2024-0111 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: 15 November 2024
To: David Hornberger
(Applicant)
Re: System Inspection Site Report for:
142 Sunnyside North, 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 from15 November 2024, the date of the
inspection.
Sincerely,
A
John O'Brien, Director
Budding & Codes Enforcement
Town of Queensbury
/kd Revised August 2023
Timothy W. Wales, P.E.
68 Waterview Drive
Saratoga Springs, New York 12866
Tel: (518) 703-2480
October 1, 2024
Horriberger Residence
142 Surinyside N
Queensbury, NY 12804
Re: Sewage Disposal Slwteiti-Engineer Is Cerlijication
142 Stinitysitle N, TIO Qt4venshur y
Mr, I lornberger
The construction of'a replacement sewage disposal system for the above referenced location, Tax #279.-2-2 has
been completed. The installation was completed by.IBSSeptie&Drain Service.
As the engineer of record, I certify to the Town of Queensbuty as follows:
I. I am in fact the designer of the system.
1 1 an) personally familiar with the actual site,conditions and in consideration of those conditions the system
was designed in compliance with the Town of' Qiieensbuq standards I'UjUiring two feet of separation
between the bottom ofthe absorption trench and the annual lngh-Nvatcr table and Part 75A of the New York
State Department of'I lealth Sarfltar-; (ode,
3. Wales Engineering staff', under my direct supervision, inspected the systern at the time of construction and I
have perional knowledge that it was Constructed in compliance with the design. There were no field
variations that were encountered during construction which inay have deviated front the conditions
observed at the time the system was designed,
4. Wales l"Aigineering prepared an asbuitt plan (see attached)depicting the septic systeiv as it Was COnStrUCtCd,
including the appropriate measurcrnents, Leach field to building strUcture and any neighboring wells to the
new disposal systern. Inspection was Performed on June28,2024.
lfyreaU have any questions or require additional information,please contact ine at your convenience,
Sincerely,
"Firuotby W. Wales,PE
Lise. 4077263
(P
o ov ded
Sewage Disposal Field
4 "ceerals 0 40'
91-1 V"
in
24.
13.6 2
100
ExWdng septic tork and
i staft to wMng deposal
i across the road.
Nok
THE AS-BUILT DIMENSIONS SHOWN WERE TAPE MEASURED DURING CONSTRUCTION WITH ACCURACY
SUITABLE FOR OWNER'S USE. THESE ARE NOT SURVEYED DIMENSIONS.
Wales Engineering
scale.111=50, Consulting Fluonmir
Hornber er Residence
142 Annyaide N
If/0 Queensbury- Warren County- State of Now York
Date: November 10,2024 As-Built Septic Site Plan FIgure,I
Timothy W. Wales, P.E.
CONSULTING ENGINEER
68 Waterview Drive
Saratoga Springs, New York 12866
Tel: (518) 703-2480
October 1, 2024
Hornberger Residence
142 Sunnyside N
Queensbury,NY 12804
Re: Sewage Disposal System-Engineer's Certification
142 Sunnyside N, TIO Queensbury
Mr.Hornberger
The construction of a replacement sewage disposal system for the above referenced location, Tax #279.-2-2 has
been completed. The installation was completed by IBS Septic&Drain Service.
As the engineer of record,I certify to the Town of Queensbury as follows:
1. I am in fact the designer of the system.
2. I am personally familiar with the actual site conditions and in consideration of those conditions the system
was designed in compliance with the Town of Queensbury standards requiring two feet of separation
between the bottom of the absorption trench and the annual high-water table and Part 75A of the New York
State Department of Health Sanitary Code.
3. Wales Engineering staff,under my direct supervision,inspected the system at the time of construction and I
have personal knowledge that it was constructed in compliance with the design. There were no field
variations that were encountered during construction which may have deviated from the conditions
observed at the time the system was designed.
4. Wales Engineering prepared an asbuilt plan(see attached)depicting the septic system as it was constructed,
including the appropriate measurements. Leach field to building structure and any neighboring wells to the
new disposal system.Inspection was performed on June 28,2024.
If you have any questions or require additional information,please contact me at your convenience.
Sincerely,
of N94,
� s'e
Timothy W. PE Wales, c ^w u'
Lisc.4077263 �z
077265
QFESS: p
f �
—- Property Transfer Sewage Disposal Information Form
Town of CZec bury.
742 Bay Road,Queensbury,NY 12804 Date: 51 l 2--0'
P:518-761-8256 www.queensbury.net
DR\rt0 1--\ RrSBERC'�E�
(Name of Applicant)
Re: Onsite Wastewater Treatment System Inspection Information Request for:
�LVz_ ,•401 0A6‘‘)E- Ong
(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 scheduling an inspection with the Town of Queensbury, we require the following:
• this completed application
• a site map indicating the location of the septic components
• the pre-inspection preparation (see the last page of this packet) is completed prior to our arrival
• the appropriate fee(s) are paid: $275.00 (an additional $2000.00 refundable deposit, if you are
requesting a waiver)
• the appointment date/time that your septic hauler is scheduled to pump out your tank. We require 48
hours notification prior to scheduling our inspection.
If an exemption is requested, 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)
• the map locating the septic system
• payment totaling$2275 ($2000 refundable deposit plus$275 permit fee). The deposit is forfeited if the
owner fails to complete the repairs or installation as stated above.
If you have any questions, please call.
Phone: (518) 761-8256 Email: kated@queensbury.net
Thank you.
Sincerely, C EI \E'
MAR 07 2�2�►
TOWN OF QUEENSBMY
'" OINO 8,CODES
John O'Brien, Director — —,�
Bu9ding and Code Enforcement
Town of Queensbury
Property Transfer Packet Revised September 2023
Office Use Only
- Permit#: 2024— \��
Town of(irecnabury Fee:_$
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 I-M. t
Tax map number: ZT9w fl 7 ,---
Current owner: 94F to
Mailing Address (c/s/z): 4Rr 1?•4 g--v-
Cell #: ;5 —616_—ZgB8 Land Line#:
Email: Vieen e,s-ab�i rneuk , I
Applicant (if different than above): PI�F
Mailing Address (c/s/z):
Cell #: Land Line#:
Email:
❑ Proposed Owner ❑ Realtor ❑ Attorney ❑ Other (explain:
Septic Contractor: VbSL
Mailing Address (c/s/z):
Cell #: Land Line#:
Email:
Reason for Inspection Request:
❑On the market ❑ Future listing ❑Sale Pending IN Deed Transfer ❑Other:
Property Transfer Packet Revised September 2023
HOUSEHOLD INFORMATION
**PLEASE SEE SEPARATE PAGE FOR EXEMPTIONS**
# Bedrooms 2- # Bathrooms Z. # Kitchens Jacuzzi tub(s) r Garbage grinder
Onsite Wastewater Treatment System:
How many systems are on the property? I
Yea s� y3`t m(s) installed: Tank rOtOSize of Septic Tank Type of Absorption System: FtE 7
Are all system components wholly wit n the property boundaries? Es ❑ No
Are system plans available? Yes El No
Does the system(s) serve multiple properties? El 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 ❑ ae-2
List known repairs/replacements, with dates:
Date Type of Repair/Replacement
Operation:
System problems? El Yes K,o
• Sewage odors? ❑ YesVd/o
• Direct surface discharge(s)? ❑ Yes o
• Back-up of toilets? El Yes
• Back-up of any other fixtures? (e.g. slow drains) El Yes ►�o
• Seasonal ponding or breakout of leach field? El Yes PA No
Property Transfer Packet Revised September 2023
Statement of Acceptance of Conditions:
I 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 one (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: ❑attorney ['agent* ❑other (specify):
Please print name: .Z4i / �
Signature: Date: 3 7'- 2 V
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.
*see Agent Authorization signature page
Property Transfer Packet • Revised September 2023
Timothy W. Wales, P.E.
CONSULTING ENGINEER
68 Waterview Drive
Saratoga Springs,New York 12866
Tel: (518)703-2480
October 1,2024
Hornberger Residence
142 Sunnyside N
Queensbury,NY 12804
Re: Sewage Disposal System-Engineer's Certification
142 Sunnyside N, T/O Queensbury
Mr.Hornberger
The construction of a replacement sewage disposal system for the above referenced location, Tax #279.-2-2 has
been completed. The installation was completed by IBS Septic&Drain Service.
As the engineer of record,I certify to the Town of Queensberry as follows:
1. I am in fact the designer of the system.
2. 1 am personally familiar with the actual site conditions and in consideration of those conditions the system
was designed in compliance with the Town of Queensbury standards requiring two feet of separation
between the bottom of the absorption trench and the annual high-water table and Part 75A of the New York
State Department of Health Sanitary Code.
3. Wales Engineering staff,under my direct supervision,inspected the system at the time of construction and 1
have personal knowledge that it was constructed in compliance with the design. There were no field
variations that were encountered during construction which may have deviated from the conditions
observed at the time the system was designed.
4. Wales Engineering prepared an asbuilt plan(see attached)depicting the septic system as it was constructed,
including the appropriate measurements,Leach field to building structure and any neighboring wells to the
new disposal system.Inspection was performed on June 28,2024.
If you have any questions or require additional information,please contact me at your convenience,
Sincerely,
Q.o��lt 1V, ey�Q\
�t y /
Timothy W.Wales PE
Lisc.k077263 �2
66 077w Sri'
I...-"----\ 1
I.
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wooded I — —
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\-
-1( Sewage Disposal Field
Z I / - 4 laterals e' 40' I
--J-- I Distribution Box
it \ \
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. ��CIO,'sepoio '(-„,...._________/- a i i , I i I
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'-drive garage 20'
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hausa ��., - / Uo.. \i \\
.1, \ J . 50°-
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iii Existing septic tank and pump
1 station to existing disposal area I
i across the road. I 1
' I
IleCe #
a l
1 ii 1
NOV 1
AS BUILT 2024 1
j 81.1ILO NG&�NSsuAl,
iopt-tz S
Note: .
THE AS-BUILT DIMENSIONS SHOWN WERE TAPE MEASURED DURING CONSTRUCTION WITH ACCURACY
SUITABLE FOR OWNER'S USE. THESE ARE NOT SURVEYED DIMENSIONS.
Wales Engineering
Scale:1"=S0' Consulting Engineer
Hornberger Residence
142 innytude N
TiO Queensbnry-Warren County-State of New York
As-Built Septic Site Plan
Date: November 10,2024 Figure 1