRED
V-4:ABSORPTION BED TO PROPERTY LINE(N)-T REQUESTED VS.THE 10'REQUIRED V-5:ABSORPTION BED TO PROPERTY LINE(W)-V REQUESTED VS.THE 10'REQUIRED FEB 0 9 2022
V-6:ABSORPTION BED TO PROPERTY LINE(S)-T REQUESTED VS.TIM 10'REQUIRED
V-7:ABSORPTION BED TO FOUNDATION-T REQUESTED VS.THE 10'REQUIRED
V-8:SEWER LINE TO PROPERTY LINE-P REQUESTED VS.THE 10'REQUIRED
V-9:SEWER LINE TO FOUNDATION-YREQUESTED VS.THE IUREQUIRED TOWN OF QUI=ENSBURY
BUILDING&CODES
-t
PLEASE ATTACH THE FOLLOWING TO YOUR APPLICATION:
1. A location map showing the site within the Town of Queensbury
2. A plot plan showing existing and proposed features of the property, including:
a. Lot dimensions
b. North arrow and scale: 1 inch=40 feet
c. Location & dimensions of existing and proposed buildings, showing setback distances and
uses
d. Parking layout to scale (if applicable)
e. Physical features (street, steep slopes, lakes, wetlands, etc.)
f. .Location of all wells and septic systems on neighboring properties
g. Adjacent ownerships
h. All properties within 500 feet
A sample plot plan and location are shown below:
.-
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Septic Variance Application Revised December 2021
RESOLUTION APPROVING JEFF HOLE'S APPLICATION FOR
SANITARY SEWAGE DISPOSAL VARIANCES
RESOLUTION NO.: BOH 14,2022
APR z3z
INTRODUCED BY: Mr.Timothy McNulty 11
WHO MOVED ITS ADOPTION TOWN Or OUEENSBURY
BUILDING&CODES
SECONDED BY: Mr.Anthony Metivier
WHEREAS, Jeff Hole (Applicant) filed an application for variances from provisions of the
Town of Queensbury On-Site Sewage Disposal Ordinance, Chapter 136 to install a replacement
wastewater treatment system with certain of its components proposed to be located as follows:
1. absorption bed to be 53' from Lake George in lieu of the required 100' setback;
I 2. pump tank to be 30' from Lake George in lieu of the required 50' setback;
vkDG I 3. Enhanced Treatment Unit (ETU) tank to be 32' from Lake George in lieu of the
a M
n n I required 50' setback;
< < M
4. absorption bed to be 2' from the north property line in lieu of the required 10'
Q.
n a] setback;
rn �
WQ 5. absorption bed to be 1' from the west property line in lieu of the required 10'
�+
Insetback
0 0 i 6. absorption bed to be 2' from the south property line in lieu of the required 10'
CD
p setback
N 7. absorption bed to be 2' from the foundation in lieu of the required 10' setback;
N8. sewer line to be P from the property line in lieu of the required 10' setback; and
9. sewer line to be 3' from the foundation in lieu of the required 10' setback;
on property located at 390 Cleverdale 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 concer_mng_the
variance requests on Monday,February 28t',2022,and
cp'l
it
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
Applicant; and
BE IT FURTHER,
RESOLVED, that the Local Board of Health hereby approves the application of Jeff Hole
for variances from the Sewage Disposal Ordinance to install a replacement wastewater treatment
system with its components to be located as follows:
1. absorption bed to be 53' from Lake George in lieu of the required 100' setback;
2. pump tank to be 30' from Lake George in lieu of the required 50' setback;
3. Enhanced Treatment Unit (ETU) Tank to be 32' from Lake George in lieu of the
required 50' setback;
4. absorption bed to be 2' from the north property line in lieu of the required 10'
setback;
5. absorption bed to be 1' from the west property line in lieu of the required 10'
setback
r
r'
6. absorption bed to be 2' from the south property line in lieu of the required 10'
setback
7. absorption bed to be 2' from the foundation in lieu of the required 10' setback;
8. sewer line to be 1' from the property line in lieu of the required 10' setback; and
9. sewer line to be 3' from the foundation in lieu of the required 10' setback;
on property located at 390 Cleverdale Road in the Town of Queensbury and bearing Tax Map No:
226.8-1-7, and
BE IT FURTHER,
RESOLVED, that such variances are contingent upon submittal of an acceptable design
plan providing a stormwater conveyance and management plan relating to the wastewater system
that must be reviewed and approved by the Town Building and Codes Enforcement Officer, 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
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.
l
Duly adopted this 280'day of February, 2022,by the following vote:
AYES:Mr.McNulty,Mr. Strough,Mr.Metivier,Mr.Freer,Mr.Ferone
NOES: None
ABSENT:None
COMMONWEALTH ELECTRICAL INSPECTION SERVICE,INC.
Main Office 176 Doe Run Road-Manheim,PA 17545
MUNICIPAL CERTIFICATE - ELECTRICAL APPROVAL
Permit No Y::....�1' 20"Cert.�0 5 0 0 9 2 Cut-in Card No...................................
Owner.......................... &Cs....................................................................................................
Location...............'351P G c�crin �.......�/>
............ ......... ...................................................................................
InstallationConsisting of...................................................................................................................................
.....................................Sslazl-sr...It4r .. .......... ...
..................................................................................................................................................................................
InstalledBy..............1.,J........ ! l ..........................................Lic.No.................................................
The conditions following governed the issuance of this certificate,and any certificate previously issued i
cancelled:- 1
This certificate only covers the electrical equipment and installation conditions as of date. Upon th
introduction of additional equip ment or alterations,application shall be promptly made for inspection.
Inspectors of this Compa y shall have the privilege of making inspections at any time, and if it
rules are violated,the Compagly shall have the right to revoke this certificate.
Date....../..�';� '. 2.....�...... INSPECTOR. .........................................-�..........................
Mnml•or N FP A I A F I