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PT-0384-2022 y Property Transfer Sewage Disposal Information Form Date: Town of Queensbuiy 742 Bay Road,Queensbury,NY 12804 P:51B-7U1-BZ56 V rW.CjUeenSbUrV.net � V Name of Owner-Applicant.) Re: Onsite Wastewater Treatment System Inspection Information Request for: qO (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. Enciosed 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$275 permit tee). The deposit is forfeited if the owner fails to complete the repairs or installation as stated above. If you have any questions, please call. Phone: (518)761-8256 Email: kated@queensbury.net Thank you. Sincerely, r� A David Hatin, Director Building and Code Enforcement Town of Queensbury Property Transfer Packet Revised April 2021 OffirA t Ica Onlu Permit#: riiG n of cl�rec Fee:_$ 742 Bay Road,Queensbury,NY 12804 P:518-762-8206 or 518-761-8205 Invoice#: www.ya.see�o�uiao y.��ev. 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: ;0 L(-,Vo kuf kCegny,, A)Y 1 Z� Tax map number: J a —/ -_&5 Property owner: � f'C\Ij /1 "G'3 � i `` p �� 3c��S Mailing Address (c/s/z): 3k)L ,;W �M_T�I" +' Or7 VGl ' Cell#: 712-(0l L g6go Land Line#: Email: ny (\n JG 6) C.61•coo 10 D CEUVE Applicant(if different than above): JUN 1 7 2022 Mailing Address (c/s/z): Cell#: Land Line#: TOWN OF QUEENSBURY BUILDING&CODES Email: ❑Proposed Owner ❑ Realtor ❑ Attorney ❑ Other(explain: ) Septic Contractor: C_ e0M . Mailing Address (c/s/z): Cell#: '�I� 7q( -310 Land Line#: Email: Reason for Inspection Request: ❑On the market ❑Future listing ❑Sale Pending NrDeed Transfer ❑Other: Property Transfer Packet Revised April 2021 HOUSEHOLD INFORMATION "PLEASE SEE SEPARATE PAGE FOR EXEMPTIONS" # Bedrooms ` # Bathrooms 3 # Kitchens 2 Jacuzzi tub(s)_AL Garbage grinder Onsite Wastewater Treatment System: How many systems are on the property? _ Year system(s) installed: Tank Size of Septic TankSG o Type of Absorption System: 9 1 o—MA T Are all system components wholly within the property boundaries? 14 Yes ❑No Are system plans available? ( Yes ❑ No Does the system(s) serve multiple properties? ❑ Yes -Ca No If yes, describe Maintenance: Service agreement? ❑ Yes 13( No; If yes, business' name Date of last inspection N/A❑ Date tank last pumped oac� N/A❑ Frequency of pumping N/A❑ List known repairs/replacements,with dates: Date Type of Repair/Replacement Operation: System problems? ❑Yes ® No Sewage odors? ❑ Yes 2 No Direct surface discharge(s)? ❑ Yes © No n__1_ ti_•1_i_'1 1�1♦i__ AI.n ♦ Dack-ijP (i LUIICI,r U Tes IVo Back-up of any other fixtures? (e.g. slow drains) ❑Yes [N No Seasonal ponding or breakout of leach field? ❑ Yes 1 No 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 p agent ❑other: Please print name: -� U U U Signature: �. 6 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 1.1 WASTEWATER\APPROVE\Tarrant—System-Components Absorption Field ETU Force Main Purnp Station Septic Tank to Lines Well Lake House In APA-5-16-2022 RESOLUTION APPROVING ROBERT AND JEAN TARRANT'S APPLICATION FOR SANITARY SEWAGE DISPOSAL VARIANCES RESOLUTION NO.: 72022 INTRODUCED BY: WHO MOVED ITS ADOPTION SECONDED BY: WHEREAS, Robert and Jean Tarrant (Applicant) filed an application for variances from provisions of the Town of Queensbury On-Site Sewage Disposal Ordinance, Chapter 136 to install a new enhanced treatment on-site wastewater treatment system with its components proposed to be located as follows: 1. Absorption field toe of fill to be 81' from the westerly well in lieu of the required 100' setback; 2. Absorption field toe of fill to be 2' from the northerly property line in lieu of the required 10' setback; 3. Fuji Clean Enhanced Treatment Unit (ETU) to be 5' from the house_in lieu of the required 10' setback; 4. Fuji Clean ETU to be 7' from the northerly property line in lieu of the required 10' setback; 5. Pump station to be 40' from the Lake George shoreline in lieu of the required 50' setback; 6. Pump station to be 7' from the property line in lieu of the required 10' setback; 7. Pump station to be 4.5' from the house in lieu of the required 10' setback; 8. Force main to be 3' from the house in lieu of the required 10' setback; and 9. Force main to be 43' from the Lake George shoreline in lieu of the required 50' setback; i on property located at 308 Cleverdale Road 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 requests on Monday, May 16th, 2022, and WHEREAS, the Town Clerk's Office has advised that it duly notified all property owners within 500 feet of the subject property, 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 Applicants; and BE IT FURTHER, RESOLVED, that the Local Board of Health hereby approves the application of Robert and Jean Tarrant for variances from the Town of Queensbury On-Site Sewage Disposal Ordinance to install a new enhanced treatment system with its components to be located as follows: 1. Absorption field toe of fill to be 81' from the westerly well in lieu of the required 100' setback; 2. Absorption field toe of fill to be 2' from the northerly property line in lieu of the required 10' setback; 3. Fuji Clean Enhanced Treatment Unit (ETU) to be 5' from the house in lieu of the required 10' setback; 4. Fuji Clean ETU to be 7' from the northerly property line in lieu of the required 10' setback; 5. Pump station to be 40' from the Lake George shoreline in lieu of the required 50' setback; 6. Pump station to be 7' from the property line in lieu of the required 10' setback; 7. Pump station to be 4.5' from the house in lieu of the required 10' setback; 8. Force main to be 3' from the house in lieu of the required 10' setback; and 9. Force main to be 43' from the Lake George shoreline in lieu of the required 50' setback; on property located at 308 Cleverdale Road in the Town of Queensbury and bearing Tax Map No: 226.12-1-82, and BE IT FURTHER, RESOLVED, that the ETU shall be maintained by the properly owner in accordance with the manufacturer's recommendations for the life of the system, 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 review by the Adirondack Park Agency during such period. Duly adopted this 16u'day of May, 2022, by the following vote: AYES NOES ABSENT: 6 Septic Inspection Repo Office No.(518)761-8256 Date Ins n neq iv Queensbury Building&Code Enforcement Arrive: s am rt: a /pm 742 Bay Rd.,Queensbury, NY 12804 Inspector's Initials: NAME: I •'� � E NO.: LOCATION PECT ON: : (0-16-ID RECHECK: . Comments and/or diagram Soil T Loam Clay Type of Water: f4u-nicipal I Well Water Waterline separation distance ft. Well separation distance Imo, ft. Other wells: I ft.--i- Well Casing Length 50'+/- Y 150'to well required if NO Absorption Field: Total lengthft. Length of each trench ft. Depth of trenches ft. Size of Stone Sizes x E 1�E►J 1 INDFLA 11� [�j�p Stone Size: . Piping Size Building to tank Tank to-BK#kUWV5M(- 11 QU Distribution Box to Field Pit r " Wg Opening Sealed: N End Ca N InletiOutlet Pipes&Baffles N Manholes 12'v or less below grade Y_N [provide extension collar if Yes Y N. Location Separations Foundation to tank CNAff,,ft. Foundation to absorption ft. ft. Conforms as per Plot Plan V Y Engineer Report and As-Built Y N ETU Maintenance Contract Y_N provided Location of System on Property: — >J E Ep F �V-EC qP I Cq� Front R r Left Side Right Side Midd Middle Approved Partial Approved and needs to be re-inspected, please call the Building&Codes Office Disapproved L:\Pam WhbV\2010WWtdit Codes FonnsVnspecdon Foam\SWft bmeWo ReporL03 29 10.doc + s NACE ENGINEERING, P.C. 169 Haviland Road,Queensbury,NY 12804 Phone-518-745-4400 Fax -518-792-851 July 12,2010 Project#49294 Dave Hatin Code Enforcement Officer Town of Queensbury 742 Bay Road Queensbury,NY 12804 Re: Choppa Residence—308 Glen Lake Road—Replacement Septic System Dear Dave: This letter is to inform you that we inspected the completed septic system for the Choppa Residence on 308 Glen Lake Road in the Town of Queensbury on June 16,2010. The septic system as installed was for a 4 bedroom house and consisted of the existing 1,250 gallon septic tank, a new pump station and force main, a new distribution box and 10 foot wide by 42 ft long absorption bed with 2-40 ft long absorption laterals constructed with 20 Eljen In Drain Units. The system conforms to the requirements of the approved design drawing. Please call me if you have any questions. Sincerely, ! Thomas R.Center Jr,P.E. Cc: Gene Choppa