PT-0004-2023 • Office Use Only•
Permit#: P1 —X4— 202,-))
Town Af(keen .ory Fee:_$
742 Bay Road,Queensbury,NY 12804
P:518-761-8206 or 518-761-8205 Invoice#:
www.queensburv.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: 22 WARD LANE
Tax map number: 240.E-1-6
Property owner: .DAVID BARLOW
Mailing Address (c/s/z): 162 HUDSON POINT, QUEENBSURY,NY 12804
Cell #:.518-955-1180 Land Line#:
Email:
Applicant (if different than above):
Mailing Address (c/s/z):
Cell#: Land Line#:
Email:
0 Proposed Owner ❑ Realtor ❑ Attorney ❑ Other (explain: ) -
Septic Contractor: SAME AS OWNER
Mailing Address (c/s/z):
Cell #: Land Line:#:
Email:
Reason for Inspection-Request:.
•
❑ On the market ❑ Future listing ['Sale Pending 0 Deed Transfer ❑ Other:
Property Transfer Packet . Revised July 2022
HOUSEHOLD INFORMATION
**PLEASE SEE SEPARATE PAGE FOR EXEMPTIONS**
# Bedrooms I # Bathrooms 1 # Kitchens 1 Jacuzzi tub(s) ri Garbage grinder_
Onsite Wastewater Treatment System:
How many systems are on the property? I
Year system(s) installed: Tank NA Size of Septic Tank NA
Type of Absorption System: CESSPOOL
Are all system components wholly within the property boundaries? ❑i Yes 0 No
Are system plans available? ❑ Yes ■❑ No
Does the system(s) serve multiple properties? ❑ Yes ❑� 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
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
EXEMPTION CONDITION OPTIONS
Due to one of the conditions listed below, I am requesting an exemption from the
Septic Inspection Upon Property Transfer by the Town of Queensbury:
PLEASE CHOOSE ONLY ONE CONDITION BELOW IF YOU ARE REQUESTING A WAIVER
❑ The property to be sold or transferred will not be inhabited, and the new owner plans to demolish the
existing structure. In order to qualify for the exemption, a notarized affidavit must be submitted to the
Building and Codes Enforcement Office stating that the dwelling will not be inhabited and that it will be
demolished with no immediate plans to rebuild or the dwelling will not be inhabited, it will be
demolished and rebuilt, in which case the affidavit shall be accompanied by a site plan, including
adequate detail to demonstrate a lawful OWTS,together with a check payable to the Town of
Queensbury in the amount of$2,000. Such funds will be held in a non-interest-bearing escrow account
and will be released, in the former case, upon issuance of a demolition permit and, in the latter case,
upon issuance of a certificate of compliance from the Building and Codes Enforcement Office. If the
Property Transfer inspection is not completed within that 6 (six) month timeframe,
the $2000 will be forfeited.
An OWTS inspection was not able to be completed prior to the conveyance of real property due to
inclement weather. In order to qualify for the exemption, a notarized affidavit from the new property
owner to complete the requisite OWTS inspection within six months of the date of the conveyance of
real property, or June 1, whichever comes first, must be filed with the Building and Codes Enforcement
Office. A check payable to the Town of Queensbury in the amount of$2,000 will be held in a non-
interest-bearing escrow account and shall be released upon the completion of a satisfactory OWTS
inspection from the Building and Codes Enforcement Office. If the Property Transfer
inspection is not completed within that 6 (six) month or June 1st timeframe, the
$2000 will be forfeited.
The property to be sold or transferred contains an existing OWTS that does not comply with the
provisions of this article, and the prospective purchasers and/or the Seller wish to forgo an inspection
in favor of installing an approved OWTS within six months of the transfer of property. In order to
qualify for the exemption, a notarized affidavit must be submitted to the Building and Codes
Enforcement Office stating that the existing OWTS will be replaced within six months from transfer of
property. The affidavit must be accompanied by a site plan, including adequate detail to demonstrate
that the replacement OWTS will comply with this article,together with a check payable to the Town of
Queensbury in the amount of$2,000. Such funds will be held in a non-interest-bearing escrow account
and will be released upon issuance of a certificate of compliance from the Building and Codes
Enforcement Office. If the Property Transfer inspection is not completed within that 6
(six) month timeframe, the $2000 will be forfeited.
Property Transfer Packet Revised July 2022
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: 12 December 2023
To: David Barlow
(Applicant)
Re: System Inspection Site Report for:
22 Ward Ln, 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 five (5) years from 12 December 2023, the date of the
inspection.
Sincerely,
A
John O'Brien, Director
Budding & Codes Enforcement
Town of Queensbury
/kd Revised August 2023
FEE
IPF WASTEWATER SYSTEM DESIGN SYSTEM MATERIAL SPECIFICATIONS
DISTURBE[ 1-BEDROOM DESIGN HOUSE SEWER PIPE
WATER SAVING FIXTURES - REPLACE EXIST. FIXTURES AS NEEDED PIPING TO BE 4" SDR-35 OR SCH-40 PVC. INSTALL WITH 114" PER FOOT MINIMUM
(1.6 GPF MAX. FLUSH, 3.0 GPM MAX. FAUCETS) SLOPE
DESIGN FLOW — 110 GPD/BEDROOM HOLDING TANK CONNECTOR PIPE
SYSTEM DESIGN FLOW - 110 GPD PIPING TO BE 4" SDR-35 OR SCH-40 PVC. INSTALL LEVEL
BACKFILL MATERIAL
Landc \ BACKFILL TO BE GRANULAR SAND BACKFILL MATERIAL WITH NO PARTICLES GREATER THAN ` HOLDING TANK DESIGN
X a rg a re NYSDOH SIZING - 5-DAYS DESIGN FLOW - 550 GALS
`z TOWN OF QUEENSBURY HOLDING TANK VOLUME REQUIRED: VARIANCE SUMMARY
B k 1 1 2000 GAL — §136-11 B.(2) THE FOLLOWING RELIEF IS REQUESTED FROM THE TOWN OF QUEENSBURY
Tax M Parc INSTALL (2) 1500 GAL POLYPROPYLENE TANKS IN SERIES CHAPTER 136 SEWERS AND SEWAGE DISPOSAL:
3000 GAL TOTAL TO BE PROVIDED
I P F C HOLDING TANK /NSTALLA710N — § 136— i 1 A.
POTABLE WATER SUPPLY 1S EXISTING LAKE WATER SUPPLY — INSTALL TWO 1500 GALLON WASTEWATER HOLDING TANKS.
— RELAY TO BE INSTALLED ON WATER PUMP CIRCUIT TO SHUT DOWN
1 WATER SUPPLY TO HOUSE WHEN ACTIVATED BY WARNING/SHUT
\ DOWN ALARM ON PANEL REQUEST A 6 MONTH EXTENSION FROM TOWN CODE CHAPTER 137 PROPERTY
TRANSFER LAW FOR INSTALLATION OF THE NEW HOLDING TANK SYSTEM.
HOLDING TANK ALARM NOTES
\ ALARM PANEL CONTROLS SHALL BE SJE RHOMBUS TANK ALERT DUO ALARM SYSTEM OR EQUIVALENT, AND PROVIDE THE
\ (NOT FOLLOWING MONITORING AND CONTROL FUNCTIONS:
WHEN LEVEL OF TANK REACHES 509 CAPACITY, ALARM WILL INDICATE "TANK HIGH LEVEL" WITH A YELLOW LIGHT ON
ALARM PANEL.
WHEN LEVEL OF TANK REACHES 957. CAPACITY, AUDIBLE ALARM WILL SOUND AND RED LIGHT WILL FLASH, INDICATING
"TANK SHUTOFF LEVEL".
SITE LOCATION
RESOLUTION APPROVINIG DAVII) HARi.QWIS APPLICA'iION FOR
r ELECTRICAL INTERLOCK SHALL BE INSTALLED TO DISABLE WATER SUPPLY UPON REACHING "TANK SHUTOFF LEVEL" SANITARY SFAVAC.F DISPOSAL VARIANCES
- RESOLUTION NO.: R014 3 2I)23
I , \ SYSTEM WILL RESET AFTER HOLDING TANKS ARE PUMPED DOWN TO BELOW THE ACTUATION LEVEL OF "TANK HIGH #NfRODUC'ED BY: nlr. Harrison Freer
I6 WHO MOVED UPS ADOT.Y110N
i I LEVEL" ALARM.
SBL`O:VL3EUIIY: �Ir,;lnthnnq.Ltetivier
I
I r
�AN ELECTRICAL INSPECTION BY A CERTIFIED ELECTRICAL INSPECTION AGENCY IS REQUIRED AFTER INSTALLATION.
:..
U E
I [CRZA, tyav#u Barlow to (Applicant) filed r . t variance f 3n & �f R EOEY fo n- ' 1''"' R , titfix) a ns !stuns
I D \
4SPHAL—T _� ELECTRICAL INSPECTION SEAL. IS TO BE AFFIXED TO ALARM CONTROL PANEL. PP � II�'
MIN. SLOP
1/4" PER FOOT r16
APPROXIMATE POLYETHYLENE EXTENSION
FINISH GRADE TO GRADE WITH TAMPER
RESISTANT ACCESS COVER
6"+ 4" PVC SDR-35
CONNECTOR PIPE
3,, INSTALLED LEVEL
SEALED WATERTIGHT
- LIQUID LEVEL .. r
50 ' CAPACITY
WATERTIGHT SLEEVE-
LEEVE
(15Q0 GAL)
AND SEAL (TYP.)
WARNING LEVEL
ALARM LIGHT ON
1500 GALLON
INJECTION MOLDED
POLYMER SEPTIC TANK
INSTALLED AS HOLDING TANK
6"# PEA GRAVEL
POLYETHYLENE EXTENSION
TO GRADE KITH TAMPER
RESISTANT ACCESS COVER
6"+
J LIQUID LEVEL
INSTALL FLOAT SWITCHES O-
TO OPERATE ALARM PANEL
AT INDICATED LEVELS
��\\\i�\" . �i.�i��i���iT�✓�iiY�i�i��,�i��i�iT�i��i��y�.
6"f PEA GRAVEL
HOLDING A
INKS IN SERIES DETAII
NTS
hoVomGTnNKsvIAw
GRAPHIC SCALE
5 0 2.5 5 10 20
( IN FEET )
CONTRACTOR TO FIELD VERIFY LOCATIONS AND DISTANCES
rnvr7l? unDD
H091
DISCHARGE
1"' BALL VALVE, PVC
/ 14" FPT CONNECTION
TO ALARM PANEL
14/6 CABLE
ANTI—SIPHON/CHECK
VALVE
ASSEMBLY
(NORYL)
ALARM
ON
19.4 n
[494 m
OFF
14.4 n 63 al
[3671nnn
47 id
11.9
[30 m
i
37 in 38 gal
940 m
SEMI —POSITIVE DISPLACEMENT TYPE PUMP
DIRECTLY DRIVEN BY A 1 HP MOTOR
BASIN CAPACITY = 91 GALLONS
—1500 GALLON
INJECTION MOLDED HOLDING TANK NOTES
POLYPROPYLENE SEPTIC TANK ALL UNITS SHALL COMPLY WITH THE REQUIREMENTS OF THE NEW YORK
INSTALLED AS HOLDING TANK STATE DEPARTMENT OF HEALTH AND SHALL BE OF INJECTION MOLDED
POLYPROPYLENE AS MANUFACTURED BY NORWESCO LOW PROFILE 1500 GAL.
TANK OR EQUIVALENT.
ALL STRUCTURES SHALL BE PLACED ON 6" LAIN. COURSE OF CRUSHED
STONE SHALL BE PLACED AS NECESSARY TO ACHEVE A STABLE BASE. TANK
95% CAPACITY SHALL BE SECURED TO BEDROCK WITH EPDXY CROUTED ANCHOR EYEBOLTS
(4275 GAL) AND THREADED ROD AS PER COUNTER BUOYAt1rY INSTRUCTIONS PROVIDED
ALARM/SHUT DOWN BY TANK MANUFACTURER.
ALARM ON RUBBER GASKETS SHALL BE INSTALLED IN ALL INSETS AND OUTLETS.
TANKS ARE NOT APPROPRIATE TO BE INSTALLED N TRAFFIC AREAS.
TANKS TO BE BACKFILLED WITH CLEAN SAIID FILL; NATIVE COBBLY
BOULDERY SOILS ARE NOT ACCEPTABLE AS BACKFILL MATERIAL.
ALL SEAMS, PENETRATIONS, & ACCESS COVERS MUST BE MAINTAINED
WATERTIGHT BY INSTALLER. FIELD COAT ADDITIONAL PENETRATIONS AS
NECESSARY WITH WATERTIGHT SEALANT.
Q6 Q
SGS 4-26-07 — 1/16
DR BY CHK'D DATE ISSUE I SCALE
SEWER SYSTEMS
IH091 STATION, DETAIL SHEET
\A0056P02
E-WE IH091 GRINDER PUMP DETAIL
SCALE: NTS
W ASTEW ATER SYSTEM SETBACK SCHEDULE
PROPERTY LINE
WELLS
HOUSE
G ORGAKE
HOLDING TANK
IV
5u
50'
10r
of the'rown of € ueensbury On Site Sewage Disliosal Ordinance, Chapter 1a6, .06-11 which
requites applicarits to obtain a vaianee fey holding hams as the Applicant wiyhos to replace a,
wastewater sysicin by installing a holding, tank systean consistiriL of twli ,,Ti holding tanks etchwith
a: capacity of 1,500 eai}on; for a total capacity of 3:fM gallons, thus meeting and exceeding the
requited total capacity of 2,000 gallocs on property to aiedat 22. Ward Lane in the T(rva of
Quoee >,;burp, and
WHEREAS, Towri Code Chapter 137 requires inspection of £)esdo fitestewater
Trea€rtent Systems (OWTS) prior to the sale of ccrian real property uid provides that a $'2,000'
escrow deposit will be forfeited to this Toxvn in the event that compaction of a w3stevvatet
tRaimc:itE S1'S€ein'IneP.nti,, all standards is trot oortipieted within trig limC prov'ideil,and
WIfERLAS, a change of deed ter the AppliaaCs property occurred, on or about.
Saptember 1, 2022 and when the required property transfer septic: htspextion took place, it was
found that tine existing wastewater system was deficient; however, the proposed no", system is
not able to be completed within the required six 161 month time period due it) the nine of year
and timing of pennfcting, and
WHEREAS, the Applicant therefore applied for a tinielineextension or until June.3"', 2023
to install the syacin-and to extcnd the data on which the $2.000 screw deposit he previously
&1xisit4d with -the"i'ovi1t-shall be antornatiottlly forfeited to the'Fowsi, and
A'HERFAS. the. T'owai s .Director of building and Codes hnf4rcertzent has recommended
Ti.,wrt Board approval of €bus reiltrestcxl.e trfeskM and
R HI -I EAS the Town Clarks Office published the Notice of pub€ic i,leating in the "lown's
official ncv spap;xand the Local Board of H-4th-duty conducted a public hearing concerning, the
varianra rerun t fin NVindc y, Fcbrilary 1-?`t. X23, and
WHEREAS, the Town Clerk's Office gas.advised that a duty notified all pnili.,:ty owners
within 501) feet Cif the subject N illvdy,
Nf:}tt '2111:MTORE. BE rl'
Rl:'.SOL:VED, that
i. duo to the nature of'the Fariarce, the Local Board. of I3eaith detei'inialas thattile
variances wouldntic he materially detrimental to the purposes aid objectives of this
Ordinance or athcr adjoining properties nor otherwise conflkl.t with the purpose and
objectives ofany Town plan or policy; and
2. th, Local Board of Health: Gads that the'granting of the variamw is aeccssary- far the
real, able use of the land and is the minimum varjuace which would. alievr- die
epu to, unnecessary hardship toand by. the Local board of. ffeAth to affect the
Applicant; and
BE I1 FURf'IiER,
RESOLVED. that the Laical Hoard of Iteaidt llwel v approves the application unite David
Barlow alT a Variance front the Sesvae'e Dislol t )rdinance to allow histatG,non (if a holding tank
rysteut consisting of two (2) hrstdme, tanks each with a uspact of 1,500 gulions:,for a tool] capacity
of 3,00 0 faflont , thus meeting, and escecdiag the iequired total cafucedy, of 2,000 gations; on
property locatedot 22 Ward Late in the:Tgwnof Quecew•bury aul;t7canng 1'µx ]dap \o: 240,6-1-6.,
Di01
g
'Safely,
New
M Call Before You Dig
® Wait The Required Time
FM C f" Ut"1' R
LOCATION MAP
B f1.E1AUILER.
RESOLVED, ,Ain f fi
r
S d the Local Board . f If Sit nether autix,tire; and grants the Applicant
r
2cd taonai t the €o 01 tarn a ewz4 h ire of cotr E t e d' � t Building d - n an ram the Loons ItddtnR �cn t.udt�s
E; i eerie t t) i
n# r n rhea vs set #x)rdrrn Chapter L-, T to urvt;,iL the holding tattle. s rem and ext itds rite
date on which the $2 000 escrowdeposit die Applicants previously deposited with d Twv ti he
taltofflat alty farfeit d to .be Town until June 3, 2023 and auatx.rixes and directs. the Director
of Budding and -Lodes Enforcement to take any and all actions necessary to effeetune the terms
oftld, Resolution, and
RESOLVED, fhar the premises shall not be colmd for rental purposes until lie holding
tank system has been installed as coiifittned by the Director of Dail' and Cafes-ISlrfr)rieniCM,
aced
131 1 f FURT1-1EIZ,
Rl?SOLVFD, that excess excavated material shalt be placed so as to comply with the ten
foot (10' j setbac:.k. telloholvelit, and
BE IT FUR.11'fBR,.
RESOLVED, that the Town: Board authotims mid directs the Tocvn C.Icrk to forward by
certified mail a certified Copy of this Resolution ice die .Adirondack Park- 'ivency (APA) -::ir its
review, and
BE.-Il' FU'M ILI:R,
RFSOLtiED, that Uis appwvai Resolution shall not be efYeotic°e until 30 days after such
noliee to the ,kPA. and. shillbe subject it, review, be the PA.durinr such peri;x#,
Duly adopted ibis. I3i6 day of Februally, 1003 by the follcxving vote:
AYIN Nlr- Metivier, Mr. ,I r r 4iir.Feroce, Mr, McNulty, ibfr. trough
NiOES None
ABSENT: stone
1, Cnllecn Rathbun, ly°poty Town Clerk ofthe e Town ct[Quuuisburg; Warren County, tNm York,
do hereby comity= that -I have compared the foregoing with the original esolnuort as listed above
adopted at a rv�(utar rnect#n:; o#' i}te Tnwn Board of the l onn of Quecnsbur'v held on the 0" day of
lebrosrs 2033, ze which a quorum was present and tfiaF the same is. a correct transcript there#�#i'om
and ofthe whole original. the.reofto date.
Eh7 SV1MESS "fldE ERE. I have hereto sot my:hatedand the SEAL ofsaid.Town of Queansbuiy.
this 1 �4" day of February, 202.i,
SEAL SIGNER
=n Rxibbuu
C_oopy
Town Cterk
of'Qu caburt•
TOWN OF QUE
BUILDING & C
Reviewed B .
Date. -
b
TAX MAP # 240.6-1 -6
ALTERATION OF THIS DOCUMENT EXCEPT BY A LICENSED
PROFESSIONAL ENGINEER IS A VIOLATION OF NYS EDUCATION LAW.
on arm ity esponse 1 ISSUED FOR SEPTIC PERMIT
M Respect The Marks
R Dig With Care 0 ISSUED FOR WASTEWATER VARIANCE
800.962.7962
www.d'egsafelynewyork.com N O. R e v i s i o n s
HOLDING TANK PLAN
IWDRAS R. prepared for
Dave Barlow
MAP REFERENCE: 22 Ward Lane
,. �p. �~:
BASE MAP INFORMATION FROM MAP OF SURVEY
_ !} Town of Queensbury, Warren County, New York
� �. �����' :��
OF LANDS OF DAVID BARLOW AND JAMES BARLOW 9> F- Drawn: TRC Checked: GTH Scale: 1"=20'
ON WARD LANE" IN THE TOWN OF QUEENSBURY, �y
WARREN COUNTY, NEW YORK. DATED NOVEMBER 169 Haviland Road
`tom Queensbury, NY 12804
16, 2022, PREPARED BY WILLIAM M. CURRAN ALTERATION 0 � CUMENT EXCEPT
PROFESSIONAL LAND SURVEYOR. BY A LICENSED PROFESSIONAL ENGINEER (518) 745-0307 Phone
IS A VIOLATION OF NYS EDUCATION LAW. Hutchins Engineering, PLLC (518) 745-0308 Fax
4113123
12122122
Date
Date: 12/14
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