PT-0048-2022 Property Transfer Sewage Disposal Information Form
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Town ofQucectsbury FEB 1 1 2022 ate:
742 Bay Road,Queensbury,NY 12804
P:518-761-8256 www.queensbury.net TOWN OF QUEENSBURY
BUILDING&CODES
(Name of Owner/Applicant)
Re: Onsite Wastewater Treatment System Inspection Information Request for:
(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 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 Is' of the current, or following year (whichever comes first), a map locating the septic
system and payment totaling$2275 ($2000 refundable deposit plus$275 permit fee). The deposit is forfeited
if the owner fails to complete the repairs or installation as stated above.
If you have any questions, please call.
Phone: (518) 761-8256 Email: kated@queensbury.net
Thank you.
i
Sincerely,
David Hatin, Director
Building and Code Enforcement
Town of Queensbury
Property Transfer Packet Revised April 2021
_ �n Office Use Only I
E C E Q �J E Permit#: �—Qo
D I
'Toren of ry c Fee:_$ o� 02 7 �, � C7
742 Bay Road,Queensbury,NY 12804 FEBFED �0 � {I ! c
P:518-761-8206 or 518-761-8205 Invoice#:
www.gueensbury.net TOWN OF QUEENSBURY
BUILDING&C.OI'�=. '
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: !7 ������ ��� � '' 1<czx-ct/ 619--
Tax map number: ��01 L/��1 24
Property owner:
Mailing Address (c/s/z):
Cell #51EI Land Line#:
Email: ��� ex��foE�C-:°s��ai�..Cc� '1
Applicant (if different than above):
Mailing Address (c/s/z):
Cell #: Land Line#:
Email:
❑ Proposed Owner ❑ Realtor ❑ Attorney ❑ Other(explain: )
Septic Contractor:
Mailing Address (c/s/z):
Cell #: Land Line#:
Email:
Reason for Inspection Request:
❑On the market ❑ Future listing ❑Sale Pending w' Deed Transfer ❑Other:
Property Transfer Packet Revised April 2021
HOUSEHOLD INFORMATION
"PLEASE SEE SEPARATE PAGE FOR EXEMPTIONS"
# Bedrooms 7- # Bathrooms I # Kitchens_j_ Jacuzzi tub(s) 0 Garbage grinder
Onsite Wastewater Treatment System:
How many systems are on the property?
Year systems) installed: Tank Size of Septic Tank 1000
Type of Absorption System:
Are all system components wholly within the property boundaries? [Z/Yes ❑ No
Are system plans available? ❑ Yes ❑ No
Does the system(s) serve multiple properties? ❑ Yes 52/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 ❑
List known repairs/replacements, with dates:
Date Type of Repair/Replacement
i
Operation:
System problems? ❑Yes E!r No
Sewage odors? ❑ Yes No
Direct surface discharge(s)? ❑ Yes [/No
Back-up of toilets? ❑Yes [;a, No
Back-up of any other fixtures? (e.g. slow drains) ❑Yes ZNo
Seasonal ponding or breakout of leach field? ❑ Yes EJOIN0
Property Transfer Packet Revised April 2021
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:
Affiliation: [/wner ❑agent ❑ other:
Please print name:
Signature: Date: 0Z/1/2Z
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 Re\ised April 2021
EXEMPTION CONDITION OPTIONS
Due to one of the conditions listed below, I am requesting an exemption from the
Septic Inspection Upon Property Transfer by the Town of Queensbury:
PLEASE CHOOSE ONLY ONE CONDITION BELOW IF YOU ARE REQUESTING A WAIVER
❑ The property to be sold or transferred will not be inhabited, and the new owner plans to demolish the
existing structure. In order to qualify for the exemption, a notarized affidavit must be submitted to the
Building and Codes Enforcement Office stating that the dwelling will not be inhabited and that it will be
demolished with no immediate plans to rebuild or the dwelling will not be inhabited, it will be
demolished and rebuilt, in which case the affidavit shall be accompanied by a site plan, including
adequate detail to demonstrate a lawful OWTS,together with a check payable to the Town of
Queensbury in the amount of$2,000. Such funds will beheld in a non-interest-bearing escrow account
and will be released, in the former case,upon issuance of a demolition permit and, in the latter case,
upon issuance of a certificate of compliance from the Building and Codes Enforcement Office. If the
Property Transfer inspection is not completed within that 6 (six) month timeframe,
the $2000 will be forfeited.
❑ An OWTS inspection was not able to be completed prior to the conveyance of real property due to
inclement weather. In order to qualify for the exemption, a notarized affidavit from the new property
owner to complete the requisite OWTS inspection within six months of the date of the conveyance of
real property, or June 1,whichever comes first, must be filed with the Building and Codes Enforcement
Office. A check payable to the Town of Queensbury in the amount of$2,000 will be held in a non-
interest-bearing escrow account and shall be released upon the completion of a satisfactory OWTS
inspection from the Building and Codes Enforcement Office. If the Property Transfer
inspection is not completed within that 6 (six) month or June 1' timeframe, the
$2000 will be forfeited.
The property to be sold or transferred contains an existing OWTS that does not comply with the
provisions of this article, and the prospective purchasers and/or the Seller wish to forgo an inspection
in favor of installing an approved OWTS within six months of the transfer of property. In order to
qualify for the exemption, a notarized affidavit must be submitted to the Building and Codes
Enforcement Office stating that the existing OWTS will be replaced within six months from transfer of
property. The affidavit must be accompanied by a site plan, including adequate detail to demonstrate
that the replacement OWTS will comply with this article, together with a check payable to the Town of
Queensbury in the amount of$2,000. Such funds will be held in a non-interest-bearing escrow account
and will be released upon issuance of a certificate of compliance from the Building and Codes
Enforcement Office. If the Property Transfer inspection is not completed within that 6
(six) month timeframe, the $2000 will be forfeited.
Property Transfer Packet Revised April 2021
❑ During the OWTS inspection, a failure of the septic system was determined. Due to winter and
frozen conditions, the repair to an existing OWTS could not occur or a new OWTS could not be
installed before the conveyance of real property. In order to qualify for the exemption, a notarized
affidavit from the new property owner to complete the installation or repair of the septic system within
six months from the date of the conveyance of real property, or June 1, whichever comes first, must be
filed with the Building and Codes Enforcement Office. A check payable to the Town of Queensbury in
the amount of$2,000 will be held in a non-interest-bearing escrow account and shall be released upon
the completion of the repair or installation of a new septic system and a satisfactory OWTS inspection
from the Building and Codes Enforcement Office. If the Property Transfer inspection is not
completed within that 6 (six) month or June 1st timeframe, the $2000 will be
forfeited.
❑ There is a record of a septic system inspection upon property transfer permit and inspection completed
and passed within the last three years. Please provide a copy of this record.
PLEASE READ NOTICE THOROUGHLY:
Failure to complete the inspection, obtain the permit or complete all repairs/installations
identified in the preceding subsections of this section within the time provided or any subsequent
deadline established by the Building and Codes Enforcement Office will result in forfeiture of the
moneys-held in escrow, and the Town may use such funds toward abating the conditions caused
by each such violation of this article.
Inspections must take place within one (1) year of submission of a completed application.
Inspections scheduled to take place after the one year period will be subject to submission
of a renewal application and payment of the renewal fee based on the current fee schedule.
***ONLY SIGN THIS PAGE IF YOU ARE OPTING FOR A WAIVER REOUEST!!***
I have read and understand the above notice regarding the expectations and possible forfeiture
of moneys submitted to the Town of Queensbury for an exemption request.
Seller:
Print Name:
Sign Name: Date:
Bu er:
Print Name: M Cic4awor
Sign Name: Date: 02 d
Property Transfer Packet Revised April 2021
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;- PROPOSED
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CARDONA RESIDENCE
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APPLICANT: �
STEVEN CARDONA
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Primerlux LLC SHEET TITLE:
COVERSHEET
17 Honeysuckle Ln
Property Transfer -- WAIVER SHEET N0. 1 3
SOIL DATA _
THE FOLLOWING SOIL ANALYSIS DATA WAS PREPARED BY THE SHORE caLawr
PZ __ WATER SUPPLY SHORE OOLONY/
ENVIRONMENTAL DESIGN PARTNERSHIP ON AUGUST STH,zOs,. ne T�., LAID: WATER
o�e' TOPSOIL _` ee jry 1` SUPPLY
6=1B' ORANCEISFI BROWN SILTY SAND L��'l• e
le 24' DARK FIRM SILTY SAND,SOME CLAY .-J41•0'CURREN ` ALO IXISTING LEACH FIELD,
GROUND TWAATER OBSERVED AT zs'CH LINE AT 22' S'sb4�E ,i� .°, N CONTRACTOR TO REMOVE
REMNANTS AND DISCARD OFF SITE .w ¢9`=
Sete Z z,•'fry
o=6' TOPSOIL O f2'LMIP (�r�
6'-16' DARK FIRM.SILTY SAND,SOME CLAY
EFFLUENT OBSERVED AT TO- (3f J<a a�-.TtLI / °'"" R�Foul d
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D'B' TOPSOIL / /Z' Y... ` r- .....•.••!5 �. i W! 'SS
6'-2D' LIGHT BROWN SILTY SAND Lands N Of nwT1/.r• l
2O'-JO' DARK BROWN FIRM RL TY SAND,SOME CLAY Jonathan 30R7h'Bodenhom (2j / at 'J �/ N a
NO SEASONAL HIGH GROUND WATER OBSER4ID / / nm.• ��- '�"�/ 5 O SHORE'COLONY/ LL N N
PERtnIAnaN RATF SHORE COLONY l fff--- R`�' '< v / TZ'•' o LAKE WATER In a a
PERCOLATION RATE ESTABLISF2D AT A DESIGN RATE OF 6-7 M/NVTNCTL WA TER SUPPLY / Jos 1'Pk I 'I h f n in SUPPLY LL }
THE ELEVATION Or THE FIELD WILL MAKE IT AN AT GRADE ,� I 4�wJ/2 I 01) �' t III Q o
SYSTEM.PERC RATE ESTABLISHED IN UPPER HORIZON SOILS .} 42 W
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1'PW f HousE I Copped Iron W U N
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55981280 t I"+c, m a
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CONDITIONS
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. .._ ..............._........ .iiii�: 1'INCH=.;30 FT,.:.:':::
VARIANCE REQUEST: ` � E
Ir av y
THE FOLLOWNG VARIANCES KERE GRANTED BY WE TOWN OF OUEEN5BURr CONSOLIDATED BOARD ra1�.NaY NOTE. �\ !� _.•ry\A1 1��
OF HFALnL• h/ NO NEIGHBORING WELLS WITHIN 100'OF q�•.j{ `'CG
V-1r WASTEWATER ABSORPTION FIELD TO Kfll 60'REQUESTED VS THE 100'REQUIRED p tl PROPOSED WASTEWATER SYSTEM ^• ��.,�
V-Z TANK TO FOUNDATION!T REQUESTED VS. THE IO'REOU6�D �� T 1, To 13EG WATER SERVICE LINE
TO BE RELOCATED {+,
V-S WASTEWATER ABSORPTION FIELD TO FDUNDAnav/O'REQUESTED VS THE 20'REQUIRED rle, L CONTRACTOR TO COORDINATE
V-Q WASTEWATER ABSORPTION FIELD TO PROPERTY LINE 5'REQUESTED VS THE f0'REQUIRED ,:l'ne WITH ENGINEER AND TOWN
s ; 1
11 EIJEN GSF TRENCHES7�.. :.�
WAS WA R ABSORPTION FI D D SI.AI CALCULATIONS: -3H E 4? > TOTAL 16 MODULES Z
WE PROPOSED ABSORPTIGN FIELD WAS DESIGNED IN ACCORDANCE WIN'NVSDON APPENDIX
7S4 A-NEW YORK GSF DESIGN MANUAL AS FOLLOWS '-•"^�. .1�� g
O• TKO' DISROIBlfTION BOX
DESIGN V-4 PERCOLATION RATE-6-7 M!N/TN t.-.-,----'....�.."�••'. ff
TOTAL BEDROOM COUNT-3 4�PVC SOR-S5 ...... .c-_..•...
DESIGN ROW-FID/WL/DAY/BR EFFLUENT SEWER AT
IID X 3-330 GAL,NAY 112"CULVERT PIPING TO BE r W ~
APPUCATI RAIE-1.0 GAL/DAY/SF• PLACED WITHIN DRAINAGE DITCH, b'/FT MIN SLOPE N`
REQUIRED TRENCH LENGTH-56 LF CONNECT TO EXISTING CULVERT 2 n 71SCeJ a
.Z.MODULES PER SYSTEM=14 TOTAL UNDER PINE TREE LANE O N N N
PROPOSED MODULES PER SYSTEM-16 TOTAL.64 LF IN LENGTH W N'
FILL AREA TO BE A y 0
GRADUAL SLOPE TO MEET V-z 0 c 1,250 GALLON PRECAST
EXISTING GRADE,NEW •� < CONCRETE SEPTIC TANK
•y I Y {- W Q N
WASTEW CULVERT TO CARRY 1CT
OF SYSTEM - HAS/S DESIGN DRAINAGE SWALE �W 1 9 V-3 � Z N Z nl
RF /ATD/T�• TOWN OF OUMII SSURY p - ' W C.) N Q
p 1 STOR ��n 4'PVC SDR-35 c C no
DESIGN STANDARDS NEW YORK STATE DEPARTMENT OF HEALTH(HTNY APPENDIX 75-Aj WASTEWATER TREATMENT fD 9 - WOOD FR BUILDING SEWETi AT C 7 z
STANDARDS-INDIVIDUAL HOUSETIOLO STST .. fO R ff=13 }'/FT MIN SLOPE W ` a
TOWN OF DUEENSBURY ORDINANCE-CHAPTER 136.SEWERS AND SEWAGE DISPOSAL-PART I.ON-SITE SEWAGE Z � > W Q
DISPOSAL SYSTEMS I O D
1 V-1 CONTRACTOR TO N XX
coNss r F A 1,250 THE PROPOSED WASTEWATER SYSTEM TO By SERVE THE THREE(J)SHALLOW
AB RESIDENCE SNAIL PROVIDE W LL Q z
CON57ST OF A 1.250 GALLON PRECAST CONCRETE SEPTIC TANK-BY GRAVITY T A SHALLOW ABSORPTION ELJEN �I\ 1 DISINFECTION UNIT ON a
TRENCH DESIGN. CONTRACTOR SHALL PRONG£uV DISNFECTION UNIT[1V THE WATER SUPPLY LINE WATER SUPPLY LINE. 2 q
PRn.c�FT ONRAIF• BASED ON A THREE(3)BEDROOM COUNT AND NYS DOH STANDARDS FOR POST/TIDY WATER \ LOCATION TO BE FIELD — Q
SAVING FIXnlRES®IID GALLONS PER DAY PER BEDROOM, THE AV£RAOE DAILY FLOW(ADF)IS J30 GALLONS SHOULD 1_TSBQ' R LOCATED U
HOUSEHOLD FIXTURES NOT BE OF THE'LOW FLOW TYPE MANUFACTURED SINCE 1SB1 THEN THE FIXTURES SHALL BE I�) � Z
REPLACED AS NEEDED. THIS FLOWRATE DOES NOT INCLUDE THE USE OF A GARBAGE GRINDER(NOR IS ONE W W J
RECOV66NDED)OR A HOT TUB/SPA. ADDITIONAL FLOWRATE MUST BE INCLUDED IN THE DESIGN SHOULD EITHER OF \ N
THESE CO 1.61ENTS BE PART OF WE HOUSE DESIGN.
gfZRtN W cYSTEM: THE ABSORPTION SYSTEM IS DESIGNED AS A 64 LF TRENCH CLWFIOURATION OLS-ERSAL OQ- COVO SLAB /
SYSTEM N17H TWO(2)LATERALS. LWTH 8 ELJ N GSF MODULES. 16 ELEN GSF MODULES IN TOTAL,64 LF TOTAL FILL k'\ Y H
SOILS(OUEENSBURY RED 01RT)SHALL BE IMPORTED TO CREATE A SUITABLE SOIL TRANSITION TO THE NATIVE SOIL. CONTRACTOR TO LOCATE
EXISTING DRAINS AND RE
INTO 12'ADS N-12 00 \ 1 U) Z }�'
FES W/STONE RIPRAP 1\a O n a
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Lest 1"=30'
nu L Q SHEET TITLE.
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FNIM GRADE CLEW BAGI6IIL
12'MN. B•TOP SGL W/VEGEfATI E
PROPER GRADE
MNAGE COVER `~_•`,��
REMOVABLE . Te am TAm AnwTW IooO•u a 12'MIN ��APPROXIMATE
COVER n .. ... GUOE •7+t'
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SDNDARD NOTES
`�\�; ,fi;,��;^. } �`,,JJ+•✓�.� `,.��. l,�•,' �• `�.�';:,.:....��,�r.. '•
'. .. 1 UNDERLYING0mPERCOLATION lace '�` � '\ ,��\•,5*'%�%`�\'`�yi\r `F�i\"�/� __ r ro� `I�
aml'am w.1a oRAYi AMU 033 SAND 4 NN •. _ '••-'^•11
..'..,. ...... REFER TO NOTE 11 ix..- .,L!y,'
12•MIN 36•UK SEPARATION TO UYHNG _
f DRIOHS OR RESTRICTIVE STIES L' .•.... •��W�..
PRECAST QISTRIBLJTION BOX
NOT TO SCALE TYPICAL GSF CROSS SECTION A—A'
Nor TO--- 0 a a
LL N D•
1 Q N
PERFORATED ASIY CT3 �• f
48. SNYO Z N Z'w
BOX(SE z
BDK csEErBELL) `/ Z r / LLJ QDISTRIBUTION m O
_ k'ow FOAL DAENfATAN Sm PLAN G. P�� 1^L Q Z
AFD QtANM r-r (L o
R
IENOTI AND MODULE NV AS PER SYSTEM DESIGNTYPI
lL UI
CAL ELJEN TRENCH SYSTEM �{ U
Lu LLB
Nor TO SCALE r NI
_ Q N
•Ixnl �— 0 I,N
x
pi{ WFlFX12,I!S U) }
wIA.A >m 9AR•�
FINAL CBIDE •onlANs AVIIE ma O m Z C
TOP o..,,,,yy.. ._.....«.'w-n W Z F v
A•DA PERLORUTEO NP - wcos 6.ROQtG Fl�REMOVED) 1,250 GALL SEPTIC TANK X,W Z o
HOLES B k T O'CLOCK NOT TO SCALE r^ 0 d
.+' U a
qD-TEXTILE COVER pV0 PR65fIRE O }LL
BNNI NG STRIPS BISTRBUDGN uTERAL FlLL SYSTEMS STANDARD NOTES: O Z O W Ts
A IN 11iS GSE MHERE lES15 EVR HIGH GROUNDWATER DETFRONATIM OR SOL PERCOLATION TESTS PROVE THAT THE QUALITY AND DEPTH 0 Z o
OF FINAL SOW IS INADEQUATE FOR AN INSTALLATION,A FILL SYSTEM WHY BE UTILIZED,PROVIDED THE FOLLOWING SPEUFIGTIONS ARE
YET..FINAL APPROVAL OF FILL SYSTEMS SHALL NOT BE GRANTED UNTIL THE FILL S IN PLACE AND THE SYSTEM EVALUATED ACCORDING TO nn V I- O
ELIEN GSF UNIT PR THE ApDN6IRATNE PROVISIONS OF THIS ORDINANCE LL C
B. THE DESIGN AND INSTALLATION OF A FILL TKNB`LL MSIEM SHALL COMPLY WIT THE FOLLOWING SPMnC T3
AMU C33 CONCRETE SAND A 1. THOIE MUST MEAT LEAST TMo(2)FEET OF NATURALLY OCCURRING SOIL(THREE(3)FEET WITHIN IN FF OF TAKE GEORGE)OVER AN RECORD OF WORK DATE BYI
l
i� IIIIS MARL- /
2 THEE MNA)ONUY MILL ON T EXISTING OF NATURAL MADE
OR SURFACE DEB SLUFF FOR BUILT-LIP LEAVES.
STRESS ND O BE TEN((ID))PERFFSH C
3 RWHENEMOVED
EDPLACINGPRIOR
FILL ON TOP E EIT Or GRADE ORGANIC DEBRIS,INSOL PLOWED
LEAVES,ROOTS,AND OTHER Fi/NJ7 FORTES,SFIA11 HE d
0•MIN. THE SO PRIOR N THE.SALTDAEBE OF THE FILL AND MY NATURAL COIL PLOWED LOAMY
MY SAND. J
4. THE SOL 115m FOE FILL.SHALL BE WELL OR CLAYS
LOAMY SAND.ING OR WELL GRADED IS OR O SO GRAVELS,AND SHOULD CONTAIN( W
YWHESM OF TWELVE(12)PERCENT SILTS OR CLAYS TO NC NO ORGANIC DEBRIS T A SIX 5)MO LARGER THAN THREE(3)
INCN6 IN DIAMETER AND -S FILL SINE BE AL SHALL E STABILIZE10MIN MINUTES
I FOR AT IFAR SIX(B)MONTHS OR BE MECHANICALLY
Y
3' 6•YIN. COI�CIENT ILL M RAZE INSTALLED
FILL O ENSURE
A MI BE t OF THREE
(PER INCH. U
A SUFFICIENT FILL MUSE BE HIS lPA TO FN MUST
A MINIMUM OF TEET WITHIN FEET BETWEEN ANY TRIENCH BOTTOM A/A WTDIUNN HIGH N
A' FI ONLYSEASONALABSORPTION
BS RPTIGROUNDWATER.FIELD THIS SEPARATION USED MIST L ACHIN(FA FEET STAIN 100 FEET OF U110:fEORGE SCALE: d
8. ONLY A9 L OR SULL SrBE USED AS THE D ABOUT FACILITY FILL
N FILL SYSFEMIS
HE
I. FROM SAND U PROVIDE M CONFIRM TAN 7. A CWWNEL RF DIVERSION AND SHEET
W SHALL O PLACED ABOUT THE FlLL SYSEN IN THE UP-SLOPE DIRECTION AND OF SUFFICIENT LQlG1N N.T.S.
3' S IAL HIGH G STRATA,BEOtOCK,O2 TO DINER SURFACE TURD SHEET WATER RUNOFF MWFA THE FILL SYSTEM.
FROM SAND SUPPUFIN TO CONFIRM gA3@UL HR31 DiAlR10VATER B THE TOP OF THE FILL OVER THE LEACHING CRAG FACILITY LOPE BE CROWNED OR SLOPED 1)NEON NATURAL SURFACE RUNOFF,AND SFl]1FD.
COMPLNNCE WITH C33 SPECIFICATION 9. SIDE SLOPES OF THE FILL SNAIL BE GRADED TO A SLOPE NOT STEEPER THAN ONE(i)VORTICAL ON THREE(3)HORIZONTAL UNLESS SHEEP TITLE:
RETAIN CO BY A OR SiAALL IE ORDERED BY SOURCE
PIT A
10. THE CONTRACTOR SHALL ERNRRI'THE SOURCE PR FOR HE FILL SOILS AL THAT THE ENGINEER CAN PERFORM I THEN PERCOLATION m
ELJEN /,SE CROSS ON TESTS(2 OWN,)TO CONFIRM THE OONPWNfE OF THE FILL SOIL ALL TESTING SMALL BE COMPLETED AND THE ENGINEER SHALL WASTEWATER z
VJ ISSUE A LETTER OF CONPUANCE BEFORE ANY SOL IS BROUGHT TO THE SITE. THE PERCOLATION FUTE OF THE FILL SOILS SHO L BE IN DETAILS p
!qT TO SCALE THE G 10 MINUTES/INCH RANGE
11. THE CONCRETE SNA USED N THE INSTALLATION OF THE EVEN GSF ABSORPTION FIELDS SHALL BE DRAWN FROM A PIT THAT WILL
PROVIDE A LETTER CERTIFYING THAT THE SAND MEETS THE SPECBTCTONS FOR THE REQUIRED ASTN CM CONCRETE SAND. 2
SHEET NO.
4
r,
February 11, 2022
Affidavit for Exemption
To:Town of Queensbury Building and Codes
Property Location: 17 Honeysuckle Lane, Lake George NY 12845
Steven Cardona,sole proprietor of Primelux llc. Wish to forgo an OWTS inspection in favor,of installing
a brand new OWTS within 6 months of the notice of violation dated January 19, 2022
Respectfully
Steven Cardona
Primerlux llc.
MARIA A. GAGLIAFt®I
Notary Public,State of New Yoh
No..01 GA6061460
Qualified in Warren County
Commission Expires July 16, �✓�
RESOLUTION APPROVING STEVEN CARDONA'S APPLICATION FOR
SANITARY SEWAGE DISPOSAL VARIANCE AND EXTENSION OF
TIME TO COMPLETE WASTEWATER SYSTEM IMPROVEMENTS
RESOLUTION NO.: BOH 13,2022
INTRODUCED BY: Mr. Timothy McNulty
WHO MOVED ITS ADOPTION
SECONDED BY: Mr.Anthony Metivier
WHEREAS, Steven Cardona(Applicant) filed an application for variances from provisions
of the Town of Queensbury On-Site Sewage Disposal Ordinance Chapter 136 to install a
replacement wastewater system with certain of its components to be located as follows:
1. Wastewater Absorption Field to be 68' from the well instead of the required 100'
setback;
2. Tank to be 8' from the foundation instead of the required 10' setback;
3. Wastewater Absorption Field to be 10' from the foundation instead of the required
20' setback; and
4. Wastewater Absorption Field to be 5' from the property line instead of the required
10' setback;
on property located at 17 Honeysuckle Lane in the Town of Queensbury, and
WHEREAS,the Town Clerk's Office published the Notice of Public Hearing in the Town's
official newspaper and the Local Board of Health duly conducted a public hearing concerning the
variance request on Monday,February 28fi`,2022, and
WHEREAS, the Town Clerk's Office has advised that.it duly notified all property owners
within 500 feet of the subject property, and
WHEREAS, Town Code Chapter 137 requires inspection of Onsite Wastewater
1
Treatment Systems (OWTS) prior to the sale of certain real property and provides that a $2,000
escrow deposit will be forfeited to the Town in the event that completion of a wastewater
treatment system meeting all standards is not completed within the time provided as established
by Chapter 137, and
WHEREAS, a change of deed for the Applicant's property occurred on or about
November 21, 2021 and when the required property transfer septic inspection took place, it was
found that the existing wastewater system was deficient; however, the proposed new system is
not able to be completed within the required six (6) month time period due to the time of year
and timing of permitting, and
WHEREAS, the Applicant has therefore applied for a timeline extension or until July 19'',
2022 to install the system and to extend the date on which the $2,000 escrow deposit he
previously deposited with the Town shall be automatically forfeited to the Town, and
WHEREAS, the Acting Director of Building and Codes Enforcement has recommended
Town Board approval of this requested extension,
NOW,THEREFORE,BE IT
RESOLVED,that
1. due to the nature of the variances, the Local Board of Health determines that the
variances would not be materially detrimental to the purposes and objectives of this
Ordinance or other adjoining properties nor otherwise conflict with the purpose and
objectives of any Town plan or policy; and
2. the Local Board of Health finds that the granting of the variances is necessary for the
reasonable use of the land and are the minimum variances which would alleviate the
specific unnecessary hardship found by the Local Board of Health to affect the
Applicant; and
BE IT FURTHER,
RESOLVED, that the Local Board of Health hereby approves the application of Steven
Cardona for variances from the Sewage Disposal Ordinance to install a replacement wastewater
system with certain of its components to be located as follows:
1. Wastewater Absorption Field to be 68' from the well instead of the required 100'
setback;
2. Tank to be 8' from the foundation instead of the required 10' setback;
3. Wastewater Absorption Field to be 10' from the foundation instead of the required
20' setback; and
4. Wastewater Absorption Field to be 5' from the property line instead of the required
10' setback;
on property located at 17 Honeysuckle Lane in the Town of Queensbury and bearing Tax Map Nos:
226.19-1-23,24,25, and
BE IT FURTHER,
RESOLVED, that such variances are contingent upon the well and water supply located on
the premises having a working UV disinfection system at all times, and
BE IT FURTHER,
RESOLVED, that the Local Board of Health further authorizes and grants the Applicant
additional time to obtain a certificate of compliance from the Town's Building and Codes
Enforcement Office as set forth in Chapter 137 to complete installation of the replacement
wastewater system and extends the date on which the $2,000 escrow deposit the Applicants
previously deposited with the Town be automatically forfeited to the Town until July 19"', 2022
and authorizes and directs the Building and Codes Enforcement Office to take any and all actions
necessary to effectuate the terms of this Resolution, and
BE IT FURTHER,
RESOLVED, that the Town Board authorizes and directs the Town Clerk to forward by
certified mail a certified copy of this Resolution to the Adirondack Park Agency for its review, and
BE IT FURTHER,
RESOLVED, that this approval Resolution shall not be effective until 30-days after such
notice to the Adirondack Park Agency and shall be subject to any lawful action by the Adirondack
Park Agency during such period.
Duly adopted this 28 h day of February,2022,by the following vote:
AYES: Mr. Ferone,Mr. McNulty,Mr. Strough,Mr. Metivier, Mr. Freer
NOES: None
ABSENT:None