PT-0008-2019 EXISITNG SEWAGE DISPOSAL SYSTEM APPROVAL LETTER
f
Tawn of Cyeensbury
742 Bay Road,Queensbury, NY 12804
P:518-761-8256 www.gueensbury.net
Date: 29 April 2019
To: Estate of John Lynch
(Applicant)
Re: System Inspection Site Report for:
70 Bay Pkwy., Lake George, NY 12845
(Site Address)
As requested, I have 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:
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.
Please see the attached System Inspection Findings Worksheet and System Sketch for inspection details.
Sincerely,
David Hatin, Director
Building & Code Enforcement
Town of Queensbury
Building&Code Enforcement January 2019
ECEOWER
Office Use Only
-? D 1Permit#: p J — l � 1
r(n„i 4 cZeit'en Shin JAN 10 2019
742 Bay Road,Queensbury, NY 12804 Fee: Z5 -60
P: 518-761-8206 or 518-761-8205 www.queensbMAIN OF QUEENSBURY Invoice#: 714
BUILDING&CODES
SEWAGE DISPOSAL SYSTEM INSPECTION INFORMATION
Individual Residential Wastewater Treatment System
Property and Owner Information: (Please attach property survey or tax parcel map)
Property address: C7 I i k we f
Tax map number: ))-Co k\�^ - l
Property owner: C)-C c..
Mailing Address (c/s/z): kTh \el t nA V C()I c S F L I Ll 13
Cell #: `a \ Land Line#:
Email: fG'b; �S,Se� w�� 1,Ccv,-'
Household Information:
# Bedrooms L l # Bathrooms # Kitchens
Onsite Wastewater Treatment System:
How many systems are on the property? 1
Year system(s) installed: Tank 1' ) Size of Septic Tank \7
Type of Absorption System: (�-, � �;� �� ,� Yam, .. tvlouAd
Are all system components wholly within the property boundaries? \,,Aires No
Are system plans available? es No
Does the system(s) serve multiple properties? Yes L-!No
If yes, describe
Maintenance:
Service agreement? Yes V No If yes, vendor name
Date of last inspection N/A Date tank last pumped N/A
Frequency of pumping COL C \_( e c CS N/A
Building&Code Enforcement January 2019
r
) Property Transfer Sewage Disposal Information Form
Town of Queensbury
742 Bay Road,Queensbury,NY 12804
P:518-761-8256 www.queensbury.net
Date: i /,/,20/
To: r_ c \ _.J--Dr,,:, : t —
(Name of Applicant)
Re: Onsite Wastewater--
asst'ewater I ( (�k{�Treatment System Inspection Information Request for:
)U.--- f
(Site Add ess)
Thank you for requesting an inspection for the onsite wastewater treatment system 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 advance information to us about the site. Prior to our inspection, we request
information regarding the property and the onsite wastewater treatment system (septic system) on that
property. We also would like to confirm property access and that pre-inspection system preparation 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 prior to scheduling an inspection. Following completion of the inspection, you will be sent a System
Inspection Site Report. The System Inspection Information Request and the System Inspection Site Report are
standardized forms used by the Town of Queensbury.
Please note the Town of Queensbury's fee for this service is $250. Be advised that all fees for services must be
paid prior to the site inspection. If you have any questions, please call. You may FAX or email the completed
Septic System Inspection Information form back to us.
Phone: (518) 761-8256 Fax: (518) 745-4437 Email: kated@queensbury.net
Thank you.
Sincerely,
(---- auspi k......
Dave Hatin
Director of Building and Code Enforcement
Town of Queensbury
Building&Code Enforcement January 2019
List known repairs/replacements, with dates:
Date Type of Repair/Replacement
Operation:
• System problems? Yes
• Sewage odors? Yes VNo
• Direct surface discharge(s)? Yes C/No
• Back-up of toilets? Yes t121v
• Back-up of any other fixtures? (e.g. slow drains) Yes 4/
• Seasonal ponding or breakout of leach field? Yes o
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.
I agree to be responsible for inspection fee payment.
Signature of property owner or authorized agent
Please print name: e C S
Affiliation: owner Vent
Signature: Date: ciLLIA7___
Prior to scheduling with the Town of Queensburv, 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 tank, expose d-box, expose any seepage covers.
Building&Code Enforcement January 2019
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INSPECTION WORKSHEET (PTI-000294-2019)
PT-0008-2019Permit Management
Case Number:Case Module:
01/16/2019Partial Pass
Inspection Date:Inspection Status:
Dave HatinProperty Transfer Inspections
Inspector:Inspection Type:
226.15-1-24
Job Address:Parcel Number:
70 Bay Pkwy
Lake George, NY 12845
Contact TypeCompany NameName
ApplicantDavies and Davies Real Estate
Primary OwnerEstate of John Lynch
Checklist ItemPassedComments
Weather/lack of information/inaccessibilityFalse
1/16/18 need to exposed outlet of tank and dig inspection hole in
mound system
Capacity in gallonsFalse
System/components indicate unacceptableFalse
Is there a high water alarm?False
Concrete tankTrue
Temperature (Fahrenheit)True25
D-box materialFalse
Apparent structural damageFalse
Visible scum layerFalse
Septic tank (include # of tanks)True1250
Number of tank compartmentsFalse
Plumbing fixtures tested & confirmedTrue
Metal septic or leech tank or cesspoolFalse
System appears undersized/undersized componentsFalse
Is there evidence of surface water infiltratingFalse
Tank coverFalse
System appears to have functioned adequatelyFalse
Metal tank (automatic failure)False
Does the pump(s) appear to be operating properly?True
Surface discharge? (if yes, to where?)False
Sand filterTrue
Leaching bedTrue
Outflow line invert above leach line invert(s)?False
Depth below grade to top of tankFalse
Evidence of prolonged high liquid levelFalse
Access riser? (if yes, depth to cover)False
Inlet baffleFalse
Recommend upgrade/expand/replace 1+ componentsFalse
No treatment tank/other critical component(s)False
Number of drop box(es)False
Mound systemFalse
Test each fixture flow to septic tankTrueverified all fixture go to septic tank
November 30, 2020Page 1 of 2
INSPECTION WORKSHEET (PTI-000294-2019)
Checklist ItemPassedComments
Liquid level AT/ABOVE/BELOW (one) discharge invertFalse
Are both switch and alarm operable?False
Ejector or grinder pump sealedFalse
Outlet baffleFalse
WeatherTruesnow, cloudy
Main tank cleanout size and locationFalse
Evidence of liquid above outlet inverts?False
Plastic tankFalse
Seepage Pits: NumberFalse
Dosing or pump tank sealedFalsedosing pump station
Absorption fieldFalse
Cracked, corroded or deformed?False
Cracked, corroded or deformed?False
Raised systemTrue
OtherFalse
OtherFalse
Are there any obvious electrical shortcomings?False
Water tight tankFalse
November 30, 2020Page 2 of 2
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