PT-0672-2021 Authenti sign-ID:92Al2A61-1 ABE-47CC•900-35 D B593427F6
Property Transfer Sewage Disposal information Form
Town of qQueens(17
Date:. 09/07/2021
742 Bay Road,Queensbury,NY 12804
P:518-761-8256 www.gueensbury.net.
Francis A. Steinbach Jr.
(Name of Owner/Applicant).
Re: Onsite Wastewater Treatment System Inspection Information Request for:
16 Sunset Lane
(Site Address foc Inspection)
Thank you for requesting an,inspection.for the onsite wastewater treatment system (OWTS) located on the
property referenced above; We look forward to completing a.thorough inspection for you. You can help us do
the best job possible,by providing some advanced.informotion.about thesite.Prior to our inspection,we request
this.completed application,'a site map indicating the location of the septic components and confirmation the
pre-inspection preparation (see the last page of this packet) will be completed prior to our ar"riva/.
Enclosed is a Septic System Inspection Information form, which must be completed, signed and returned to
this.office,with the appropriate fee(s) and documentation, prior to scheduling an inspection.
Please note the Town of Queensbury's fee for this service is$215. Be advised that all fees must be paid prior to
scheduling the inspection.. We require'48 hours notification-prior,to scheduling the inspection.
If the purchaser is requesting an exemption, please submit�this application alongwith.a notarised letter.stating.
the septic system will be inspected or repaired/.replaced.within 6 months from the date of the Property .
Conveyance or June 1st of the current, or following year _(whichever comes first), a map.locating the septic
system and payment totaling$2275'($2000 refundable deposit plus$275 permit fee). The'deposit is forfeited
if the owner fails to complete the repairs or installation as stated above.
If you have any questions, please call.
Phone: (518) 761-8256 Email: 'kated@queensbury.net
Thank you.
Sincerely,
SEP ®8
TO
David-Hatin,.Director u oli Q
Building and Code Enforcement VUI,
O CO':-iBURY
Town of Queensbury
Property Trans rer Packet Revised April 2021
Authentiaign ID:9M2A81-1ABE-47CC-901B-35DB593427F6
Office Use Orily
Permit#:
Town of[Zrecnl6an Fee:
742 Bay Road,Queensbury,NY 12804
P:518-761-8206 or 518-761-8205. Invoice#:
www.gueensburV.net-
SEWAGE DISPOSAL SYSTEM INSPECTION INFORMATION
Individual Residential Wastewater Treatment System
CONTACT INFORMATION (please print legibly or type and include,an email address)
Property and Owner Information: (Please attach property-survey or tax parcel map)
Property address for inspection: 16 Sunset La
Tax map number:,-),,�,(o. (.°i. (may
Property owner: Joseph and Deborah Ritano
Mailing Address (c/s/z): )3a1 .) 5z;i1 A(Iac.n�j l av3
Cell M I'�(K-41-41-5U Land.Line#: I
Email: dfty' t�10 � oti�c.c . ct;��
Applicant If different than above):
Mailing Address
Cell#: Land Line#: .
Email:
E) Proposed Owner ❑:Realtor [] Attorney ❑.Other(explain: )
Septic-Contractor:
Mailing Address (c/s/z):
Cell#: Land Line#:
Email:
Reason for Inspection Request:
❑On the market ❑Future listing e5ale Pending ❑Deed Transfer ❑Other:
Property Transfer Packet Revised April 2021
Authekisign 10:92p12A61,7ABE-47CC-901 8-35OB593927F6
HOUSEHOLD INFORMATION
**PLEASE SEE SEPARATE PAGE FO.R EXEMPTIONS**
# Bedrooms 4 # Bathrooms 2 # Kitchens 1 _ Jacuzzi tub(s) Garbage grinder Q
Onsite Wastewater Treatment System:
How many systems are on the property? link,
Year System(s)_installed: Tank. Unk Size of SepticTank Unk
Type of Absorption System Unk
UNKNOWN
Are all system.components wholly within the property boundaries? ❑Yes ❑No.
Are system plans available?, ❑ Yes ❑ No.
Does the systems) serve multiple properties? p Yes No
If yes, describe
Maintenance:
Service-agreement? [j Yes tX "No; If yes, business' name
Date of-last inspection N/A.❑ Date'tank last pumped N/A❑
Frequency of.pumping N/A❑
List--known repairs/replacements, with:dates:-
Date Type of.Repair/Replacement
Operation:.
System problems? p Yes , ® No
Sewage odors? ❑ Yes ER No
Direct surface discharge(s).? ❑ Yes [R No
Back-up of toilets? ❑Yes ER No .
o Back-up of any other fixtures? (e.g. slow drains) ❑Yes [f No
Seasonal ponding or breakout of leach field? ❑ Yes ®. No
Property'rrmulcrPacket Revised April 2021
Authendsign 10;,92Al2A81-tABE-47CC-801B-35D85834270fi
Statement of Acceptance of Conditions:
I agree to:
o Ensure that the septic tank(s), distribution box (es),and/or seepage pit(s), if any, will
be uncovered-prior to the requested inspection.time;
® Have a seppage hauler on site (to pump the tank after*the inspector verifies flow
from fixtures);
Tank must be pumped in presence of inspector
o Have an authorized representative present at the site;
A- Allow the inspector to verify information provided above, and to conduct an
inspection-of'the indicated onsite wastewater treatment system(s), including all
system components and interior plumbing in crawl spaces and basements.
To the best of my knowledge;the information provided above is accurate and I acknowledge
the following:
.After 1 year from date.of,submission and.there is no activity on this permit, the permit will
-expire and will be subject to submission of.a renewal application-and payment of the renewal
fee based on the current fee schedule. All fees must.be paid ' 10R TO SCHEDULING any
inspections:. In.addition, if the permit is withdrawn 20% of the fee is retained by the Town of
Queensbury.
Signature of property:owner or authorized.agent:
Affiliation: 9.owner [Q agent ❑other:
r
please.print name: 3or,-et �U
AuthentisraM'
� '
Signature: Date: -
6/812021 3:38.48 Phi GMT'
Prior to scheduling with the Town of Queensbury, you MUST:
1. Schedule a sewage hauler to be on site to pump tank While inspector is on site.
Hauler should. arrive 3045 minutes after scheduled time with the Town of Queensbury's
Code Enforcement Officer.
2. Expose inlet and outlet of septic tank; and/or pump station; expose d-box, expose
any seepage pit covers.
3. Excavate test hole in leach field if there is no d-box,
Property'rransfer Packel Revised April 2021
. :i
.;r
RESOLUTION APPROVING SEWAGE DISPOSAL VARIANCE
APPLICATION OF JOSEPH RITANO
RESOLUTION NO.: 26,2002 BOH D E E
INTRODUCED BY: Mr.Daniel Stec SEP 10 20 1
WHO MOVED ITS ADOPTION 4$
TOW( OF QUEEN38URy
SECONDED BY: Mr.Theodore Turner BUILDING
WHEREAS, Joseph Ritano has filed an application for variances from provisions of the
Town of Queensbury On-Site Sewage Disposal Ordinance, such application requesting that the
Local Board of Health allow placement of a:
1. septic tank 8' from the dwelling in lieu of the required 10' setback;
2. septic system 1' from the property line in lieu of the required 10' setback; and
3. septic system 11'•from the dwelling in lieu of the required 20' setback;
on property located at 16 Sunset Lane, 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 May 20 ',2002;and
WHEREAS; the Town Clerk advises that properly owners within 500 feet of the subject
property have been duly notified,
NOW, THEREFORE;BRIT
RESOLVED,that
p ,
j due to the nature of the variances, it is felt that the variances would not be materially
detrimental to the purposes and objectives of this Ordinance or to other adjoining
' properties or otherwise conflict with the purpose and objectives of any plan or policy of
the Town of Queensbury; and
j•
b) the Local Board-of Health finds that the granting of the variances is necessary for the
reasonable use of the land and that the variances granted 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 Town of Queensbury Local Board of Health hereby approves Joseph
Ritano's application for variances from the Sewage Disposal Ordinance to allow placement of a:
4. septic tank 8' from-the dwelling in lieu of the required 10' setback;
5. septic system 1' from the property line in lieu of the required 10' setback;and
6.. septic system 11' from the dwelling in lieu of the required 20' setback;
o
on property located at.16 Sunset Lane, Queensbury and bearing Tax Map No.: 226.19-1-9.
Duly adopted this 200'day of May,2002 by the following vote:
AYES Mr. Turner,Mr. Stec,Mr. Brewer, Mr. Brower,Mr.Boor
NOES None I,DarleenM.Dougher,Town Clerk-of the-town ofQueensbury,Warren Cou*
New York,do hereby certify that I have Compared the oreitoi4qgwith the
ABSENT: None original resolution as listed above adopted sts Meeting
of th,Town Board of the Town of Queensbury bole cm ft a b day of
20 a fat which a quorum was presets and that the
sa is a correct transcripttherdrolmpdofthewh*4Vn lthereof
IN; ESSTHEREOF,Ihaveheeet UIjVIgfd#WtheSIXof said Town
of Queensbury,this ( #Vol 20d L
S : j v
Darleen M. Dougher
Town Clerk
Town of Queensbury
18
t o �.; 7017 °Gres ` Wt� OF CUEBNBBt` �
CA 11 BUILDNG&COD
'V>"
.`� i STORY WWI) tu
FRAME HOU5E
tp 2.5 ... .=.r_._._ 0p
S Y}N1 WNL` t�i t0`. e.; 1. Q `
'`�=�`•'e1s d,;:r .•_._ :.�. ;,� 4:.s� 'A950RP710N SYSTEM o
124 SPRLlCttES 024' EAW �, R
'� 'CONCRETE Cu :l r -,Cw DETALS),
t -.e•— Of
` N,79'33`02°W (J/t ti._ TF=98.7a
SUNSET/
1 ff
viv
105 f'
fir. �'�*�,••,,.�,�^�'% !"
° J " i f f
i� )