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PT-0406-2023 Property Transfer Sewage Disposal Information Form Date: • I0 a3 Town of Queensbury 742 Bay Road,Queensbury,NY 12804 P:518-761-8256 www.queensbury.net a.6felf I v\�cKe r (Name of Owner/Applicant) Re: Onsite Wastewater Treatment System Inspection Information Request for: / GOYh Lane @ueehs,o - J J\fY IZRo� (Site Address for Inspection) O 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 1st of the current, or following year (whichever comes first), a map locating the septic system and payment totaling $2275 ($2000 refundable deposit plus $275 permit fee). The deposit is forfeited if the owner fails to complete the repairs or installation as stated above. If you have any questions, please call. Phone: (518) 761-8256 Email: kated@queensbury.net Thank you. ECEOWEB Sincerely,. N JUL 10 2023 TOWN OF QUEENSBURY / "x BUILDING&CODES John O'Brien, Director Building and Code Enforcement Town of Queensbury Property Transfer Packet Revised July 2022 Office Use Only n Permit#: '— ®v\O b- it lu Toren of C2Lrecniblry Fee:._$ tb — 742 Bay Road,Queensbury,NY 12804 P:518-761-8206 or 518-761-8205 Invoice#: www.queensbury.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: 1 q. gOnn Lane ( uc ens4vry,,IV Y Tax map number: 2.2./. V r --1-15 / Property owner: Qa,Nett 3 h/�n kupiker Mailing Address (c/s/z): 3'1 /t('S4J . AS Al G11 j N 1 !2a�- 1 ,�` Cell #: �I� 2-PR - � Land Line#: Email: ®arr°L. '�rueckPf '�yoJioo a coil, Applicant (if different than above): Mailing Address (c/s/z): Cell#: Land Line#: Email: ❑ Proposed Owner ❑ Realtor ❑ Attorney ❑ Other (explain: ) Septic Contractor: ban g 1 Mailing Address (c/s/z): Cell #: )e_2 6a'6"I I 1 Land Line#: Email: Reason for Inspection Request: ❑ On the market ❑ Future listing ❑Sale Pending ' 1 Deed Transfer [' Other: Property Transfer Packet Revised July 2022 HOUSEHOLD INFORMATION **PLEASE SEE SEPARATE PAGE FOR EXEMPTIONS** # Bedrooms ti # Bathrooms 3 # Kitchens 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: Are all system components wholly within the property boundaries? XYes ❑ No Are system plans available? Yes ❑ No Does the system(s) serve multiple properties? ❑ Yes 1 No If yes, describe Maintenance: Service agreement? ❑ Yes ® No; If yes, business' name Date of last inspection N/A Date tank last pumped N/AN Frequency of pumping N/A VI List known repairs/replacements, with dates: Date Type of Repair/Replacement Operation: • System problems? ❑ Yes a No • Sewage odors? ❑ Yes A `I7 No • Direct surface discharge(s)? ❑ Yes No • Back-up of toilets? ❑ Yes No • Back-up of any other fixtures? (e.g. slow drains) ❑ Yes )4 No • Seasonal ponding or breakout of leach field? ElYes A No Property Transfer Packet Revised July 2022 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 30% of the fee is retained by the Town of Queensbury. Signature of property owner or authorized agent: Affiliation: II owner 0 agent ❑ other: Please print name: �a rr r -kuecke Signature: Date: F3/JO/'z3 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 PROPERTY TRANSFER SEWAGE DISPOSAL INSPECTION LETTER Satisfactory Compliance Notice Town of Qyccnsbury Building&Codes Enforcement 742 Bay Road,Queensbury, NY 12804-5902 P: 518-761-8256 www.gueensbury.net Date: 27 September 2024 To: Tyson Ruecker and Garrett Ruecker (Applicant) Re: System Inspection Site Report for: 14 Gunn Lane, 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 from27 September 2024, the date of the inspection. Sincerely, A John O'Brien, Director Budding & Codes Enforcement Town of Queensbury /kd Revised August 2023 4 BE MI-F7EM44rR F/ELD 70 6e CONNECTED 7O CAMP /N TKEFUTURE. SET TKEKCN 8o)TOM AT fZ' MAX BEZO J trx 1ST1w qa (7eAz7E dz \aa � _ +)1' � 2 ••'�, BAR / r —_� f\ SANE '! ,/^ f'ROPERIy UHE )D. 1', 74 ..//✓✓/!!! O �� 6FLLE.V�. tp�`\`a �� \t N\ 11 it \•\ \ 1 ' �'�\\` } J.y ilB PL U4 'PVC FOR / AlYAR7SELi _ ON 7d CAMP 2"PYC J4(r-40 a. `•, \ \ t i \ 1 a\ 3 r .t[E MAA•L !N lDENCE •�O x! yugNC# JJ/NG Van Warta" Bny 1 9� / P ' e 1 Xiddte j B y K.Mk y Bay (aeeeraak'..r.. y Po,m / / Saady Bay ;ROrkhn,a Speak Hack � . E PROJfff ' oc�ROA ,,�tis .7rvE2T etLtleFF _ AQpUNO �EY.O 250 �R 1 aya, NOTE0"1" 7D R VP CJJAMBEK. �.� `•�\ � � 396 4'JOL/O PYf JOK -SS "` _ o c J l 1 Cr r oYC SDK 35 6 i __ 1 LIUTC/BUT/DA/ BOT O %Q�FT 6— SCOPE I ` 'lyPI�;AL ALL HEACEMS) a LOCRTION MAP Ira w5p F c::f D vG \ 3 MEs fe. FOQCEjA ,41 ''PETANCNES lGJF o ¢76 ) b , /.. = ZOOo' _ EACH S a-, �'q C"i �ininenferpnses,nr_a Lri ILUO `L IS:aI faYtlH Grp 1 ,- - �� \' January 2,1909 _ _ esouiter 6 nccormack j ,-`- __[' a_ _�__�__ U.v6gaz3•: ne,xtold.aysorrdsarze<loeafeC. ot Nun.Tt Y. • 31 INBope3York. Road, m o[ 4ue0nsbrY• LL 08 l, mb ,SN On Oecee[ :9.198R 3 eksoloed )soil .at pits eith C.T. Nacy CW MQ you ® _ ^ I r � [row i staff. Li scatloe beai• my obs0[vations: • +�yi � al TPa 6 // topsoil inches, ioam s nay sanm [arcs a nenes y tine d, mottllnq s t 28 llcnes l'_ GPNQI' N�f OF GE,PALL) J F/EtvETT "+ OTHER LANO,}' OF nIT` ,2UECKEQ m TPR 9 • )O f /�' n1V ' o - nines, copao[i J L L n -6] mines, fine a'ndy I.I. REP[ACE PAPEMENr nfrr /"= 20 PLI,PCOL.AT/ON Tf,YT TP0 -09 i-t— enpapll 2-3�LAYEPJ LV' NYJO TYPE 3 B/NOIR - - EX/JT/N6 f14YEME , I /✓L EXTEND CAS/NG 5' BEYOND .Eb1qDW4y JY/.P14C6 TAO,f000NLY MACH E M/N/MUM �l I i � o� '• a ' COYE,Q R=:'>•�o 'so"e•".� G"JIX'ELY/LE 40 -MME-1 CASIAW (A-1 l 0 � a "a °'�D 3 %0,'.b � 2"P✓l.tr"NEDULE af0 ' !! .,; FCkrE MA/N qP l[s4TE E �\ m �! 6 .H/N/MUM 6PgYEL dE G • ,GOADWAY C)205,YIAI'6 �fT4/L OWai ,a X71,Fu "V fA,CTN � %B n f/1/fL FA,Sff �CNf/lL � �4 ,L• f _ l ffjf t'M1a J/j ro 1lt°dIAACD 6lAVFt ,� t,x. a.w 0� ��Ui(NEO �raNE 4 MIu (/pVGrIUDIWL Jfrr/Du cao� f Soo Nov rcr-roN. F/.V/JN GRADE w4ii D/STUreBEO Ae..fvr .PEPLACE •! FMCE M QP/G/,U,4L CRUO/T,1JN. OR AS PEgUlR£D / MCU141 T TOR �� COU1PA/N FRosr J2 a UFrfFT.f.PR 07CC710AI I6 OV£K P/PE TN4RDU6NLy�MPACIf� ", sN� ; �;i�,`}�P/PF CCENIJ 5AND 1�� tr /r 60•PIOVIEO P/AF Tv�icQ� T )[dCH DETP1 L a LOCATION DEPT/a d7146/ULEO.PA7-Z- ? -lt In<nes. Sear loam moccl ine starts It to inches .l-BO Inches, illy illy loam AS J//OWN 21" /"//S 4fL3y. TPp • : a - 8 Inches. topsoil pERCOLATTON 7FJT BY- a 26 incbes, Ioawy [ine sans, mnetlrny :tarts It zs l�inea 'r6 JRMES E NUTCN/NS', P E. ON' /1�0.9�92 26 inches, silly lily loam Te. 12 o 15 inehesr topao53 Inc .5-36 bes, fine nay loam 36-69 Inches, loamy till sa ad. mottling seares at 55 loth— l�fJ/G/V DATFI T46 " 0 - 6 [nine[, top•o1e 6 -3o in<n•s, fins s oar to L.i'J/GN JYJTEM FOR 4AELJeOOA1S roe) '; 3oa0 cones, Italy rim vans, mottling starts at 51 cocoas PBQ NYJ DO.//. APPENO/X 7-5,A ? Ter u (SIOI.LAR TO LCi PC ,PEGULAT/ON,f } I o -ly Inches• tupeail LJEJ/6N FLOYV� j 31-ya rncnes, rim aanay 1 m In -To lninea, loamy rina s.na. wcu in9 •tare• at ss lnenea A.SJU.NE NEW JTA,V0.4RO F/XA%PES, � i[ It. na a any ynest ions azmt the abova soli tnformatlon. ol•aae f�-1Gf— totacr me. 3 0 GALLON�M/MUTE GPM) FAUCETS �.L .THOWE,PHEAQl'AND /G GALLON PE,Q !.![�-'�"�'4•�'/4""` FL UJ:V TU/LET 11-/XTU.PE.3'. cnarlea 9, xa1rQ soil se wnt tse DES/C,V FLOW= 4BK x L3O SPD/CR I DES/GN FLOW • 520 7,PD I MA P ,PfFf:efIVCE' NE/TIlz,e G,POUNOWATE,e we A,YJ7T1/.U4 ENCOUNTE,PEO. •MAP OF LANDS Of HARRY ,PUECKER • � DATED APR/L 2G� /988 A.t'ci L/!JT USE JTANOARD 4OJt Ar1ON TRENCH REY/JE17 ON ,jEPTEMBEQ 25 /992. PE,PCOLAT/ON RATE ° r.SMLUUTEJ//NCH MADE BY O9611.7.eR �S M<COeA44C.4. APPL /C.HT/ON RATE = O B GPO/SF f7BJO.PPT/O.V WeW = 520 CP0/0,6 FJBJORP770N •9R'EA= 6.50 JF /t j� J•fT41 / (� FIB.iO,PPT/ON TRENCH = 650 Sf 2SF LF i IT f )DZ �t,J\ // L fav7l 1V/ L / /y L J l F/dSO,PPT/ON TpENC'H 325 LF T.PENCH USE .5 LATE,PALJ 65 = 3Z5 iT T?ENGV. W4STfW4TfR DEs161V f� /,�q,e/ey ,pvEcxE,e LE: JFS NOTPD DRAWN BSa �CcL4%./ Tout? OATEN �E'C. /2, /992 �Orr¢n tJJ 7%Sr% J r (¢1(A V/Vl'� C'NECC'ED 6Y: JG ,<�/ c7gm(7s �. �Ncr�fc�irrl✓s, p� 2 © AV S/ 5/94 JT.N. 4paq-T'CLND SykFO / U 'QW/'vC' I 1 a/re/9z JO LOCATEOTESrA& AO. /I j99 %?bt1I tSfree% Abl-MLM- �, �• ✓" 92' OG9 - 2.EVISION DATE LiY COMMENT ro / . 1 rr. 21 /1 21 2r w 47 ! t7 L o i✓1� J e - - - `\ TpErJN O/- OUE1N,1'BUR.Y, T.4rr MAE JECT,OrJ NO. /2 T.1 _W.P _.D. P.DPE.T} ... 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