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PT-0280-2023 Property Transfer Sewage Disposal:Information Fo Dater �1'3 Town of Queensbui7 742 Bay Road,Queensbury,NY 12804 P:518-761-8256 . www.gueensbury:net (Name of Owner/Applicant) S �y �'��g i yl OWN LS- E:.:V i�EN;SBt)RY" 6 Re: Onsite,Wa'stewater Treatment System Inspection Information-Request forE.;t II, I?I(a0&COD=u 1 (Site Address for 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-u's do - the bestjob possible by providing some advanced information about the site 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 arrival. 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 s $275. 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 along with a notarized letter stating the septic system will be inspected or repaired/replaced within 6 months from the date of the .Property Conveyance or June 15t of the current, or following year (whichever comes first), a map locating the-septic system and payment totaling $2275 ($2000 refundable deposit plus $275 permit fee). The deposit is forfeited _ if the owner fails to complete the'repairs or 'installation as stated above. If you have any questions, please call. Phone: (518) 761-8256 Email: kated@,lqueensbury.net Thank you. Sincerely, John 0 Brien, Director j BuJ'ding and Code Enforcement Town of Queensbury `}' C, 4t*z -7Yz 9 Al Property Transfer Packet —W-ea/v V l? ►`/wised February 2022, ' 1 _ Office Use OnlyAar " r4 s � Z© Permit#: � �? ax Tow, aft2 axn5 U T Fee: ,$ 742 Bay Road,Queensbury,NY 12804 P:518-161-8206 or 518-761-8205 Invoice#: .. .. www.gueensbury.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: 2to 11 Tax map number: -.g 2-3 Z r� e®Q�l� C3`Q� dui —C 0GO Property owner: �ev� - 1�'`► 1-Pill & � Mailing Address (`c/s/z): Cell #: � y Land Line #: Email: �t� ► i�r�* da3®�.LP [ e��` i - Applicant (if different than above): . Mailing Address (c/s/z): Cell #: Land Line#: Email: ❑ Proposed Owner ❑ Realtor_ ❑...Attorney ❑ Other (explain:. i ) Sep tit Contractor: Mailing Address (c/s/z): Cell #: . 7��.'� - Land Line#: Email: Reason for Inspection Request: ❑ On the market Z/Future listing ❑Sale Pending ❑ Deed Transfer ❑ Other: . Property Transfer Packet Revised Febniary 2622 i HOUSEHOLD INFORMATION ; = - **PLEASE SEE SEPARATE PAGE FOR EXEMPTIONS** # Bedrooms 3 # Bathrooms 1/ # Kitchens t Jacuzzi tub(s) Garbage grinder Onsite Wastewater Treatment System: How many systems-are on the property? Year system(s) installed: Tank Size of Septic Tank Type of Absorption System:_3�>,o V%u- Are.-all system components wholly within the property boundariels? s 0 No Are system plans available? [ Yes ❑ No Does the system(s) serve multiple properties? ❑ Yes [EX0 If yes, describe Maintenance: Service agreement? E] Yes E?' N o; If yes, business' name Date of last inspection . . N/A 12/11" Date tank last pumped ti 10 'N/A Frequency of-pumping N/A ❑ List known-repairs/replacements; with dates: - I Date Type of Repair/Replacement 1 Operation: System problems? ❑II Yes Lie* Sewage odors? ❑j Yes ["No Direct surface discharge(s)? ❑! Yes t�J No. Back-up of toilets? ❑i Yes [�'f No Back-up of any other fixtures? (e.g. slow drains) ❑' Yes dNo Seasonal ponding or breakout of leach field? ❑�, Yes [�44No Property Transfer Packet Revised February 2022 i Statement of Acceptance of Conditions: agree to: • 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 septage hauler on site (to pump the tank after*'the inspector verifies flow from fixtures); ➢ Tank rrmust.be pumped in presence of inspector • Have an authorized-representative present at the site; • 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 jand payment of the renewal fee based on the current fee schedule. All fees must be paid PRIOR 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: ERowner ❑ agent ❑ other: I Please printJnae: -� Signature. I Date: 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 30-45 minutes after scheduled time with the Town of Oueensbury'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 Transfer Packet Revised February 2022 TOWN OF QUEENSBURY 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201 - Community Development - Building & Codes (518) 761-8256 CERTIFI CATE 0E----00MPLIAX'C-'P-' -' Permit Number:- __P20040646 :.:;Date.Issued: Friday;August'20 ,2004 - This is to certify that-work requested to-be done as shown`b ,Permit Number --:_ has been completed. - Tax Map Number: - 523400-226-016-0001-041-000-0000 Location: 280 CLEVERDALE Rd Owner: _ MICHAEL &LINDA MONTEMARANO Applicant: MICHAEL &LINDA MONTEMAR.ANO =_ This structure may be occupied as a: By Order of Town Board Septic Alteration Residential TOWN OF QUEENSBURY Director of Building&Code Enforcement a r GEO-TEXTILE COVER 4•• PERFORATED PEE TYPAR 3401 OR EQUAL SLOPE vlw-1/32` PER FT. 10, MIN. SLOP 'tie •i{{a�. -i0 .J{u •gyp'e•.°i^i ^i°o°°-e. I W 6 W BV g3-DRAW`UNIT' CONCRETE `WAND JEN CORPORATION NY5DOT ITEM #703-07 ORPTION 5Y5TEM w ��5 a RD f3ED PROFILE � N.7.5. 1 -1 Z ALL DISTRIBUTOR PIPES MUST BE �����® � UiNLESS I'NT ERi.ON Esc NEC T . RE :RALS TO BE OF EQUAL LENGTH. AUG 92004 TOWN OF QUEENSBURY ar BUILDING AND CODE b CI ON OF DISP 0 SAL FIELDS w ;ZTIoN SHALL BE AS SttOWN ON THI5 DRAWMG. i �► AL! BE IN ACCORDANCE WITH THE N.Y.S. ' ►-i LENT OF HEALTH HNDIVIDUAL HaJ5EHOLD SYSTEMS. AND 481-7G IN5TALLA1I0N OF TH MOPLASTIC PIPE AND ',ATED TUBING IN SEPTIC TANK LEACH FIELDS- sVY EQLVWNT SHALL BE ALLOWED WITHW THE LIMITS w DISPOSAL FIELDS AFTER PIPE INSTALLATION HA5 BEGUN. EXCAVATION OF BED AREA TO THE DEPTHS REQLARED• ►LL5 AND FLOOR SHOULD BE GLEANED AND RAKE TO AN EVEN SURFACE AND TO L005EN 5MEARED SECTION ENT OF CONCRETE SAND IN-DRAM UNITS. PERFORATED PEE. O TEXTILE SHALL BE A$ SttOWN AND IN ACCORDANCE WITH N-DRW DESIGN Mp,N,I& AND NY5DOH APPROVAL CONDITIONS. Date; JUNE 2004 'E AND IN-DRAIN LHT5 Waj") BE LAID AT THE M DE5 Scale; AS NOTED RELATIONSHIPS SHOWN ON THI5 DRAWING. MAINTAINING HOR OTHER 1��455UTAAB SGOND O N5 ATTHSE PIPE 5M� BE IE HOLES DOWN rN ALL CASES. 491 p R 05 5P05AL FIELDS SHALL BE GRADED TO SHED RAINFALL SURFACE CE RUHOFF FROM W AGENT AREAS AWAY ,T OF THE DISPOSAL FOLD SHALL BE IN UNDER DRIVEWAYS. WEET 1 OF t 1� 1• �,�n-ram � ,� a •� '� � � 1 No�,° ,.8 •8 ■sa O '8 ■ l 1 s N O1 � F It�_/JI Da NM 1Cl'\) O F n 1 v _ Z ' `-� CF\) O D � m -ul > 111 0 cj r1l Q --i CF\) , BOLTON ■ rOV/y r� t a ,s ,c _ ■ A A a •a a s NO110fl NAM a - •x.v.�1.t+ -E--11�EN-T- -S-E-P--T-IC---S-Y-S-T-I��-� - - --- ,,,,,���'4�.��'w,;;�%,,,---- --- - -------- - --- ------- --- --- - - ------ FOR -- [ONTEMARANO - 280 CLEVERDAY.E RD OF QUEENSBURY, WARREN COUNTY, NEW YOB; '% .,,,,, 59150,,,•�`�' ��� 0 6104 ISS(IFD FOR PLAN �c DETAILS _-. . ._ .00 DA , DF_SCRiP . r �. an -: -,:-:,+ram_ear•aa::aatr:► :- Septic Inspection Report Office No. (518) 76178256 Date Inspection re es t r c ve . Queensbury Building&Code Enforcement Arrive: am/p part: a m 742 Bay Rd., Queensbury,NY 1..2804 Inspector's Initi NAME: AC E IT NO.: LOCATION: 0 PECT ON: - RECHECK: Comments and/or diagram Soil T e: n j Type of Wa . Ipal IVAI WhfW Waterline separation distance ft. gWefl-separation distance Absorption Field: Total length ft. Length of each trench Depth of trenches ft. Size of Stone ROD Seepage Pits: Number Size: . x Stone Size: Piping Size Type Building to tank L Tank to rs ' r r jj� � ass QuMQ Distribution Box F e1d Pit e �► O ening Sealed• Y Partial I Location/Separations' Foundation to tank ft. Foundation to absorption Separation of Pits ft. Conforms as per Plot Plan Y N i Location of System on Property: i Front Rear Left Side Right Side Middle Fro Middle Rear System Use S s• Approved Partial Approved and needs to be re-inspected,please can the Building&Codes Office Disapproved L:\.SueHemingway\Huilding.Codes.Inspection.FORMS\Septic Inspection ReporLdoc January 28,2003 SOILS DATA TEST PIT 0-8" TOP SOIL 8-28" FINE SILTY SAND MOTTLING ® 19"+/- WATER ® 24"+/- PERCOLATION RATE - 1" IN 27 MINUTES, 20 SECONDS TEST BORING BY NACE ENGINEERING - 5/6/04 PERCOLATION TEST BY NACE ENGINEERING - 05/6/04 SEPTIC SYSTEM DESIGN DESIGN FLOW - EXISTING 3 BEDROOM CAMP - REPLACE ALL OLD PLUMBING FIXTURES WITH NEW CODE COMPLIANT FIXTURES - 3 BEDROOMS ® 110 GAL./DAY/BDRM = 330 GPD SEPTIC TANK - USE EX. 1,000 GAL. TANK & PUMP STATION ABSORPTION FIELD - TEST PIT SHOWS 19" TO MOTTLING - USE STABILIZED FILL ABSORPTION SYSTEM KEEPING BOTTOM OF SYSTEM 3'+ MINIMUM ABOVE MOTTLING - PLACE APPROX. 3'+ OF FILL BEFORE INSTALLING SYSTEM & MECHANICALLY COMPACT.. - PERCOLATION RATE OF FILL TO BE 1" IN 3 TO 5 MINUTES. PERCOLATION TEST OF IN -PLACE FILL MATERIAL TO BE CONDUCTED BY ENGINEER BEFORE ELJEN SYSTEM IS INSTALLED. - ELJEN IN -DRAIN SYSTEM PROPOSED DUE TO SITE CONSTRAINTS. - AT NYSDOH APPLICATION RATE 90 L.F. OF ELJEN TRENCH REQUIRED. USE BED WITH 3 LATERALS EACH 30 L.F. LONG = 90 L.F.TOTAL. NEW SEWER FOF M EXISTING 28" t0 TREE TO REMAIN CROWN ABSOPPTI TO SHED STO NOT TO SCALE APPROX. LOCATION OF EXISTING SEPTIC TANK & PUMP STATION -ILL AREA __RSA LOK RETAINING WALL OR EQUAL "0 BE DESIGNED & INSTALLED BY CONTRATOR ) EX. SEPTIC TANK APPROXIMATE FINISH GRADE NOT TO SCALE WEIGHT (TYP.) EXISTING SEWAGE PUMP STATION NOT TO SCALE 1. PUMP CONTROL PACKAGE TO BE SUPPLIED BY CONTRACTOR. AUDIBLE AND VISIBLE ALARM TO BE ACTIVATED BY ALARM FLOAT PROVIDE OWNER WITH AS -BUILT MEASUREMENTS TO ALL BURIED COVERS FROM AT LEAST 3 FIXED, PERMANENT OBJECTS SUCH AS BUILDING CORNERS. LEAVE 6" LONG IRON REBAR BURIED 2" BELOW SURFACE TO MARK COVER n f :R #1 DISTRIBUTION BOX BY FORT MILLER OR EQUAL _L OUTLET INVERTS JST BE SET AT (ACTLY THE SAME .EVATION. LEVEL BOX ON :A GRAVEL AND USE SPEED 'VELERS ON ALL OUTLETS. )JUST SPEED LEVELERS TH WATER. �o* `S.�R�Ov�ON 0 1-1/2" FORCE MAIN SLOPE TO DRAIN BACK TO PUMP STATION OVERFILL TO ALLOW 4" MIN. TOPSOIL, FOR SETTLEMENT SEED AND MULCH BACKFILL WITH SUITABLE MATERIAL 12" MIN. b i� Z_ 24" to TYPICAL MAXIMUM SEASONAL HIG GROUNDWATER ELEVATION OR BEDROCK BIO—MAT ABSORPTION SYSTEM STANDARD BED SECTION N.T.S. 4"0 PERFORATED PIPE GEO-TEXTILE COVER TYPAR 3401 OR EQUAL TYPE B IN -DRAIN UNIT BY ELJEN CORPORATION CONCRETE SAND NYSDOT ITEM #703-07 FILL USED IN AREA OF ABSORPTION BED SHALL BE FINE SANDY LOAM WITH AN IN -PLACE PERCOLATION RATE OF 3 TO 5 MINUTES. PLACE FILL IN 12 INCH LIFTS AND LIGHTLY COMPACT WITH TRACK EQUIPMENT. DO NOT ALLOW RUBBER TIRE EQUIPMENT OR TRUCKS IN ABSORPTION TRENCH AREA. ENGINEER TO PERFORM PERCOLATION TEST IN FILL PRIOR TO CONSTRUCTION OF ABSORPTION SYSTEM. 17" MAX. - o . � � w w w n Zn 1 226,12 Z. m of PROJECT 31 =� w� LOCATION .A ~'_ Z LOCATION MAP 4" PERFORATED PIPE -1111= TYPE B IN -DRAIN UNIT BY ELJEN CORPORATION GEO-TEXTILE COVER TYPAR 3401 OR EQUAL SLOPE 1/16"-1/32" PER FT. 10" MIN. S�QPE CONCRETE SAND SAND'r NYSDOT ITEM #703-07 BIO—MAT ABSORPTION SYSTEM STANDARD BED PROFILE N.T.S. NOTES: 1. END OF ALI. DISTRIBUTOR PIPES MUST BE PLUGGED UNLESS INTERCONNECTED. 2. ALL LATERALS TO BE OF EQUAL LENGTH. INSTALLATION OF DISPOSAL FIELDS 1. CONSTRUCTION SHALL BE AS SHOWN ON THIS DRAWING, AND SHALL BE IN ACCORDANCE WITH THE N.Y.S. DEPARTMENT OF HEALTH INDIVIDUAL HOUSEHOLD SYSTEMS, AND ASTM F481-76 INSTALLATION OF THERMOPLASTIC PIPE AND CORRUGATED TUBING IN SEPTIC TANK LEACH FIELDS. 2. NO HEAVY EQUIPMENT SHALL BE ALLOWED WITHIN THE LIMITS OF THE DISPOSAL FIELDS AFTER PIPE INSTALLATION HAS BEGUN. 3. AFTER EXCAVATION OF BED AREA TO THE DEPTHS REQUIRED, THE WALLS AND FLOOR SHOULD BE CLEANED AND RAKE TO ACHIEVE AN EVEN SURFACE AND TO LOOSEN SMEARED SECTION OF TRENCH. 4. PLACEMENT OF CONCRETE SAND IN -DRAIN UNITS, PERFORATED PIPE, AND GEO TEXTILE SHALL BE AS SHOWN AND IN ACCORDANCE WITH ELJEN IN -DRAIN DESIGN MANUAL AND NYSDOH APPROVAL CONDITIONS. 5. THE PIPE AND IN -DRAIN UNITS SHOULD BE LAID AT THE GRADES STTRDAIGOHT CONTIINUODUSSGRADES SHOWN NHOUT TSAS DRAWING MAINTAINING SEPARATIED JOINTS OR OTHER UNSUITABLE CONDITIONS.- TE PIPE HALL BE LAID WITH THE HOLES DOWN IN ALL CASES. 6. ALL DISPOSAL FIELDS SHALL BE GRADED TO SHED RAINFALL AND TO DIVERT SURFACE RUNOFF FROM ADJACENT AREAS AWAY FROM THE DISPOSAL FIELD. 7. NO PART OF THE DISPOSAL FIELD SHALL BE INSTALLED UNDER DRIVEWAYS. d- 12m A a� W � a z vZ ~ coU acq W w o z Z z z W Z nna M� O ^� a w H NW � W W c co w 0 O I� Cr Z O w� z cd M--1 W oa CO Ono Date; JUNE , 2004 Scale; AS NOTED 49138 SI-Eff 1 OF 1 PROPERTY TRANSFER SEWAGE DISPOSAL INSPECTION LETTER V Satisfactory Compliance Notice Town of Qyccnsbury Building&Codes Enforcement 742 Bay Road,Queensbury, NY 12804-5902 P: 518-761-8256 www.gueensbury.net Date: 23 June 2023 To: Michael Montemarano (Applicant) Re: System Inspection Site Report for: 280 Cleverdale Rd,Town of Queensbury, NY (Site Address) As requested, the Town of Queensbury's Building and Code Enforcement Department has made an inspection of the wastewater system components serving the property referenced above. All system components have been found, and are noted in the System Inspections Findings Worksheet. Inspector's observations: The system appears to have functioned adequately under past and present loading. There can be no assurance or guarantee of future performance for any period of time. Numerous factors, such as household water usage, leaking toilets, soil characteristics and seasonal ground water table fluctuation, as well as owner failure to manage and maintain the system, will affect its performance. This approval is valid for 3 years from22 June 2023, the date of the inspection. Sincerely, A John O'Brien, Director Budding & Codes Enforcement Town of Queensbury /kd Revised March 2022