PT-0452-2021 Property Transfer Sewage Disposal Information Form
Town of Quccnsbury
Date: lo. 10 •21
742 Bay Road,Queensbury,NY 12804 (1 r. � a---._a_
P:518-761-8256 www.queensbury.net ( III(...JJJi cy
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1 Brnan
.1UN 11 2021 I
Name of Owner/Applicant) LOW
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Re: Onsite Wastewater Treatment System Inspection Information Request f OF QuE.EP iSaG—Y
ISO & OOZES
Privo le, !Cr) i i) QUCerbbtvq
(Site Address for Inspection) J
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$275 permit fee). The deposit is forfeited
if the owner fails to complete the repairs or installation as stated above.
If you have any questions,please call.
Phone: (518)761-8256 Email: kated@queensbury.net
Thank you.
Sincerely,
("" 4,44
David Hatin,Director
Building and Code Enforcement
Town of Queensbury
Property Transfer Packet Revised April 2021
Oft\ Office Use Only
Permit#: FT.-0A`D2-2 2
Timm of Qiicensbury Fee:_$ 2-1-5
742 Bay Road,Queensbury,NY 12804 eZ
P:518-761-8206 or 518-761-8205 Invoice#: U(121—
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: Prii/ai cL. g I , L111, undo(,r IciCkyzycic,deickg
Tax map number: 24D.9 - I -(?
Property owner: ni1ol'15'. 1 (1I10 Ir !.
E [))
Mailing Address(c/s/z): 34- Sara 1Ifpc( OI('11vi lie, Nl( 11302 JUN 11 2021
Cell#: MA - Land Line#:
TOWN OF CCU ENSBURY
Email: BUILDING& CODES
Applicant(if different than above): Cii�1
Mailing Address(c/s/z): 240 -h a Y1 fl}f(CG J d, Tvo9 Il(&'
Cell#:(510)P59.046,1 Land Line#:
Email: I ' /•COM
IX,Proposed Owner Realtor ❑ Attorney ❑ Other(explain:
Septic Contractor: I do not hau-e, Sephc COI'i f yc c-t- k
Mailing Address(c/s/z):
Cell#: Land Line#:
Email:
Reason for Inspection Request:
❑On the market ❑Future listing pale Pending ❑Deed Transfer In Other:
Property Transfer Packet Revised April 2021
HOUSEHOLD INFORMATION
**PLEASE SEE SEPARATE PAGE FOR EXEMPTIONS**
#Bedrooms 5 #Bathrooms 3 #Kitchens I Jacuzzi tub(s) Garbage grinder Q
Onsite Wastewater Treatment System:
How many systems are on the property? k
Year system(s) installed: Tank 7. Size of Septic Tank .?
Type of Absorption System:
Are all system components wholly within the property boundaries? [ Yes D No
Are system plans available? 0 Yes pi No
Does the system(s) serve multiple properties? ❑ Yes No
If yes, describe
Maintenance:
Service agreement?0 Yes JNo; If yes, business' name
Date of last inspection N/A 0 Date tank last pumped N/A 0
Frequency of pumping N/A 0
List known repairs/replacements,with dates:
Date Type of Repair/Replacement
Operation:
System problems? ❑Yes itSt No
• Sewage odors? 0 Yes No
• Direct surface discharge(s)? 0 Yes 63' No
• Back-up of toilets? ❑Yes No
• Back-up of any other fixtures? (e.g.slow drains) ❑Yes Ifj No
• Seasonal ponding or breakout of leach field? 0 Yes No
nonC rcpcfMat
Property Transfer Packet Revised April 2021
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 20%of the fee is retained by the Town of
Queensbury.
Signature of property owner or authorized agent:
Affiliation: ❑owner Qagent [other: Buy(
Please Please print name: WOW Sfl t3 i O 1 J
• J •
Signature: ( ALi'Y, Date:
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 April 2021
RESOLUTION SETTING PUBLIC HEARING ON SEWAGE DISPOSAL
VARIANCE APPLICATION OF MORGAN STRITSMAN
RESOLUTION NO.: BOH 75,2021
INTRODUCED BY: Mr.Anthony Metivier
WHO MOVED ITS ADOPTION
SECONDED BY: Mr.Harrison Freer
WHEREAS, the Queensbury Town Board serves as the Town's Local Board of Health and
is authorized by Town Code Chapter 136 to issue variances from the Town's On-Site Sewage
Disposal Ordinance, and
WHEREAS, Morgan Stritsman (Applicant) has applied to the Local Board of Health for
variances from Chapter 136 to install a replacement wastewater system with certain of its
components to be located as follows:
1. Wastewater Absorption Field to be 71' from the well instead of the required 100'
setback;
2. Enhanced Treatment Unit to be 4' from the foundation instead of the required 10'
setback;
3. Pump Tank to be 3' from the foundation instead of the required 10' setback;
4. Wastewater Absorption Field to be 11' from the foundation instead of the required
20' setback; and
5. Wastewater Absorption Field to be 7' from the property line instead of the required
10' setback;
on property located at 19 Private Road#1 off of Cleverdale Road in the Town of Queensbury,
NOW, THEREFORE,BE IT
RESOLVED, that the Town of Queensbury's Local Board of Health will hold a public
hearing on Monday, December 6th, 2021 at 7:00 p.m. at the Queensbury Activities Center, 742 Bay
Road, Queensbury, to consider Morgan Stritsman's sewage disposal variance application
concerning property located at 19 Private Road #1, Queensbury (Tax Map No.: 240.9-1-6) and at
that time all interested persons will be heard, and
BE IT FURTHER,
RESOLVED, that the Local Board of Health authorizes and directs the Queensbury Town
Clerk to publish the Notice of Public Hearing presented at this meeting and send a copy of the
Notice to neighbors located within 500' of the applicant's property as required by law.
Duly adopted this 15th day of November,2021,by the following vote:
AYES : Mr. Ferone,Mr. McNulty,Mr. Strough,Mr. Metivier,Mr. Freer
NOES : None
ABSENT: None
ENVIRONMENTAL DESIGN
PARTNERSHIP LLP 900 Route 146 Clifton Park,NY 12065
' (P)518.371.7621 edpllp.com
Shaping the physical environment
December 1, 2021
Mr. Dave Hatin ,1- bk`jZ- ICI2A
Director
Town of Queensbury Board of Health
742 Bay Road
Queensbury, NY 12804
Regarding: Stritsman Residence- 19 Private Road#1
Property Transfer Replacement System Extension
Dear Mr. Hatin:
On behalf of the applicant, Morgan and Evan Stritsman, we respectfully ask that the 6-month period for
installation of an engineer designed replacement wastewater system be extended an additional 6 months.
This would extend the deadline for a replacement system to June 1st 2022.
Based on the Town property files, the existing wastewater system was inspected June 17th of this year and
failed the inspection at that time. The applicant is actively working towards replacing the existing septic
system,an application for wastewater variances has been submitted will be before the Town Board seeking
approval on Monday December 6th 2021. Assuming that approval is granted, the applicant will submit an
application for a septic permit and plans to begin construction in April of 2022, weather permitting.
Please do not hesitate to reach out to me if you have any questions or concerns. Thank you for your
consideration of this request.
Sincerely,
•
Nicholas Zeglen, P.E.
Environmental Design Partnership
cc:
ENVIRONMENTAL DESIGN
-\Alk • PARTNERSHIP, LLP. 900 Route 146 Clifton Park,NY 12065
(P)518.371.7621 (F)518.371.9540 edpllp.com
Shaping the physical environment
May 25, 2022 /�
9 000 YC '.•..�F`�'ll;? Ili:
Town of Queensbury Building &Codes
742 Bay Road �' I
Queensbury, NY 12804 1-4
Attn: John O'Brien, Director
g.17-hif3 3 3 LqJ
Re: Stritsman—19 Private Road#1 (Cleverdale)
Dear Mr. O'Brien:
In compliance with application approvals granted by the Town of Queensbury I offer the following regarding
the referenced project.
The design plans, prepared by this office, reviewed and approved by the Town as associated with the
wastewater system application, are as follows:
Proposed Wastewater Improvements For Stritsman Residence
19 Private Road#1 Town of Queensbury
May 3rd, 2022
Sheet CS-1 Cover Sheet i
Sheet S-2 Existing Conditions I I 7J
Sheet S-3 Wastewater Plan
Sheet S-4 Wastewater Details
Sheet S-5 Enhanced Treatment Details
During the course of construction Environmental Design Partnership LLP was on the job site to observe key
components of the system installation culminating with the 'start-up' of the pump assembly and control panel
system on May 24, 2022. I have provided an 'as-built' plan which indicates the system component locations.
The pump system was tested/inspected on May 20th with the pump and alarm working as designed. The
time-dose control panel was programmed for operation and the Owner was provided basic operational
guidance.
Based on my inspection of the system installation it is my opinion that the wastewater system is in
compliance with the intent of the approved design plan and is ready for operation.
Sincerely,
Nicholas Zeglen, P.E.
Attachment
Cc: Morgan &Evan Stritsman
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TOWN OF QUEENSBURY TAX MAP. No. 240.9-1-6 900;Rqute 146`Cliftor''PaFk';�NewY_o`rk 12068
N N N o WARREN COUNTY, NEW YORK OCTOBER 21,2021 .(`�113),371-7,621 j 1 jJI,;J//,j,!�i''.-edpllp:com
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