OWTS Inventory Worksheet FECEgyER
Lawrence M. Stone
N
P.O. Box 31NOV 2 6 2018 ii
kattskill Bay, NY 12844
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July 6, 2017
Kathleen S.L. Bozony
Town of Queensbury Planning Office
742 Bay Rd.
Queensbury,NY 12804
Dear Ms. Bozony,
Enclosed is a completed OWTS Inventory Worksheet for 32 Bean Road. The sketch you
request is on a separate piece of paper.
I have also included the preliminary design for our wastewater system when it was built
in 1993. This consists of eight photocopies. To put it together, match the letters—A to A,
B to B, etc.
Please note that our two 1,000-gallon septic tanks are not by the garage as indicated on
the sketch and preliminary design. I have indicated where they are actually located. The
location of the Soil Treatment Area is accurate,though.
We have the septic tanks pumped out about every five years—most recently on May 5,
2015. Invoice is enclosed. This is a seasonal camp and used only five months per year.
Sincerely yours,
Lawrence M. Stone
227.10-1-22 RC-0739-2018
Townsend, Penny
32 Bean Rd
672 s.f.
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Town of Queensbury
742 Bay Road
Queensbury, NY 12804
Onsite Wastewater Treatment System (OWTS) inventory Worksheet
This Inventory Worksheet has been designed to collect information on existing Onsite Wastewater Treatment Systems (OWTS)within
the Town of Queensbury in order to create a database and encourage wastewater pollution reduction through regular maintenance of
septic systems. Please complete this worksheet and return it(with the requested attachments)to the Town of Queensbury Planning
Office. If you need assistance with filling out this worksheet, have questions regarding the requested information or would like an
assessment of your OWTS when the septic tank is being pumped out,please call Kathy Bozony at 518-761-8231.
Thank you in advance for participating in this public health initiative.
Date Tax Map ID# (Tax Map ID#located on mailing label)
Name
Address Lake address
Lake phone
Phone (home) (cell)
Email
SEPTIC SYSTEM SKETCH _
> On the back of this worksheet,please sketch your onsite wastewater treatment system. If available,include a copy of your property's
site plan map showing your septic system design(preferably the'as-built')
o Sketch the approximate shape of your house,labeling its front and back
o Identify property lines
o Indicate the distance of your existing OWTS(tank and field)from your house and adjacent waterbodies
o Label driveway,roads,accessory structures,well and distance to lake,streams,tributaries and wetlands
FINDINGS
• Unknown [check here if you do not know the specifics about wastewater treatment on your property]
• Household wastewater flows into:
Concrete septic tank y gals(size of tank) t 4.0 A1I.1 Z !,Oittx at k/ki"'
Plastic septic tank gals (size of tank)Metal septic tank gals (size of tank)
Clarus Fusion or comparable gals (size of tank)
Holding Tank gals (size of tank)
Cesspool gals (size and construction of cesspool)
• Secondary treatment for effluent(partially treated wastewater)from septic tank flows to:
Soil Treatment Area(STA)
Seepage pit/drywell
Eljen ETU
Puraflo ETU
Other(please describe)
OTHER INFORMATION
• Age of septic system Distance to lake or stream: septic tank ft I 2nd treatment y ft
• Age of home . • It of bedrooms f -•
x Garbage disposal? Yes No (please circle)
x Water treatment system? Yes No (please circle)
x Sump pump to OWTS? Yes No (please circle)
DATE of last septic tank pump out Septic hauler ' "'
[Please attach a copy of your most recent pump out receipt]
Thu form developed by and used with permission from the Lake George CBOH
iv*"* :
TOWN OF QUEENSBLIRY
742 Bay Road, Queensbury, NY. 12804-5902
Onsite Wastewater Treatment System (OWTS) Inventory Database
June 12,2017
Dear Lake George Property Owner,
The Town of Queensbury Town Board is committed to support wastewater pollution reduction by encouraging
property owners to recognize the importance of effective wastewater treatment on lands within close proximity to
Lake George and other waterbodies within the Town.
As you may know, an onsite wastewater treatment system (OWTS), typically known as a septic system, can be
effective for treating wastewater from your home or business when it is properly designed,installed and maintained.
However, an undersized septic system with increased seasonal usage, an OWTS installed on land with poor soil
conditions,treating wastewater using an antiquated design(a cesspool or a metal septic tank that may be corroded),
or lack of routine maintenance can all lead to inadequate wastewater treatment. Polluting septic systems near
waterbodies can detrimentally affect our drinking water and recreational enjoyment,specifically swimming,fishing
and boating. It has been observed that insufficient treatment of wastewater within close proximity to Lake George
or its tributaries negatively impacts water quality. Algal blooms (identified to be the algae genus that grows in
sewage)have been documented in recent years adjacent to the lake's shoreline.
Completion of the attached OWTS Inventory Worksheet will assist the Town of Queensbury in its database creation,
specifically to record the type of wastewater treatment(septic system)and septic system maintenance done on your
property. Developed properties being inventoried at this time are located within 500 feet of Lake George and its
tributaries,referred to as the Critical Environmental Area(CEA). Information regarding your septic system's location,
its age,initial design and installation,overall functionality and necessary routine maintenance is being requested. If
you do not have knowledge about your septic system,please check'Unknown'and complete the top portion of the
worksheet, including a contact phone number and email. Please note that your Tax Map ID# has been printed on
the address label located on the envelope mailed to you. Completed worksheets with attachments and a copy of
your most recent pump out receipt can be mailed (or hand delivered)to my attention at the Town of Queensbury
Planning Office,742 Bay Road,Queensbury,NY 12804. After receiving your completed OWTS Inventory Worksheet,
I may contact you to discuss your wastewater treatment or to assist you in scheduling a pump out and inspection.
In addition, the Town is asking that a property owner please request that a hired Septic Hauler completes the
attached Septic Hauler Worksheet at the time of a septic tank pump out. This worksheet (as well as the OWTS
Inventory Worksheet)can be printed from the Queensbury website.
Please don't hesitate to call me with questions, or if you would like me to work with you on any issues regarding
your septic system. Thank you in advance for cooperating with this important public health initiative.
Sincerely,
Ka hleen S Lindberg Bozo y
Environmental Program anager,Consultant
518.761.8231
Attachments
" Home of Natural Beauty ... A Good Place to Live "
Town of Queensbury
Septic Hauler Worksheet for Onsite Wastewater Treatment System (OWLS)
(Septic Hauler to complete during septic tank pump out and inspection)
Property owner: Please submit this worksheet with a copy of the septic hauler's paid pump out receipt to the
Town of Queensbury Planning Department at 742 Bay Rd,Queensbury,NY 12804 [Questions CALL 518-761-8231j
Date Septic Hauler
inspector onsite
Homeowner
Address
Number of Bedrooms
Phone Age of OWTS
SEPTIC SYSTEM SERVICE (please circle Yes/No)
Tank uncovered Yes/No
Inlet riser to grade Yes/No [if No riser,minutes required to locate and uncover septic tank lid
Outlet riser to grade Yes/No [if No riser,minutes required to locate and uncover septic tank lid
Inlet Sanitary Tee Yes/No
Outlet Baffle Yes/No [if Yes,CONDITION of Baffle/Sanitary Tee Good Failed
Liquid Level Acceptable High Liquid below Outlet? Yes/No
Scum depth Inches
Sludge depth Inches
Toilet flushed Yes/No
Other components: Effluent Filter Effluent Pump Grinder Pump (please circle if applicable)
EVALUATION FINDINGS
Household wastewater flows into: Condition of septic tank/primary wastewater treatment
Concrete septic tank gals(size of tank)
Plastic septic tank gals(size of tank)
Metal septic tank gals(size of tank)
Holding tank gals(size of tank)
Cesspool gals(size of pit)
Other (describe OWTS technology or ETU)
Effluent from septic tank flows to: (as evidenced by Septic Hauler or noted by homeowner)
Absorption field Visual condition of field
Drywell
Eljen
Puraflo
Other(please describe)
OTHER FINDINGS (use back of worksheet for additional assessed information and sketch of OWTS on property)
Signature of Hauler Certification It
Signature of Homeowner
Thank you for your participation in the Town of Queensbury Septic Inventory Program
This form developed by and used with permission from the Lake George CBOH
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PREPARED BY JAMES E.HUTCHINS,P.E. A LICENSED PROFESSIONAL ENGINEER IS A (578)745-0307 Phone
VIOLATION OF NYS EDUCATION LAW. Hutchins Engineering 518 745-0308 Fax