PT-0383-2023 Property Transfer.Sewage Disposal Information Form
Date: 6/30/23
Town of Queens6ury
742 Bay Road,Queensbury,NY 12804
P:518-761-8256 www.gueensbury.net
John Mason for Richard O. Mead Revocable Trust
(Name of Owner/Applicant)
Re: Onsite Wastewater Treatment System Inspection Information Request for:
365 Cleverdale Road
(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 us do
the best job 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 is$275. 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 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 15Y 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, D
JUN 3 0 2023
/ 1 TOWN OF QUEENSBURY
BUILDING &CODES
John O'Brien, Director
Building and Code Enforcement
Town of Queensbury
Property Transfer Packet Revised July 2022
Office Use Only
Permit#:
T0471 dQyecnsbury Fee:
742 Bay Road,Queensbury,NY 12804
P:518-761-8206 or 518-761-8205 Invoice#: l�F
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: 365 Cleverdale Road
Tax map number: 226.12-1-54
Property owner: Richard O. Mead Revocable Trust
Mailing Address (c/s/z): 80 County Colony Road Queensbury, NY 12804
Cell #: Land Line#: 518-656-9956
Email: sunsoval@gmail.com
Applicant (if different than above): John Mason for Richard O. Mead Revocable Trust
Mailing Address (c/s/z): same address
Cell #: Land Line#:
Email:
❑ Proposed Owner ❑ Realtor ❑ Attorney ❑■ Other (explain:Agent )
Septic contractor: Crandall Excavating
Mailing Address (c/s/z): 63 Woodchuck Hill Rd Lake George, NY 12845
Cell#: 518-470-4694 Land Line#:
Email:
Reason for Inspection Request:
❑ On the market ❑ Future listing ❑Sale Pending ❑N Deed Transfer ❑ Other:
Property Transfer Packet Revised July 2022
}
HOUSEHOLD INFORMATION
**PLEASE SEE SEPARATE PAGE FOR EXEMPTIONS"
# Bedrooms 5 # Bathrooms 3 1/2 # Kitchens 1 Jacuzzi tub(s) 0 Garbage grinder 0
Onsite Wastewater Treatment System:
How many systems.are on the property? 1
Year system(s) installed: Tank 2023 Size of Septic Tank 1,50.0 gallons
Type of Absorption System: Absorption Bed (15' x 46')
Are all system components wholly within the property boundaries? ❑■ Yes ❑ No
Are system plans available? ❑■ Yes ❑ No
Does the system(s) serve multiple properties? ❑ Yes ❑0. No
If yes, describe
Maintenance:
Service agreement? ❑ Yes ❑■ 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
6/2023 Septic System Replacement
Operation:
System,problems? ❑ Yes ❑ No
Sewage odors? ❑ Yes ❑ No
Direct surface discharge(s)? ❑ Yes ❑ No
Back-up of toilets? ❑ Yes ❑ No
Back-up of any other fixtures? (e.g. slow drains) ❑ Yes ❑ No
Seasonal-ponding'or breakout of leach,field? ❑ Yes ❑ No
Property Transfer Packet Revised July 2022
e
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 must 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 and 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 3.0% of the fee is retained by the Town of
Queensbury. j
Signature of property owner or authorized agent:
Affiliation: ❑owner ❑■ agent ❑ other:
Please print me: G. Tho s Hutchins, P.E.
Signature: _ C� �' Date: 6/30/23
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 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 Transfer Packet Revised July 2022
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REDUCING TEE POINTED DOWNWARD TO PROVIDE A 50. GALLON DO
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SEMC TANK N07FS
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1,000 GALLON PRECAST CONCRETE PUMP STATION
-� _
WITH In, BALL VALVE THROTTLED TO EFFLUENT PUMP Tn BE GOULDS PUMPS WE SERIES,
ALL UNITS SHALL COMPLY NTH THE REQUIREMENTS: OF THE NEW YORK STATE DEPARTMENT
ALLOW TRICKLE DRAIN BACK INTO MODEL VE03L SUBMER98LE EFFLUENT PUMP 11.3 HP,
BOTTOM OF TEST PiT EL. 99.3'
OF HEALTH AND SHALL BE OF PRECAST CONCRETE AS MANUFACTURED BY UTOPIA
KTWELL 230 VOLT, 1PH
p
0 72
NO GROUNDWATER T
ENTERPRISES OR. EQUIVALENT.
SEPTIC TANK PUMP STATION DETAIL
RICAL TRICAL SERVICE PRIOR TO
VERIFY EMSnELECT
NO. MOTTLING
F
ALL STRUCTURES. SHALL BE PLACED. ON nRM, COMPACT. SAND OR GRAVEL BASE. WHERE
SCALE: NTS
PURCHASING PUMP.
ROOTS ENARE DEPTH
,
EXiSANG SOIL CONDITIONS ARE UNSUITABLE, . CRUSHED STONE SHALL BE PLACED AS
ELECTRICAL Wk?IIK TO' BE INSPECTED BY A
4 ; �
NECESSARY TO ACHIEVE A STABLE BASE.ALL
PRIOR TO
s,
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CERTIFIED ELECIRiCAL INSPECTIOI AGENCY PERCOLATION TEST
START-UP OF PUMP STATION. �e N
SEPTIC TANKS INSTALLED JN TRAFFIC AREAS SHALL BE OF EXTRA HEAVY CONSTRUCTION PT I - 121912022 BY TOM HUTCHINS, P.E.r.
DESIGNED FOR H-20 WHEEL LOADING PER
STABILIZED PERCOLATION RATE 7:zo INCH --- -� OF QUEENS�Uf2Y u� W
ACED IMTH BUTYL SEALANT JOINTS BELOW THE LIQUID LEVEL. MUST LIMIT OF 15'x46' 4" PERFORATED PVC LATERALS B ILDiNG & CODES DEPTe
ALL. JOINTS MUST BE SE STONE BED INSTALLED NEAR LEVEL iN
BED GURATION
BE TESTED BEFORE BACKFILLING nate, cavFJ Reviewed y: MAP # ZZ61Z-1 9---_ .
..PROPOSED
✓ DISTRIBUTION BOX
TRANSITION FORCE Dig Safely.Jill' J
4 TOPSOIL COVER ABOVE 4 PVC PERFORATED LATERAL LTER `FABRIC
. ... � ��. .�.� ; � MAIN TO 4 PVC New York
INSTALLED LEVEL. IN BED MIRAn .140N OR EQUAL ,� _) 0 ���
TOP OF STONE BED; - -- --' - OX t�11.
SEED & £STASUSH TURF comnGURA77OI W17H MANIFOLDED ENDS 5' PIPE SPACING Z'S ' �` -- _ _ __ ' OUTSIDE. OF D 8 ■ ao+�r. Yow �
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3/4'-1-1/2' WASHED
y 46
CRMED STONE N S t @ V e' S sFO P 169 Havilond Road
ABSORPTION BED SECTIO
Orb
Qaeensbury, NY 12804
SCALE NTs
ABSORPTION BED PROFILE Lanni Survey ,�,�„�,,, acr 291967 01
SCALE• N75 �� H..liana �a
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WASTF�IIIATER SYSTEM SMACK REQUIREMENTS
PROPEMTY:LW
HOUSE
STREAM, LAKE
WAS
WELL
S�P71C TANK
10,.
10,
50'
ASS .MPnaV FIELD
10' -
20'
100'
100,
O" Oak
o
15" Hem ock
C >>>) l I
I I O" Pine
/a-, .
I
/ ov
ra te-VJalk
E---i:
L-,..—J
�,00 o -
)
l I I f
--�-� 1178. 23'
N P9°29'10" W
O /
Lake Georg*
I " Hemlock \
1 krea
BM Top of Nail in 40" stump 1 778 7. $q, F�et
Elev.= I09.44' �
0.411 Acres '
I y
SEP71C TANK TO BE DECOMMISSIONED. INTERIOR
G TO BE RE-ROUTED TO NORTH SIDE BUILDING
EXISTING WASTEWATER SYSTEM PLAN
SCALE: 1 "=20'
GRAPHIC SCALE
10 0 5 10 20 40
( IN FEET )
CONTRACTOR TO FIELD VERIFY LOCATIONS AND DISTANCES
RECORD DRAWING NOTE:
SEPTIC TANK AND PUMP STATION RISERS /NSTAI
APPROXIMATELY 6" BELOW FINISHED GRADE. PROXIMATE
DIMENSION TABLE FOR LOCATIONS _ ISH GRADE
4" PVC INLET
MIN. SLOPE
1/8" PER FOOT
WATERTIGHT SLEEVE -
AND SEAL (TYP)
1,500 GAL PRECAST
CONCRETE SEPTIC TANK
Crushed Stone
Lands N/F of
Mary Mattson
B:1014 P:111 I
226. 12-1-53 U.P. NM4
LAKE WATER SUPPLY I
WASTEWATER SYSTEM SETBACK REQUIREMENTS
PROPERTY LINE
HOUSE
STREAM, LAKE,
WATERCOURSE,
WE7L4ND
WELL
SEP71C TANK
10'
10'
50'
50'
ABSORP77ON FIELD
1 10'
20'
1 100'
100'
POLYETHYLENE EXTENSION TO GRADE
WITH TAMPER RESISTANT ACCESS COVER
12" MIN.
COVER
1/8" PER FOOT
j r 2" MIN. SLOPE
LIQUID LEVEL
DUAL COMPARTMENT. 18"
16" BAFFLE MIN.
CLzx
o g g -
nl M
<. 1. MINIMUM 2X WIDTH I
MAXIMUM 4X WIDTH
OUTLET 4" PVC
°.
e.°
Ga .< ° a 8.
SEPTIC TANK NOTES
ALL UNITS SHALL COMPLY KITH THE REQUIREMENTS OF THE NEW YORK STATE DEPARTMENT
OF HEALTH AND SHALL BE OF PRECAST CONCRETE AS MANUFACTURED BY UTOPIA
ENTERPRISES OR EQUIVALENT
ALL STRUCTURES SHALL BE PLACED ON FIRM, COMPACT SAND OR GRAVEL BASE. WHERE
EXISTING SOIL CONDITIONS ARE UNSUITABLE, CRUSHED STONE SHALL BE PLACED AS
NECESSARY TO ACHIEVE A STABLE BASE.
SEPTIC TANKS INSTALLED IN TRAFFIC AREAS SHALL BE OF EXTRA HEAVY CONSTRUC77ON
DESIGNED FOR H-20 WHEEL LOADING.
ALL JOINTS MUST BE SEALED WITH BUTYL SEALANT. JOINTS BELOW THE LIQUID LEVEL MUST
BE TESTED BEFORE BACKFILLING.
ALARM 3" ABOVE 'PUMP ON'
& LAG PUMP ON
PUMP ON
PUMP OFF
POLYETHYLENE EXTENSION TO GRADE
WITH TAMPER RESISTANT ACCESS COVER
INSTALL FLOAT SWITCHES TO
OPERATE PUMP AND MAINTAIN
LEVELS AS INDICATED
BALL VALVE T
BALL
CHECK
VALVE
FLOAT SWITCHES
° -INSTALL INSIDE
PUMP PIT IN
LOCA77ON ACCESSIBLE
M774OUT PIT ENTRY
DUPLEX
16" MIN. EFFLUENT
PUMPS
4
° ° a G d
RECORD DRAWING DIMENSIONS
TABLE
CORNER "A"
CORNER "B"
S. T. INLET PORT
18.67'
25'
S T. OUTLET PORT
22.5'
21.3'
PUMP STATION PORT
25.8'
19'
DIS7R1BU1TON BOX
36.5'
21 '
1,000 GALLON PRECAST CONCRETE PUMP STATION
SEPTIC TANK & PUMP STATION DETAIL
SCALE. NTS
4" TOPSOIL COVER ABOVE
4" PVC PERFORATED LATERAL __\FILTER
FABRIC
TOP OF STONE BED,
INSTALLED LEVEL, IN BED
MIRAFI 140N OR EQUAL
SEED & ESTABLISH TURF
CONFICURA77ON WITH MANIFOLDED ENDS
5' PIPE SPACING
2.5' TO EDGE
OF BED
8-16"
-
COVER
.::
:..,. ..... .....
2 STONE
TO TA
C01/ER OVER
-
P•.
,
STONE DEP1N
PIPE
.
�.,
= / ._; r ;,
. y:®'�° .r:...? .: �:.. BOTTOM OF STONE EL.
102.5 .. .:
-
,r._.
-
6" MIN STONE `.:
BELOW PIPE _
__
BED WIDTH & GEOMETRY
PER PLAN3'
MINIMUM
SEPARATION
...
T 0 BOUNDARY
...
CONDITION
3/4"-1-1/2" WASHED
CRUSHED STONE
A l 1/'•/1 A P1TT/ 0 A ! ^ rr1 nri+-rr^ n
SCALE. NTS
LIMIT or r' .
S7
15'
PROVIDE 5'
FROST
PROTEC77ON
� 4r Al l C n -F
PROPOSED WASTEWATER SYSTEM PLAN
SCALE: 1 "=20'
GRAPHIC SCALE
i
I 10 0 5 10 20 40
( IN FEET )
I
CONTRACTOR TO FIELD VERIFY LOCA77ONS AND DISTANCES
EXTERIOR WEATHERPROOF JUNCTION BOX
(IF NECESSARY). SEAL CONDUIT GAS TIGHT.
INSTALL CONTROL PANEL IN HOUSE. ALL ELECTRICAL
WORK TO BE INSPECTED BY A CER71FIED ELECTRICAL
INSPECTION AGENCY PRIOR TO START-UP OF PUMP STATION.
12" MIN. COVER
DISTRIBUTION BOX
L 2" MIN.
2" MIN. DROP
BETWEEN INVERTS
PUMP STATION NOTES
SEAL ALL TANK OPENINGS W47ER11GHT.
PROVIDE AND INSTALL UL LISTED PACKAGED PUMP
CONTROL PANEL WITH VISUAL AND AUDIBLE ALARM.
1-1 2" SCH-40 PVC PIPING
INSTALL SIMPLEX, DEMAND DOSE CONTROL PANEL
INSIDE WET WELL THROUGH WALL
INSIDE HOUSE IN ACCESSIBLE LOCATION.
INSTALL POWER & CONTROL WIRING TO CONTROLLER
UNION - LOCATE SUCH THAT
WITH ALARM IN HOUSE IN ACCORDANCE WITH
UNION CAN BE DISCONNECTED AND
MANUFACTURER'S INSTRUCTIONS AND NA77ONAL
PUMP REMOVED WITHOUT TANK
ELECTRIC CODE (N.E.G) REQUIREMENTS.
ENTRY
PUMP CONTROL AND FLOAT LEVELS TO BE INSTALLED
REDUCING TEE POINTED DOWNWARD
TO PROVIDE A 50 GALLON DOSE.
WITH 1 " BALL VALVE THROTTLED TO
ALLOW TRICKLE DRAIN BACK INTO
EFFLUENT PUMPS TO BE GOULDS PUMPS WE SERIES,
MODEL WEO3L SUBMERSIBLE EFFLUENT PUMP 1/3 HP,
WETWELL
230 VOLT, 1PH
VERIFY EXISTING ELECTRICAL SERVICE PRIOR TO
PURCHASING PUMP.
ALL ELECTRICAL WORK TO BE INSPECTED BY A
CER77FIED ELECTRICAL INSPECTION AGENCY PRIOR TO
START-UP OF PUMP ST4770N.
46' '
ABSORPTION BED PROFILE
SCALE. NTS
co
Or
U
4 u,LU
a
�w
co fE
W C/)
t—
Y
J
Lands N/F of
Mary Mattson
B:1014 P:111
226.12-1-53
LAKE WATER SUPPLY
WASTEWATER SYSTEM DESIGN
5-BEDROOM RESIDENCE
DESIGN FLOW - 110 GPD/BEDROOM
SYSTEM DESIGN FLOW - 550 GPD
SEP71C TANK - NEW 1,500 GALLON PRECAST CONCRETE
PUMP STATION - NEW 1,000 GALLON PRECAST CONCRETE
DESIGN APPLICATION RATE: 0.8 GPD/SF, BASED ON
6-7 MIN/IN PERCOLA77ON RATE
ABSORP71ON BED AREA REWD = (550 GPD)/(0.8 GPD/SF)
= 688 SF
AB E77QU BED AREA PROVIDED = 15 z46' = 690 SF
POTABLE WATER SUPPLY IS LAKE GEORGE
MAINTAIN 10' MINIMUM SEPARA7ON BETWEEN WATER SUPPLY
LINE(S) AND ALL WASTEWATER SYSTEM COMPONENTS
SITE SOILS DATA
TEST PIT
TP-1 - 121912022 BY TOM HUTCHINS, P.E.
GRADE EL. 105.3'
0-4" - WOODS DUFF/TOPSOIL
4-20" - LIGHT BROWN FINE SAND, LITTLE SILT
20-38" - RED -BROWN LOAMY FINE SAND,
VERY OLD FILL
38-72" - MEDIUM BROWN GRAVELLY SILTY FINE
srTE LOCATION --J LOCATION MAP
SYSTEM INSTALLATION NOTES
CONSTRUCTION SHALL BE AS SHOWN ON THIS DRAWING AND IN ACCORDANCE WITH THE N.Y.S. DEPARTMENT OF
HEALTH INDIVIDUAL HOUSEHOLD SYSTEMS AND ASTM F481 INSTALLATION OF THERMOPLASTIC PIPE AND CORRUGATED
TUBING IN SEPTIC TANK LEACH FIELDS.
AFTER EXCAVATION OF 15' WIDE X 46' LONG ABSORPTION BED TO THE DEPTH REQUIRED, THE WALLS AND FLOOR
SHALL BE CLEANED AND RAKED IN ORDER TO LOOSEN SMEARED AREAS OF SOIL.
PLACEMENT OF CRUSHED STONE, PERFORATED PIPE AND FILTER FABRIC SHALL BE AS SHOWN, AND CARE SHALL BE
EXERCISED TO AVOID INCLUSION OF FINE GRAINED SOILS AND WASTE MATERIAL IN THE STONE AND PIPE.
THE PIPE SHOULD BE LAID AT THE GRADES INDICATED, MAINTAINING STRAIGHT CONTINUOUS GRADES WITHOUT SAGS,
HUMPS, SEPARATED JOINTS, OR OTHER UNSUITABLE CONDITIONS PIPE SHALL BE LAID WITH HOLES DOWN IN ALL
CASES.
ALL DISPOSAL FIELDS SHALL BE GRADED TO SHED RAINFALL AND DIVERT SURFACE RUNOFF AWAY FROM THE
DISPOSAL FIELD.
DO NOT USE HEAVY EQUIPMENT WITHIN THE ABSORPTION AREA AFTER PIPING HAS BEEN INSTALLED.
THE WASTEWATER TREATMENT SYSTEM IS DESIGNED AND APPROVED BASED UPON THE INSTALLATION OF WATER
CONSERVING FIXTURES AND A DESIGN FLOW OF 110 GPD PER BEDROOM. THE SYSTEM IS NOT DESIGNED TO
ACCOMMODATE EXTREME WATER USE FIXTURES, SUCH AS JACUZZI-TYPE SPA TUBS OR WATER TREATMENT EQUIPMENT.
THE INSTALLATION OF NON -CONSERVING WATER FIXTURES OR EXTREME WATER USE FIXTURES IS CONTRARY TO THE
APPROVAL OF 7HIS WASTEWATER TREATMENT SYSTEM.
ROOF, FOOTING, GARAGE, CELLAR AND SURFACE WATER DRAINAGE MUST BE EXCLUDED FROM THE WASTEWATER
SYSTEM.
CONSTRUCT DRAINAGE SWALE UPGRADE OF SYSTEM IN ORDER TO DIVERT SURFACE RUNOFF AROUND ABSORPTION
FIELD.
SEPTIC TANK, PUMP STA77ON & ABSORPTION BED MUST BE INSPECTED BY LOCAL BUILDING DEPARTMENT AND DESIGN
ENGINEER PRIOR TO BACKFILL AND FINAL GRADING. IT IS THE RESPONSIBILITY OF THE CONTRACTOR TO IDENTIFY THE
NECESSARY PARTIES AND REQUEST INSPECTIONS.
SYSTEM MATERIAL SPECIFICATIONS
ABSORPTION FIELD AGGREGATE
STONE IS TO BE 3/4" TO 1-1/2" WASHED CRUSHED STONE.
EFFLUENT FILTER
EFFLUENT FILTER TO HAVE 1/16-INCH FILTRATION, POLYLOK PL-122 OR EQUIVALENT.
EFFLUENT SEWER PIPE
PIPING TO BE 4" SDR-35 OR SCHEDULE 40 PVC. INSTALL WITH 1/8" PER FOOT MINIMUM SLOPE.
FILTER FABRIC
FILTER FABRIC TO BE 4.8 OZ/SY NON -WOVEN SEPARATION FABRIC, TENCATE MIRAFI 140N OR EQUIVALENT.
HOUSE SEWER PIPE
PIPING TO BE 4" SDR-35 OR SCHEDULE 40 PVC. INSTALL WITH 1/4" PER FOOT MINIMUM SLOPE.
TOPSOIL
PLACE 4" MINIMUM TOPSOIL OVER ENTIRE BACKFILL AREA. SEED, MULCH, AND ESTABLISH TURF.
SAND RECORD DRAWING NOTE:
A REPRESENTATIVE OF OUR OFFICE VISITED THE SITE
BOTTOM OF TEST PIT EL. 99.3' DURING CONSTRUCTION AND IT IS MY OPINION THAT
NO GROUNDWATER TO 72" THE SYSTEM IS INSTALLED IN GENERAL CONFORMANCE
NO MOTTLING WITH THE APPROVED PLAN AND THIS RECORD
ROOTS ENTIRE DEPTH DRAWING FINAL SURFACE FINISHING AND TURF
ESTABLISHMENT IS ONGOING
PERCOLATION TEST G. THOMAS HUTCHINS, P.E.
PT-1 - 12/9/2022 BY TOM HUTCHINS, RE 6/30/2023
STABILIZED PERCOLA77ON RATE. 7.20 PER INCH
RECORD DRAWING
INSTALLATION DATE: 6/30/2023
ALLED BY - CRANDALL EXCAVATING INC.
TAX MAP # 226.12-1-54
)POSED
TIBU77ON BOX
7FSafely.
RANS ON FORCE
MAIN TO 4" PVC
FA
Dig
NdwFffork
OUTSIDE OF D-BOX
® Call Before You Dig
03 Wait The Required Time
® Confirm Utility Response
1
RECORD DRAWING
61301202
EM Respect The Marks
Dig With Care
8®®'962'796�
0
ISSUED FOR PERMIT
1/16/202.
www.d igsafelynewyork.com
No.
Revisions
Date
WASTEWATER SYSTEM PLAN DETAILS
prepared for:
Richard 0. Mead Revocable Trust
365 Cleverdale Road
Town of Queensbury, County of Warren, State of New York
MAP REFERENCE:
BASE MAP INFORMATION FROM "MAP OF A
TOPOGRAPHIC SURVEY MADE FOR RICHARD &
MADELINE MEAD," IN THE TOWN OF QUEENSBURY,
WARREN COUNTY, NEW YORK. DATED APRIL 12, 2022.
PREPARED BY.
n D us e
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S t e V@ S
LOLild S1.1Y'VeyO3r8
169 Haviland Road Queensbury, New York 12804
(518) 792-8474 New York Lie. No. 50135
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ALTERATION OF THIS XCEPT BY
A LICENSED PROFESSION ' ENGINEER IS A
VIOLATION OF NYS EDUCATION LAW.
Drawn: JRS
Checked: GTH
Scale: NOTED
Date: 51212022
169 Haviland Road
Queensbury, NY 12804
(518) 745-0307 Phone
Hutchins Engineering PLLC (518) 745-0308 Fax
291967-01
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: 5 July 2023
To: Richard O. Mead Revocable Trust
(Applicant)
Re: System Inspection Site Report for:
365 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 from6/30/2023, the date of the inspection.
Sincerely,
A
John O'Brien, Director
Budding & Codes Enforcement
Town of Queensbury
/kd Revised March 2022