BOTH-000337-2015 TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5904 (518)761-8201
Community Development-Building& Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: BOTH-000337-2015 Date Issued: Tuesday, May 17, 2016
This is to certify that work requested to be done as shown by Permit Number BOTH-000337-2015
has been completed.
Tax Map Number: 239.20-1-16
Location: 2938 State Rte 9L
Owner: CAROL BUTKIEWICZ
Applicant: CAROL BUTKIEWICZ
This structure may be occupied as a: Residential Septic Alteration
By Order of Town Board
TOWN OF QUEEEENSBURY
Issuance of this Certificate of Compliance DOES NOT relieve the
property owner of the responsibility for compliance with Site Plan,
Variance, or other issues and conditions as a result of approvals by the Director of Building&Code Enforcement
Planning Board or Zoning Board of Appeals.
TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5904 (518)761-8201
Community Development-Building&Codes (518)761-8256
BUILDING PERMIT
Permit Number: BOTH-000337-2015 V VMS- Z'�Z-
Tax Map No: 239.20-1-16
Permission is hereby granted to: Henry Butkiewicz REVISE
For property located at: 2938 State Rte 9L
In the Town of Queensbury,to construct or place at the above location in accordance with application together
with plot plans and other information hereto filed and approved and in compliance with the NYS Uniform
Building Codes and the Queensbury Zoning Ordinance
Type of Construction
Owner Name: Henry Butkiewicz Septic Disposal $0.00
Owner Address: 2938 State Rte 9L Total Value $0.00
Lake George,NY 12845
Contractor or Builder's Name/Address Electrical Inspection Agency
Onsite Engineering
PO Box 6265
Syracuse,NY 13217
Plans&Specifications
Residential Septic Alteration
PERMIT FEE PAID-THIS PERMIT EXPIRES: Monday,May 30,2016
(If a longer period is required,an application for an extension must be made to the code Enforcement Officer
of the Town of Queensbury before the expiration date.)
Dated at the Tgare'eF ueensb ; id ,1 ,2015
4
SIGNED BY: for the Town of Queensbury.
Director of Building&Code Enforcement
TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Vri$1
Community Development-Building&Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20150232 Application Number: A20150232
Tax Map No: 523400-239-020-0001-016-000-0000
Permission is hereby granted to: HENRY BUTKIEWICZ
For property located at: 2938 STATE ROUTE 9L
in the Town of Queensbury,to construct or place
at the above location in accordance with application together with plot plans and other information hereto filed
and approved and in compliance with the NYS Uniform Building Codes and the Queensbury Zoning
Ordinance. Type of Construction Value
Owner Address: CAROL BUTKIEWICZ Septic Alteration Residential
BARBARA SMITH Total Value
42 COUNTRY KNOLL Dr
BINGHAMTON,NY 13901-0000
Contractor or Builder's Name /Address Electrical Inspection Agency
Plans&Specifications
BP 2015-232
Residential Septic Alteration
$40.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Sunday,June 05,2016
(If a longer period is required,an application for an extension must be made to the code Enforcement Officer
of the Town of Queensbury before the expirati•• date.)
Dated at the Town • • eet/ry; f+r'ay June 05,2015
SIGNED BY /,�I 4/ / for the Town of Queensbury.
/e-.'
a . Building& f
Enforcement
SEPTIC DISPOSAL APPLI A,TION� Office Use Only
J�� Received
DATE: 6j 3 it u u JUNTax Map ID '� .2n-I -I ko
04 2015
TAX MAP ID: .._ _. Permit No. IS-02.1Z
Permit Fee ACIfk
ZONE:
APPLICANT hien le-.11]3 j,T-k/1e Gt2Q/C.Z� �j� PHONE/E-MAIL
ADDRESS 22 /3 j l & Fotk { G Zaole€ 4•ez2fo ) N f /- S
INSTALLER/ L2N Sa^ PHONE/E-MAIL
BUILDER / !/ 3/1--Z-Cf-07)
Z�7)
OWNER lie"r-si Gd -iee4. /.�Z I {-�
ADDRESS L-2 Lot ,,,,1-,,,y 141 D ! l D'1�Q_ R��n (AGt-*^~�D+J/ l V J7 0 I
CONTACT PERSON FOR BUILDING&CODE COMPLIANCE: G /G MuP00�
PHONE/E-MAIL 3 tS - Z.S-1' 6 0 (g 1 e yv`c eSr}-e - 'Wo i v ee✓1'✓AI , v S
RESIDENCE INFORMATION
Year Built #of bedrooms X gallons per bedroom =total Daily flow
1980oI er 3 a P.c./..p Ws../... 1.1° 9 Pc) 3-so o r""� Garbage inder installed Yes No
%-u1•-oda,,, tom'5P"i 44-05P-i gin
1981-1991 Spa or Hot Tub installed _Yes _K No
1992-Present
PARCEL INFORMATION G Act. 3 r c 111J z I•C Te�� t,,,-,,/-�� --SF'P },(e,_6,—S c His—
Topography /4/1 I Flat rolling Steep slope %Slope
Soil Nature N... Sand Loam Clay Other
Groundwater At what depth: /t' ' >
Bedrock/Impervious material At what depth: 6 i >
Lc4.Le Gtex,- "
Domestic Water Supply Municipal Well(if well,water supply from any septic system absorption is ft.)
Percolation Test Rate: per minute per inch(test to be completed by licensed engineer/architect)
PROPOSED SYSTEM FOR NEW CONSTRUCTION
Tank size gallons(min.size 1,000 gallons,add 250 gallons to size for each garbage cylinder or spa or hot tub
ystem Absorption field with#2 stone Total length ft.;Each Trench
Seepage Pit with#3 stone How many: ;Size
Alternative System Bed or other type:
Holding Tank System Total required capacity? Tank size #of tanks
Notes: 1)Alarm system&associated electrical work must be inspected by a Town approved electrical inspection agency;2)We will
no longer allow systems to be covered until such time as an As-Built plan is received&approved. The installed system must match the
septic system layout on file—no exceptions.
Declaration: Any permit or approval granted which is based upon or is granted in reliance upon any material representation or failure
to make a material fact or circumstance known by or on behalf of an applicant, shall be void. I have read the regulations and agree to
abide by these and all requirements of the Town of Queensbury Sanitary Sewage Disposal Ordinance.
PRINT NAME: 0121 C- Ikit ort.Do dt-" DATE: GMS
SIGNATURE: __.—az---- e. A.-_ - DATE: q 'S-
Town of Queensbury Building&Codes Principal Structure Application Revised September 2014
SITE LOCATION MAP
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Fjt-E COPY
TOWN OF Q
BUILDING &
Reviewed B)
Date:
INDEX OF DRAWINGS
�P, 3uii o 4 2015
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FIGURE 1 — SITE LOCATION MAP & DRAWINGS INDEX
FIGURE 2 — REPLACEMENT ONSITE WASTEWATER TREATMENT SYSTEM
FIGURE 3 — SELECTED DETAILS
FIGURE 4 — SYSTEM SPECIFICATIONS & GENERAL NOTES
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375 00 s3o 365 370�\ THIS PLAN INCLUDES INFORMATION PERTAINING W J cD w
3251 335340 Sas 350 355 Seo ��. \_�---�---'� TO REPLACING TWO EXISTING METAL SEPTIC J v
/ TANKS WITH ENHANCED TREATMENT UNITS AT 0 N m
AN EXISTING 2 BEDROOM COTTAGE ("ACORN"
DOCK V / Seo COTTAGE — BROWN DWELLING) AND AT A 3 Z M 0 a
\ V A BEDROOM COTTAGE (GREEN DWELLING). BOTH — a
DMV A I OF THESE SEPTIC TANKS ARE AT LEAST 50' I ' ¢ v
FROM LAKE GEORGE AND 10' FROM THE W � Z o I V A PROPERTY LINE. THE COTTAGES ARE W 2 0
SEASONAL USE ONLY AND ARE ON THE SAME Z O
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PORE I J J ALL THE WASTEWATER GENERATED AT THE Z U w
0) COTTAGES. NO ADDITIONAL BEDROOMS ARE Ld
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\ � TWO CLARUS FUSION ZF450 ENHANCED o m
PORCH \ i \ TREATMENT UNITS. THE FUSION ZF 450 IS AN z z
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Of WITH A 450 GPD TREATMENT CAPACITY. w
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J�J 1 STORY BROVIN \ o J uv ucnr / I Z BROWN DWELLING: DESIGN FLOW 110 GALLONS 00 W I--
2 \ Oa UNIT I PER BEDROOM X 2 BEDROOMS = 220 GALLONS Of >
Y / SEE,7 DET / — — 375 PER DAY; NO GARBAGE GRINDER. NO Q
\ ADDITIONAL BEDROOMS SHALL BE ADDED. p Z
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\DRY WEU GREEN DWELLING: DESIGN FLOW 110 GALLONS p
�( PUNS \ I PER BEDROOM X 3 BEDROOMS = 330 GALLONS W O > n
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LOCATED WITHIN 100' FROM THE EXISTING N w W lyl
SEPTIC SYSTEM.
CONSTRUCTION SHALL BE UNDER THEY m Z O 3: 355 \ SUPERVISION OF THE PROFESSIONAL ENGINEER I— cn D F— W
�320 1 / sas 30 �� 350 CERTIFYING THAT THE SYSTEM WAS INSTALLED m Z O :2 H
325 330 1 \ IN SUBSTANTIAL ACCORDANCE WITH THE W U Q UDI
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CURRENT PROPERTY OWNER. UNAUTHORIZED Ld
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ALTERATION OR ADDITION OF THESE PLANS IS z LO m Lu
A VIOLATION OF THE NEW YORK STATELu
��OF NEw� EDUCATION LAW ARTICLE 145, SECTION 7209. a C >
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W ONSITE WASTEWATER TREATMENT SYSTEM PLAN a
FILE NUMBER
o� ,.M 1" = 30'-0" 0 30 60 100 EEM2015-026
DATE
06-01-2015
SCALE: 1" = 30' FIGURE NO.
2
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NOTES:
1) OMENSO S 'F AND 'E' ARE TO THE BOTTOM OF THE KET/OJT ET PIPE
2) THE OVERALL HEIGHT DIMENSION 'H' IS TO THE TOP OF THE NARROW
ADAPTER RING. NOT THE RISER UD.
3) A BSER COVER COMES STANDARD. ADDITIONAL RISERS ARE
PURCHASED SEPERATELY.
FUSION 450 - DIMENSIONS & EXCAVATION DETAILS
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FUSION CONTROL PANEL
CLEANOUT
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FUSION 450 - TYPICAL PROFILE
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FUSION 450 - TYPICAL PROFILE
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FUSION TREATMENT UNIT
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FUSION 450 - AIR PUMP DETAILS
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FILE NUMBER
EEM2015-026
DATE
3
INLET
M
GRADE
ELECTRICAL JUNCTION BOX
4'0 SCHD 40 RISER
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SCHD 40 TYP.
UV LIGHT DISINFECTION UNIT DETAIL
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SYSTEM SPECIFICATIONS
INSTALL FUSION ZF 450 AT THE LOCATION SHOWN ON FIGURE 2 IN ACCORDANCE WITH
MANUFACTURES WRITTEN INSTALLATION INSTRUCTIONS FOUND IN CLARUS DOCUMENT
CL0056, DATED 2012. TREATMENT TANK SHALL BE PLACED ON 6" LAYER OF WASHED
BROKEN STONE (1/4 - 1/2 INCH DIAMETER) LEVELED TO WITHIN 1/8 -INCH SIDE TO SIDE
AND END TO END. TANK EXCAVATION SHALL EXTEND 12-18" LONGER AND WIDER THAN
TANK. FUSION 450 TANK MEASURES 85'1 X 44"W X 62'H. SUITABLE GRANULAR
MATERIAL SHALL BE PLACED ON THE SIDES OF THE FUSION UNIT TO BRING THE
SURROUNDING GROUND TO GRADE. INSTALL THE FUSION WITH A MINIMUM OF ONE
6 -INCH RISER TO BRING THE LIDS TO GRADE.
INSTALL ONE DEDICATED 115 VOLT, 20 AMP ISOLATED ELECTRIC CIRCUIT FROM THE MAIN
ELECTRICAL SERVICE TO FUSION PANEL. INSTALL A GROUND FAULT INTERRUPTER (GFI)
EXTERIOR OUTLET INSIDE THE RISER WHERE THE COMPRESSOR IS LOCATED.
FUSION EFFLUENT SHALL BE PIPED THROUGH A 4" DIAMETER SCHEDULE 40 PVC WITH
SOLVENT -WELDED JOINTS, LAID AT MINIMUM GRADE OF 1/8 INCH PER FOOT INTO AN
GENERAL CONSTRUCTION NOTES
ALL ELECTRICAL WORK SHALL BE COMPLETED BY A QUALIFIED ELECTRICIAN IN COMPLIANCE WITH
THE NATIONAL ELECTRIC CODE, STATE CODE, AND LOCAL CODES.
NO ROOF DRAINS, FOOTING DRAINS, OR WATER SOFTENING BACKWASH SHALL BE CONNECTED TO
THE SYSTEM.
ANY CURTAIN DRAINS MUST BE 15 FEET FROM THE DISPERSAL FIELD.
LANDSCAPE - INSTALLER SHALL, TO THE EXTENT PRACTICAL, LIMIT DISTURBANCE TO THE
EXISTING VEGETATION INCLUDING MATURE TREES. SOME TREE REMOVAL MAY BE NECESSARY
HOWEVER, NO TREES SHALL BE REMOVED WITHOUT THE OWNER'S EXPLICIT CONSENT. ALL
AREAS DISTURBED BY THIS CONSTRUCTION SHALL BE COVERED WITH A MINIMUM OF 4 -INCHES
OF TOPSOIL AND PROPERLY SEEDED TO GRASS AND MULCHED.
SETTLING OF FINISHED LANDSCAPING IS LIKELY TO OCCUR AND MAY REQUIRE REGRADING IN A
YEAR.
SILT FENCE AND STRAW BALES SHALL BE INSTALLED AS NEEDED TO PREVENT SOIL FROM
WASHING OFF-SITE.
THE CONTRACTOR SHALL CALL DIG SAFELY NEW YORK (1-800-962-7962) AND HAVE THE
PROPERTY OWNER LOCATE ANY ON-SITE UTILITIES PRIOR TO INITIATION OF ANY CONSTRUCTION
ACTIVITIES, ANY UNDERGROUND ELECTRICAL UTILITIES IN THE VICINITY OF THE OWTS DISPERSAL
FIELD SHALL BE RELOCATED AS NEEDED AT THE DISCRETION OF THE OWTS INSTALLER.
MAINTENANCE SHALL BE PERFORMED BY ONSITE SALES & SERVICE, LLC. IN ACCORDANCE WITH
THE EQUIPMENT MANUFACTURES RECOMMENDATIONS OUTLINED IN THE HOMEOWNER'S MANUAL
(CLARUS DOCUMENT CL0056, DATED 2012). ONSITE SALES & SERVICE, LLC. HAS BEEN
TRAINED TO PERFORM INSTALLATION, OPERATION & MAINTENANCE BY THE EQUIPMENT
MANUFACTURE AND IS AN AUTHORIZED SERVICE PROVIDER.
ALL SYSTEM COMPONENTS SHALL BE INSTALLED, OPERATED, AND MAINTAINED IN ACCORDANCE
NTH EQUIPMENT MANUFACTURES RECOMMENDATIONS, DESIGN DRAWINGS, AND ALL STATE AND
LOCAL REGULATIONS.
CONSTRUCTION SHALL BE UNDER THE SUPERVISION OF THE PROFESSIONAL ENGINEER
CERTIFYING THAT THE SYSTEM WAS INSTALLED IN SUBSTANTIAL ACCORDANCE WITH THE
APPROVED DOCUMENTS.
NO GUARANTEE AS TO THE FUNCTIONALITY OR LIFE EXPECTANCY OF THE OWTS IS WARRANTED
OR IMPLIED BY THE ENGINEER.
THIS SEPTIC SYSTEM IS DESIGNED FOR USE WITH BIODEGRADABLE PRODUCTS ONLY. USE OF
ANY OTHER PRODUCTS MAY CAUSE PREMATURE FAILURE.
CORRECTING MATERIAL/PRODUCT DEFICIENCIES IS THE RESPONSIBILITY OF THE
MANUFACTURE/SUPPLIER. WORKMANSHIP IS THE RESPONSIBILITY OF THE INSTALLER. THE
UNDERSIGNED ENGINEER DOES NOT GUARANTEE OR WARRANTEE EITHER OF THE ABOVE.
THE ENTIRE WASTEWATER TREATMENT SYSTEM INCLUDING TANKS, PIPING, RISERS, COMPONENTS,
AND LIDS SHALL BE INSTALLED WATER -TIGHT. THE SYSTEM MAY BE TESTED FOR WATER
TIGHTNESS. CONTRACTOR WILL RE -INSTALL ANY EQUIPMENT/COMPONENT THAT IS NOT FOUND
TO BE WATER TIGHT. TANKS SHALL BE INSTALLED AS NEEDED (TO BE DETERMINED BY THE
INSTALLER) TO RESIST BUOYANCY.
SPECIFIED EQUIPMENT AND MATERIALS MAY BE REPLACED WITH ENGINEER -APPROVED
EQUIVALENT EQUIPMENT OR MATERIALS. PROPOSALS FOR PRODUCTS SEEKING
APPROVED -EQUAL STATUS SHALL BE SUBMITTED TO THE ENGINEER FOR REVIEW.
THESE PLANS HAVE BEEN PREPARED FOR THE USE BY THE CURRENT PROPERTY OWNER.
UNAUTHORIZED ALTERATION OR ADDITION OF THESE PLANS IS A VIOLATION OF THE NEW YORK
STATE EDUCATION LAW ARTICLE 145, SECTION 7209.
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FILE NUMBER
EEM2015-026
Ell
MAY U 9 2016 ILS
ENGINEERING PLLC TOUVNOFQUEENSBURY
BUILDING & CODES
May 9, 2016
Town of Queensbury `7 BU 11.7
Atm: Mr. John O'Brien, Codes
742 Bay Road
Queensbury,New York 12804
www.ikobrien93(r4vahoo.com
Re: Onsite Wastewater Treatment System Installation
Butkiewicz Cottages
2938 State Route 9L
Lake George, New York 12845
Town of Queensbury
li Dear Mr. O'Brien:
The undersigned completed final observation of the above-referenced onsite wastewater
treatment system on May 6, 2016. Construction observation was completed during the
construction phase. The installation was completed in substantial conformance with the
intent of the design drawings dated June 1, 2015. 1 have attached a copy of the Service
Agreement and an As Built sketch showing the installation.
Do not hesitate to contact me at(315)254-6891 if you have any questions.
Sincere
Eric E. Murdock, P.E.
cc: Mr. Henry Butkiewicz, Owner
P.O. Box 6265, Syracuse. New York 13217 . Phone (315) 254-6891
www.onsite-enginee ring.us
j) H
SALES & SER , LLC
VICE
FUSION INSPECTION & MAINTENANCE AGREEMENT
Property Location: 2938 State Route 9L, Lake George,New York, 12845
Owners Name: Mr. Henry Butkiewicz
Address: 42 County Knoll Drive, Binghamton, NY 13901
Phone Number: (607)759-2909
Term: 2 Years; 5/6/16—5/6/18
FUSION SERVICE PROGRAM—AGREEMENT TERM
Clarus Environmental, Inc. (Clarus) the manufacture of the Fusion treatment unit recommends the Fusion be
maintained every 6 months by a Clarus trained service provider. This Fusion Inspection & Maintenance Agreement
(AGREEMENT) is between the owner and Onsite Sales& Service, LLC. (OSS). Two years of scheduled maintenance
is included in the purchase of the Fusion. After this two year term expires, the Fusion owner must subscribe to the
inspection and maintenance program.
SCOPE OF SERVICES
OSS will perform the maintenance and inspection steps outlined in the Clarus document entitled "Owners Manual"
(document number CL0056). Inspection and maintenance of the Fusion will be conducted every 6 months at the
above-referenced address during the term of this Fusion Maintenance and Inspection Agreement. This Agreement
includes 4 visits to the site. Field data will be collected and the system will be adjusted. A Maintenance Service
Report(Document Number FM2418) will be competed as needed. Completed inspection checklist will be provided to
the owner and the applicable regulatory agency as requested. Applicable regulatory entity may be notified if the
agreement is terminated at any time, regardless of the reason.
ADDITIONAL SERVICES
The owner will be notified of outstanding conditions that need to be addressed that are not included in the scope of this
Agreement. These items may include replacement of parts, laboratory testing, pumping out accumulated foam/sludge
or site grading. The cost associated with additional items is not included in this Agreement.
Property owner agrees to operate the unit in accordance with the manufactures recommendations as presented in the
Owner's Manual. The undersigned agrees to the terms of this Inspection & Maintenance Agreement.
wn Date
P.O. Box 6265, Syracuse, New York 13217 • Phone (315) 254-6891 • eric@onsite-engineering,us
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375
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325 330 335 340 345 350 355 380
DOCK T�
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2GREEN
3 BEDROOM
1 RESIDENCE
CH
CONNECT TO
JUI DING SEWER. TP.
I� FUSION ZF450 UNIT
SEE SPECS G DETAILS
1 1 STORY BRONN O UV LIGHT
y 1 2BEDROOM � DISINSECTION UNIT
RESIDENCESEE SPECS a DETAILS
1 /
\
/ —E)0STING
1�
Pump DRY WELL
FUSION g'450 UNIT O /
SEE SPECS k DETAILS
1 UV LIGHT
DISINFECTION UNIT } SHED
1 SEE SPECS h DETAILSI
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DR
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Certificate of Electrical Compliance
New York Atlantic-Inland, Inc.
997 McLean Road Ext.
Cortland, NY 13045
Certificate No.:600951
Building Permit No.:
Issue Date: 6/25/2015 Building Permit Date:
Inspected By: Devin Pratt Occupancy: R-1
OWNER SITE ELECTRICIAN
Henry Butkiewicz 2938 State Route 9L Dan Lambert
42 Country Knoll Dr Queensbury, NY 12804 Double LL Electric
Binghamton, NY 13901 Town of Queensbury 46 Twin Channels Rd
QLeensbury, NY 12804
SCOPE:
200amp Over Head Service Change
INSPECTION INFORMATION:
Service: Service Type: Overhead, Service Size: 120/240V 10 200A
4'
na
This certifies that the process noted above was complete as specified at the time of inspection and any conditions not within the
scope of the inspection are excluded. Because there exists a multitude of proprietary specifications,the adherence to the relevant
Building Code of New York State is applicable to the electrical requirements on the above noted date and valid for one year
forward. In connection with areas at the time of inspection and does not constitute areas that are enclosed,concealed or
inaccessible. Should the electrical system be altered in any way, including,but not limited to,the introduction of new electrical
equipment,this certificate shall be null and void.This certificate only applies to the occupancy use as stated.Changes in use,or
occupancy as indicated above,negates this certificate in its entirety.
COMMONWEALTH ELECTRICAL INSPECTION SERVICE,INC.
Main Office 176 Doe Run Road-Manheim,PA 17545
MUNICIPAL CERTIFICATE - ELECTRICAL APPROVAL
Permit ...Cert. N2 42959 Cut-in Card No.....................................
Owner............/4/09612 >rf . ............................................
Location... ..... .�d......(. ......P.................................................. GGI......................
Installation Consisting of../..:..r!1 . ..... ...........Cr .J
®/Lr-tJc`�
....................................................•.................... . . ... ..... ..................................................................
Installed By......��t.....I....vJeL��:Y...................
......................Lic.No...................................................
The conditions following governed the issuance of this certificate,and any certificate previously issued is
cancelled:-
This certificate only covers the electrical equipment and installation conditions as of date. Upon the
introduction of additional equipment or alterations,application shall be promptly made for inspection.
Inspectors of this Company shall have the privilege of making ' s tions at any time, and if its
rules are violated,the Company shall have the right to r vo a this rtif e. 7
Date..&..`�..T /�` -..........................
INSPECTOR.......... ......�......... l
Member N.F.P.A.,I.A.E.I.