Wastewater Report900 Route 146 Clifton Park, NY 12065
(P) 518.371.7621 edpllp.com
Date: April 8, 2022
To: Mr. Craig Brown
Zoning Administrator and Code Compliance Officer
Town of Queensbury
742 Bay Road
Queensbury, NY 12804
Re: Existing Wastewater System – 3 & 5 Antigua Way
Dear Mr. Brown:
At the request of Joseph Gross, owner of the property located at 3 & 5 Antigua Road., I have been asked to
provide a Septic System Certification as per the requirements of Zoning Ordinance – Chapter 179-3-040A
(5)(e). Based on review of the files via the Towns database and existing conditions I offer the following.
· On June 3, 1990 the Town of Queensbury received a signed and stamped ASBUILT of the system
consisting of 5-50’ laterals providing a treatment area for a then 2 bedroom house. With modern
plumbing fixtures the area is sized for a 4 bedroom house and can be re used for the proposed
dwelling
· On August 12, 2020 the Town of Queensbury issued a Property Transfer Sewage Disposal Information
Form for previous owner Marilyn Breyo.
· On August 26, 2020 the Town of Queensbury performed an Inspection of the System signed by previous
Zoning Administrator and Code Compliance Officer Mr. Dave Hatin.
· On April 5, 2022 The Environmental Design Partnership performed a site visit for any noticeable blow
outs in the system, there was visibly no issues on the existing septic system.
In compliance with Section 179-3-040A (5)(e) and with information provided by the Town of Queensbury in
August of 2020 there has been no changes to the system, the operating system with adopted standards and
requirements based on the Town’s approvals and issuance of a Signed Inspection Report during the transfer
period. While the dwelling was in place the operating condition of the system was providing satisfactory service
to the residence. This letter shall serve as the septic system certification required for Site Plan Review to
proceed.
Sincerely,
Connor DeMyer
Environmental Design Partnership,LLP
cc: Joseph Gross, Chris Keil
P
CERTIFICATE OF COMPLIANCE
TOWN OF QUEENSBURY
WARREN COUNTY, NEW YORK
Date 7 /2 0 19 6.0
This is to certify that work requested to be done as shown by Permit No. 90-468
has been completed.
Thia structure may be occupied as a sewage alteration
Location
Antigua Road-Plum Point-Cottage
PAUL& BONNIE AARONS
Owner
By Order Town Board
TOWN OF QUEENSBURY
WjeTh C4c(Ekil I
r
Director of Bldg. & Code/E,forcement
BUILDING PERMIT
TOWN OF QUEENSBURY 90-468No.
WARREN COUNTY, NEW YORK O
PERMISSION is hereby granted to
BONNIE & PAUL AARONS
OWNER of property located at
Antigua Road—Cottage Street, Road or Ave.
in the Town of Queensbury,To Construct or place a Sewage alteration
at the above location in accordance to application together with plot plans and other information hereto filed and
approved and in compliance with the Town of Queensbury Building and Zoning Ordinance.
1. OWNER'S Address is
SamePzi
0
2. CONTRACTOR or BUILDER'S Name sP
Mike McLaughlin o
P.
3. CONTRACTOR or BUILDER'S Address D
fl°
4. ARCHITECT'S Name
5. ARCHITECT'S Address
oq
s
6. TYPE of Construction— (Please indicate by X)PZI
Wood Frame ( ) Masonry ( )Steel ( )n
0
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7. PLANS and Specifications
No. Sewage alteration to include 1000 gallon tank and 1000 gallon pump chamber
with 250 feet of tile field with #2 stone at 1 ft depth
8. Proposed Use
Sewage alteration 5
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an
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25.00 92 SID
PERMIT FEE PAID —THIS PERMIT EXPIRES July 17
19CD
If a longer period is required an application for an extension must be made to the Building and Zoning inspector of the
town of Queensbury before the expiration date.)
Dated at the Town of Queensbury this
17th
Day of July 19 90
SIGNED BY 1 }.(ftA/ i&t 2 , for the Town of Queensbury
building and Zoning Inspector
TOWN OF QUEENSBURY , i PI
APPLICATION FOR SEPTIC DISPOSAL PERMIT 6
kDATE:
Ix
LOCATION OF PROPERTY FOR INSTALLATION 416 /./e4
Owner' s Name: <,i / -f-- ae-„,, ,4? % ,.e;
Address: ,o4 7`4
r,a /
629L , Q/,e
Installer' s Name: C .,,, 6 //,' elephone: 6- i-- 9 ''/, .
Jr"`
Number of bedrooms (residential only)
Total daily flow (compute @ 150 gal per bedroom)
Topography: Circle one: Flat Rolling—Steep Slope % of Slope
Soil Nature: Circle one: Sand Looam Clay Other Depth:
Ground Water: At what depth? /L//// Feet
Bedrock or Impervious Material : At what depth? Feet
Percolation test: Circle one: not required required
Rate -Ir;_Min. Per Inch
Domestic water supply: Circle one: Municipal Well Other
If domestic water supply is a, well :
Separation: Water supply from any septic absorption feet.
O .44
PROPOSED SYSTEM: Se tic Tank v d Pc' p J al . (minimum size: 1,000 gal )
TILE FIELD: Each Trench A So . feet/Total system length 5-0 feet
SEEPAGE PIT(S):Number of Size each feet
by feet
Size of stone to be used if, c- /Depth or Thickness / / feet 1-
HOLDING TANK SYSTEM IF REQUIRED
NO. of Tanks Size of Each Gal .
Alarm _system and associated electrical work to be inspected by an approved
agency.
I have read the regulation on the reverse side of this sheet and agree to abide
by these and all requirements of the Town of Queensbury Sanitary Sewage Disposal
Ordinance.
L
SIGNATURE OF RESPONSIBLE PERSON: I D^; Q, DATE: ' J _U'
J
cc
Jown of Queeniurj)
BUILDING .nd ZONING DEPARTM T
Bay and Ha ,iland Road, R.D. 1 B x 98
Queensk•ury, New York 128 1,
SEPTIC DISPOSAL SYSTEM I PECTION
NAMFL4 'f2o vi j
LOCATION
DATE_ 2 NO.
ISOILTYPE - SandIERMITLoam Clay -
Percolation Test 'Require4? YES - NO
Percolation rate 4 Min/ rnch
TYPE of SYSTEM: 1i
Absorption field, `tot length
Length of each trench a'''
Depth of trenches ', If
Size of gravel ' 02.
SEEPAGE PITS{Numbe of)
Size-ft. X ` ft.
Gravel size
PIPING: Size Type
Bldg. to tank a"
r 41 460
Tank to dist. box , 3.2' 1elt, "74
Dist. box to fie]jd/pit ,`
Openings sealed?/ YES NO Partial
LOCATION/SEPARA, IONS:
Foundation to t nk ;i go ft.
Foundation to . sorption /JO ft.
Absorption to , of line /0 ft.
Separation of •its i ft.
LOCATION OF S STEM ON` PROPERTY(circle one)
Front - eari,T Left slide - Right side -
COMMENT
i PLaied.di, -
0,
e-t-- PW
e4-44.
Q
g,,: j heid„„,,,, got, .
E '
0 44, i
SYSTEM SE APPROVED YE N
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Bu -ing I Spector
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Property Transfer Sewage Disposal Information Form
Date:
8/12/2020
Town of Queensbury
742 Bay Road,Queensbury,NY 12804
P:518-761-8256 www.queensbury.net
MARILYN BREYO
Name of Owner/Applicant)
Re: Onsite Wastewater Treatment System Inspection Information Request for:
5 ANTIGUA ROAD, QUEENSBURY, NEW YORK
Site Address)
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$250. 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$2250 ($2000 refundable deposit plus$250 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,
W p
David Hatin, Director
Building and Code Enforcement AUG 1 2O2O
Town of Queensbury TOWN OF QUEENSSURY
BUILDING&CODES
Property Transfer Packet Revised February 2020
Office Use Only
e.--ai Permit#: Fr -9 1c2 20?z
Town ofC eeenibury Fee:
742 Bay Road,Queensbury,NY 12804 2Z
P:518-761-8206 or 518-761-8205 Invoice#:
www.queensbury.net
SEWAGE DISPOSAL SYSTEM INSPECTION INFORMATION
Individual Residential Wastewater Treatment System
Property and Owner Information: Please attach property survey or tax parcel map)
Property address:
5 ANTIGUA ROAD
Tax map number:
239.17-1-2
Property owner:
MARILYN BREYO
Mailing Address (c/s/z):
51 WINDING BROOK DRIVE,SARATOGA SPRINGS, NEW YORK 12866
Cell #: 518-928-2968 Land Line#: 518-581-0626
Email: JJbvt@email.com
PLEASE SEE SEPARATE PAGE FOR EXEMPTIONS**
ousehold I o rm. o 0
COTTAGE o qil. N/' _ YES
dr•• s Bathrooms Kitchens acuzzi us s rba_e gri de
MAIN HOUSE-3 7 1 NO YES
Onsite Wastewater Treatment System:
How many systems are on the property?
2
Year system(s) installed: Tank Size of Septic Tank
Type of Absorption System:
Are all system components wholly within the property boundaries? ®Yes No
Are system plans available? 0 Yes 0 No SOME C
Does the system(s)serve multiple properties? 0 Yes RI No
i
If yes, describe AUG 13 2020 :J
Maintenance:TOBUILDI!au&C 7
t_____
I
ServiceService agreement? 0 Yes ® No If yes,vendor name
Date of last inspection N/A 0 Date tank last pumped N/A 0
Frequency of pumping N/A 0 Every 3-4 Years
Property Transfer Packet Revised October 2019
List known repairs/replacements, with dates:
Date Type of Repair/Replacement
NONE
Operation:
System problems? Yes X No
Sewage odors? Yes X No
Direct surface discharge(s)? Yes X No
Back-up of toilets? Yes X No
Back-up of any other fixtures? (e.g. slow drains) Yes X No
Seasonal ponding or breakout of leach field? Yes X No
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 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 20%of the fee is retained by the Town of Queensbury.
Signature of property owner or authorized agent
Please print name: MICHAEL J.O'CONNOR
Affiliation:
p\{
owner `X agent ATTORNEY
Signature: \\V 1,J U (:'v - Date: 8/12/2020
g
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 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 October 2019
INSPECTION WORKSHEET (PTI-004435-2020)
Town of Queensbury - Building and Codes - Fire Marshal
742 Bay Road - (518) 761-8256 Building (518) 761-8206 Fire Marshal
Case Number:PT-0472-2020 Case Module:Permit
Inspection Date:Wed Aug 26, 2020 Inspection Status:Partial Pass
Inspector:Hatin, Dave Inspection Type:Property Transfer Inspections
Job Address:Parcel Number:5 ANTIGUA RD
Lake George, NY, 12845
239.17-1-2
Contact Type Company Name Name
Primary Owner Breyo, Marilyn
Agent Little, O'Connor & Borie, P.C.
Checklist Item Status
Weather Passed
Sunny
Temperature (Fahrenheit)Passed
65sw
Test each fixture flow to septic tank Passed
Whirlpool tub add 250 gal NA
Garbage grinder add 250 gal NA
Is septic tank sized for bdrms+whirlpool+grinder - If applicable Passed
Leaking water fixtures Passed
Aug 26, 2020 Page (1)
INSPECTION WORKSHEET (PTI-004435-2020)
Checklist Item Status
No
Stormwater NA
Sump pump(s)NA
Foundation drain(s)NA
Roof gutters don't discharge over leach field NA
Roof runoff NA
Other NA
Plumbing fixtures tested & confirmed - for flow and point of discharge Passed
Holding tank (if yes, include capacity)NA
Holding Tank:verify level rises; cap. w/in 250 gal NA
Verify 50% & 90% floats NA
Excavate 18" around,no leach field connected NA
Aug 26, 2020 Page (2)
INSPECTION WORKSHEET (PTI-004435-2020)
Checklist Item Status
Watertight NA
Outlet pipe (automatic failure, if yes)NA
Cesspool NA
Overflow pipe (automatic failure)NA
Septic tank (include # of tanks)Passed
1000 gallons
Concrete tank Passed
Metal tank (automatic failure)NA
Plastic tank NA
Other NA
Aerobic system NA
Type NA
Manufacturer NA
Aug 26, 2020 Page (3)
INSPECTION WORKSHEET (PTI-004435-2020)
Checklist Item Status
Model NA
Service contract (required)NA
Access riser? (if yes, depth to cover)Failed
Install access riser on pump station
Depth below grade to top of tank Passed
6" to 12"
Tank cover Passed
Inlet baffle Passed
Outlet baffle Failed
Need to verify
Liquid level AT/ABOVE/BELOW (one) discharge invert Passed
No
Number of tank compartments Failed
Need to verify
Visible scum layer Passed
No
Main tank cleanout size and location Passed
12"
Aug 26, 2020 Page (4)
INSPECTION WORKSHEET (PTI-004435-2020)
Checklist Item Status
Capacity in gallons Passed
1000
Water tight tank Passed
Cracked, corroded or deformed?Passed
No
Evidence of a pipe bypassing tank Passed
No
Is tank pumped more than 4x/year? - AUTOMATIC FAILURE Passed
No
Dosing or pump tank sealed Passed
Ejector or grinder pump sealed Passed
Does the pump(s) appear to be operating properly?Passed
Is there a high water alarm?Failed
Alarm not working
Are both switch and alarm operable?Failed
Submit certification from Mahoney Alarms
Is there evidence of surface water infiltrating - the pump chamber?Passed
O
Are there any obvious electrical shortcomings? - NOTE: ToQ Code Enforcement Officer is not a certified
electrical inspector
Passed
Aug 26, 2020 Page (5)
INSPECTION WORKSHEET (PTI-004435-2020)
Checklist Item Status
No
D-box material NA
Solids in D-box NA
Number of drop box(es)NA
Outflow line invert above leach line invert(s)?NA
Evidence of liquid above outlet inverts?NA
Sump pump not connected to septic system NA
Water softener not hooked to septic system NA
Cracked, corroded or deformed?NA
Surface discharge? (if yes, to where?)NA
Absorption field NA
Leaching bed NA
Aug 26, 2020 Page (6)
INSPECTION WORKSHEET (PTI-004435-2020)
Checklist Item Status
Raised system Passed
No failure
Sand filter NA
Mound system NA
Seepage Pits: Number NA
Other NA
System appears to have functioned adequately Passed
System/components indicate unacceptable NA
No treatment tank/other critical component(s)NA
Apparent structural damage Passed
No
Evidence of prolonged high liquid level Passed
No
Metal septic or leech tank or cesspool NA
Other NA
Aug 26, 2020 Page (7)
INSPECTION WORKSHEET (PTI-004435-2020)
Checklist Item Status
Weather/lack of information/inaccessibility NA
System appears undersized/undersized components NA
Recommend upgrade/expand/replace 1+ components NA
As-built provided is accurate Failed
Provide as built for tank cover locations
On-site as-built req'd before insp is complete Failed
Yes
Building Inspector Notes Failed
System needs repairs Passed
No
System passes all function testing Passed
Aug 26, 2020 Page (8)
Hatin, Dave