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2011-326 VOID TOWN OF QUEENSBURY 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201 Community Development-Building&Codes (518) 761-8256 BUILDING PERMIT Permit Number: P20110326 Application Number: A20110326 Tax Map No: 523400-226-019-0001-060-000-0000 Permission is hereby granted to: SANDRA POULOS For property located at: 22 NORTH Ln in the Town of Queensbury,to construct or place at the above location in accordance with application together with plot plans and other information hereto filed and approved and in compliance with the NYS Uniform Building Codes and the Queensbury Zoning Ordinance. Tyke of Construction Value. Owner Address: SANDRA POULOS Septic Alteration Residential 16 WINDY RIDGE Rd Total Value GLENS FALLS,NY 12801-0000 Contractor or Builder's Name/Address Electrical Inspection Agency Plans&Specifications 2011=326 septic alteration residential $40.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Friday,July 06,2012 (If a longer period is required,an application for an extension must be made to the code Enforcement Officer of the Town of Queensbury before the expiration date.) Dated at the Tow of�u�.nsbu w dd2r,,July 06,2011 P SIGNED BY for the Town of Queensbury. Director of Building&Code Enforcement p ECEOVE Community Development Office JUN 2011 Town.of Queensbury • 742:Bay Road • Queensbury, New York .12 W OF QUEENSBURY Office Use Only TAX MAP NO: 22j�o` PERMIT NO. PERMIT FEE APPROVALS: ZONING TOWN.CLERK APPLICATION FOR SEPTIC DISPOSAL SYSTEM PERMIT: A PERMIT MUS BE OBTAINED BEFORE WORK BEGINS.APPLICATION IS SUBJECT.TO REVIEW BEFORE ISSUANCE OF A VALID PERMIT. OWNER: SRN -9,A INSTALLER: TVSD ADDRESS: 11Z2 ADDRESS: PHONE NOS. PHONE NOS. LOCATION OF INSTALLATION: ZZ L 4�l� F-1 L_,oeyxE- 'RESIDENCE INFORMATION: NO.OF. COMPUTATION YEAR BUILT X = TOTAL DAILY FLOW BEDROOMS Gallons per bedroom GARBAGE GRINDER 1980 or older X 150 = INSTALLED? 6 1981-1991 X 130 = SPA OR HOT_TUB 1992-_present . X 110 = INSTALLED? Q PARCEL INFORMATION: TOPOGRAPHY: FLAT ROLLING STEEP SLOPE %SLOPE / ✓ SOIL NATURE: SAND�� LOAM ✓ CLAY OTHER ✓ GROUNDWATER: AT WHAT DEPTH? ✓ BEDROCK/IMPERVIOUS MATERIAL: AT WHAT DEPTH? ✓ DOMESTIC WATER SUPLY: MUNICIPAL ✓WELL (If well:water supply from any septic system absorption is: ft) . ✓ PERCOLATION TEST: RATE IS PER MIINUTE PER INCH-[mpi] (Test to be completed by a licensed professional engineer or architect) PROPOSED SYSTEM FOR NEW CONSTRUCTION: All individual sewage disposal systems must be designed by a licensed professional engineer or architect(unless installed in a Planning Board approved subdivision). TANK SIZE: %000 GALLON (MIN.SIZE IS 1,000 GAL.)Add 250 gallons to the size of the septic tank for each garbage grinder, spa or whirlpool tub. SYSTEM TYPE: - ❑ABSORPTION FIELD(WITH NO.2 STONE) Total length ft. Each trench X ❑SEEPAGE PIT(S)(WITH NO.3 STONE) How many? Size? ALTERNATIVE SYSTEM Bed or other type?�c,�iiZAEL.© I�10r1LTt2A71©tid�E�3--1�t N tSt ❑ HOLDING_TANK SYSTEM Total.required capacity? Tank size? Number of tanks? NOTE: ALARM SYSTEM AND ASSOCIATED ELECTRICAL WORK MUST BE INSPECTED BY A TOWN APPROVED ELECTRICAL , INSPECTION AGENCY. PLEASE REVIEW LIST PROVIDED. For your protection, please note that.pursuant to Section 136-29 of the Code of the Town of Queensbury,any permit or approval granted which is based upon or is granted in reliance upon any material misrepresentation or failure to make a.material factor circumstance known by or on behalf of an applicant;shall be void. I have read the regulations.with respect to this application and agree to abide by these and all requirements of the Town of Queensbury QUESTIONS? CALL 761-8256 OR EMAIL ary Sewage Disposal Ordinance. ,1 codes(Mgueensburb.net l �2 L VISIT OUR WEBSITE FOR MORE INFORMATION ature of Person Responsible Date vvww.aueensburv.net E TAIn of Queensbury Building &Code Enforcement Office No. (518) 761-8256 Septic Inspection Report Inspection request received: Name: Inspected on: s �y Location: t'L y Arrive: a.m.1 p.m. Permit No.: %/- 3 !r Inspector's Initials: All$ Comments and/or diagram Soil Type: Sand/Loam/Clay Type of Water: Municipal/Well Water �� Waterline separation distance ft. 6're S Re-,cl4!(� Well separation distance ft. 1 Other wells: ft.. 4?9f — �D 5 Well Casing Length 50'+I Y N N/A _: [150'to well required if NO] ij� Absorption Field: Total length ft. l Length of each trench ft. Depth of trenches ft. P� Size of Stone 2 3/ 13 v Seepage Pits: Number Size: x Stone Size: Piping Size Type Building to tank Tank to Distribution Box Distribution Box to Field/Pit 6� Opening Sealed: Y N End Cap _Y_N Inlet/Outlet Pipes&Baffles _Y_N Manholes 12"or less below grade Y N [provide extension collar if Yes] _Y_N e \ Location I Separations cio5e OJ Foundation to tank ft. Foundation to absorption ft. Separation of Pits ft. Conforms as per Plot Plan _Y_N Engineer Report and As-Built _Y_N ETU Maintenance Contract provided _Y_N Location of System on Property: Front Rear Left Side Right Side Middle Front Middle Rear System Use Status: Approved Partial Approved and needs to be re-inspected, please call the Building&Codes Office Disapproved Septic Inspection Report t . US Septic Inspection Report Office No. (518) 761-8256 Date Inspection request received: Queensbury Building &Code Enforcement Arrive: amp%( Depart: am/pm 742 Bay Rd., Queensbury, NY 12804 Inspector's Initials: NAME: PERMIT NO.: LOCATION: r INSPECT ON: RECHECK: f� Zy-p Comments and/or diagram Soil Type: Sand/ Loam Clay Type of Water: Municipal/ Well Water Waterline separation distance ft. Well separation distance ft. Other wells: ft. Well Casing Length 50' +/ - Y N N/A 150'to well required if NO Absorption Field: Total length ft. Length of each trench ft.Depth of trenches ft. t`� Size of Stone Le� Seepage Pits: Number G� Size: x !�y Stone Size: Piping Size Type Building to tank s Tank to Distribution Box Distribution Box to Field Pit Opening Sealed: Y_N End Ca _Y_ N Inlet/Outlet Pipes&Baffles Y N Manholes 12"or less below grade Y_N [provide extension collar if Yes Y N Location/Separations Foundation to tank ft. Foundation to absorption ft. Separation of Pits ft. Conforms as per Plot Plan _Y_N Engineer Report and As-Built _Y N ETU Maintenance Contract Y_N provided Location of System on Property: Front Rear Left Side Right Side Middle Front Middle Rear System Use Status: Approved Partial Approved and needs to be re-inspected, please call the Building &Codes Office Disapproved L:\Pam Whiting\2010\Building Codes Forms\Inspection Forms\Septic Inspection Report 03 2910.doc Septic Inspection Report Office No. (518)761-8256 Date Inspection request received: Queensbury Building&Code Enforcement Arrive: am/ m epart: am/pm 742 Bay Rd., Queensbury, NY 12804 Inspector's Initials: NAME: SC'�I �cS2 PERMIT NO.: / '3 ! LOCATION: < - INSPECT ON: RECHECK: Comments and/or diagram Soil Type: Sand/ Loam/Clay Type of Water: Municipal/Well Water Waterline separation distance ft. Well separation distance ft. Other wells: ft. Well Casing Length 50'+/ - Y N N/A 150'to well required if NO Absorption Field: Total length ft. Length of each trench ft. Depth of trenches ft. Size of Stone Seepage Pits: Number Size: x Stone Size: Piping Size Type Building to tank Tank to Distribution Box Distribution Box to Field/ Pit Opening Sealed: Y_N End Cap Y_N Inlet/Outlet Pipes&Baffles Y N Manholes 12"or less below grade Y_N [provide extension collar if Yes Y N Location Separations Foundation to tank ft. Foundation to absorption ft. Separation of Pits ft. Conforms as per Plot Plan _Y_N Engineer Report and As-Built _Y N ETU Maintenance Contract Y N provided Location of System on Property: Front Rear Left Side Right Side Middle Front Middle Rear System Use Status: Approved Partial Approved and needs to be re-inspected, please call the Building &Codes Office Disapproved L:\Pam Whiting\2010\13uilding Codes Forms\Inspection Forms\Septic Inspection Report 03 2910.doc `76z-20,� Ki• • Home ofNatural Bea uty...A Good Place to Live TOWN OF QUEENSBURY 742 BAY ROAD QUEENSBURY,NEW YORK 12804 518.761.8201 WWW.QUEENSBURY.NET September 30,2013 Sandra Poulos 16 Windy Ridge Road Glens Falls,NY 12801 RE: Building Permit No. 11-326 Septic System Alteration and Replacement-22 North Lane Dear Sandra: I have been advised that your permit for the above replacement septic system has expired on July 6, 2012. This means in order to keep this permit active, you must pay renewal fees for the Year 2012 and 2013. It is my understanding that you have an agreement with the APA that the system must be installed this Fall. Please remit the $100 renewal fees required to keep this,permit active and please make sure that we are called for inspections when the system is installed. If you,have any questions, I can be reached at 761-8253. Thank you for your attention in this matter. Sincerely, TOWN OF QUEENSPJJRY J David Hatin,Director Building and Code Enforcement DH/mg Celebrating Our Sestercen tennial 1762-2012 f F1J 5'CRK STATE Adirondack parkagency March 11, 2014 Sandra Poulos 16 Windy Ridge Road Glens Falls, NY 12801. RE: Agency File No. E2008-0294 Tax Map Parcel 226.19-1-60 Town of Queensbury, Warren County . Dear Ms. Poulos: Thank you for discussing this matter with me on March 5, 2014, and for your March 5, 2.014 request to extend the deadline for replacement of the on-site wastewater treatment system on the above-referenced property as required by Settlement Agreement E2008-0294 by one year. Agency staff are agreeable to extending the deadline to September 30, 2014 . Please submit written certification by a design professional that the wastewater treatment system was installed in accordance with the plan approved by the Agency within 30 days of replacement but no later than October 7, 20-14 . Thank you for your cooperation in resolving this matter. Sincerely., J hn M. Burth Environmental Program Specialist 2 JMB:sas Copy: Dave Hatin, Director,_ Town of Queensbury Building and Codes P.O.Box.99•NYS,Route 86•Ray.Brook,NY 12977•phone:518 891-4050 •fax:518 891-3938-v iww.apa#'y:gov STATE OF NEW YORK: ADIRONDACK PARK AGENCY -------------------------------------------------------------X In the matter of the apparent violations of Executive Law § 809 (2) (a) and 9 NYCRR Part 578 on lands owned by: SETTLEMENT- AGREEN�NT Agency,- l� SANDRA POIILOS i D' L ?� a Respondent, on property ?' n ,.f • the Town of located in Warren County ! APR 1 L�'13 Queensbury, ! (Tax Map Parcel 226.19-1-60) LUA:' Moderate Intensity Use ADlRGNCACK PARK AGENCY -------------------------------------------------------------X WHEREAS: 1. Pursuant to Executive Law Section 809 (2) (a) , a permit is required from the Adirondack Park Agency prior to the undertaking of any land use and development involving wetlands in a Moderate Intensity Use land use area in the Adirondack Park. 2 . Pursuant to 9 NYCRR Part 578, a permit is required from the Adirondack Park Agency prior to the excavation of, deposit of fill in, or construction of any road or structure in a wetland in the Adirondack Park. .3 . Tax Map Parcel 226 .19-1-60 ("Lot 60") is an approximately .34 acre pre-existing property located entirely within a Wetland in a Moderate Intensity Use land use area. Lot 60 is improved by a pre-existing single family dwelling with an 875 square foot footprint and a pre-existing wastewater treatment, system, both located in wetlands . Respondent is the current owner of Trot 60, as described in a deed recorded in Book 3133 , Page 157, in the Warren County Clerk's Office. 4. Agency investigation reveals that, in 2008, Respondent's agent replaced the pre-existing piers supporting the single family dwelling on Lot 60 with a cement foundation, constructed a gravel driveway and footpath to the dwelling, and filled wetlands surrounding the dwelling with topsoil. This new land use and development resulted in the Adirondack Park Agency File E2008-294 March 18, 2013 settlement Agreement Page 1 S y excavation and filling of wetlands on Lot 60. No permit was obtained from the Agency prior to. this excavation of, deposit of fill in, and construction of a foundation and driveway-in a wetland. 5. On March 22, 2011, Agency staff received from Respondent a plan, entitled "Proposed Replacement Wastewater System for the Poulos Residence, " prepared by Environmental Design Partnership, LLP, and dated March 15, 2011, for replacement of the wastewater treatment system located on Lot 60. On July 6, 2011, the Town of Queensbury Town Board approved implementation of this plan. 6 . Respondent desires to resolve this matter and agrees to be bound by the terms of this Settlement Agreement. NOW, THEREFORE, THE AGENCY AND RESPONDENT AGREE AS FOLLOWS: 1. By December 31, 2013, Respondent shall implement the plan described in Paragraph 5 above for replacement of the wastewater treatment system on Lot 60. Within 30 days of replacing this wastewater treatment system, Respondent shall submit to the Agency written certification by a design professional. (i .e. licensed professional engineer, licensed architect, exempt licensed land surveyor] that the plan was implemented as approved. 2 . By December 31, 2013, Respondent shall disconnect all pipes associated with the pre-existing on-site wastewater treatment system on Lot 60 . 3 . Respondent, her successors or assigns may replace the single family dwelling on Lot 60 on the same footprint- as the existing structure without an Agency permit. Any expansion in footprint of this dwelling or replacement structure shall require a permit from the Agency. 4. The violations referenced herein shall be deemed to be finally resolved with respect to Respondent upon the full execution of this Settlement Agreement. Adirondack Park Agency File E2008-294 March 18, 2013 Settlement Agreement Page 2 Dated: Ap-r,.) 1 7. 2013 Ray Brook, New York ADIRONDACK PARK AGENCY By: T r ry deFranco Ma tino Executive Director STATE OF NY ) SS: COUNTY OFSSe}!, ) On this 1 7 ' day 'of in the year before me, the undersigned, a Notary Public in and for said Sta eN personally appeared Terry deFranco Martino, personally known to me or proved to me on the basis of satisfactory evidence to be the individual whose name. is subscribed to the within instrument and acknowledged to me that she executed the same in her capacity, and that by. her signature on the instrument, the individual, or the person upon behalf of which the individua acted, executed the instrument. Notary Public Notary Public A. o INawVr.rr Qualified in Franklin Courity No.01 ST6229306 Commission Expires Oct,12,2®_1� AGREEMENT - Respondent agrees to the terms set forth in this Settlement Agreement to resolve the matter of Adirondack Park Agency File E2008-294. By: Sandra Poulo STATE OF ) SS: COUNTY OF �^ ) On this r` l day of in the year o , before me, the undersigned, a Notary Public in and for said Sta a personally appeared personally known to me or proved to me on the.basis of satisfactory evidence to be the individual whose name is subscribed to the within instrument and acknowledged to me that she executed the same in her pacity, and that by her signature on ,he instrument, the individual, or the person upon behalf o which the incl'vidual to out the instrument. `I,Illlllllf,' 'I ���`v�tYN E . otary lic GQ ... . A - ?xF.41�RCy 16 � �C - Adirondack Park Agency File E2008-294 March 15, 2013 Settlement Agreement Page 3 ��Illlitll5 f RESOLUTION APPROVING SANDRA POULOS' APPLICATION FOR SANITARY SEWAGE DISPOSAL VARIANCE C C E0NIE RESOLUTION NO.: BOH 16,2011 INTRODUCED BY: Mr.Ronald Montesi JUN 2 9 2011 WHO MOVED ITS ADOPTION TOWN OF QUEENSBURY BUILDING&CODES SECONDED BY: Mr.John Strough ' vi�A1�1P�A TQtlt�.O� - WHEREAS, S,�n ies.filed an application fora variance from provisions of the Town of Queensbury On-Site Sewage Disposal Ordinance, Chapter 136 to install an absorption field 0' from a watercourse (wet area) in lieu of the required 100' setback on property located at 22 North Lane 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 conducted a public hearing concerning the variance requests on Monday,May 16"..2011, 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 variance, the Local Board of Health determines that the variance 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 variance is necessary for the reasonable use of the land and is the minimum variance 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 Sandra Poulos' application for a variance from the Sewage Disposal Ordinance to install an absorption field 0 from a watercourse (wet area)in lieu of the required 100' setback on property located at 22 North Lane in the Town of Queensbury and bearing Tax Map No.: 226.19-1-60. Duly adopted this le day of May,2011,by the following vote: AYES: Mr. Strough,Mr.Brewer,Mr. Stec,Mr.Metivier,Mr. Montesi NOES: None ABSENT:None �.Rose Melton,holy Tom C%*of the Taws of(Weenshury,Warren County, Now York do fnereby that f ham compW the forgoing with the .ort YW m M tlon ae UdW WWe odopted#2 Q-,-5 0 r,� meting cIftTmt afttt oIQueensbMWdonnft c�� dayof g4 tk ,Stwbkb a quorum Was presentand thatft t�bi tt ind of the wax>it�irta!tt�8r8of to date .Imwmmmw,ollmwosdnvwmdft$KolswTowo 41 f t�-� dbpinf m � og0 r� IL Rasa Mellon DIP*Town T�rn�f� au� 2