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SEP-0631-2019 Office Use Only SEPTIC DISPOSAL PERMIT APPLICATION Permit#: "YYPermit Fee:$ Invoice#: 2© 2- No Town or2eensb�ry Septic Variance? Yes 742 Bay Road,Queensbury,NY 12804 P:518-761-8256 -www.gueensbury.net Tax Map ID#: Project Location: `l s 5+tee Zd:4e, `I L- ► 62v zel,sbz o • Applicant: Name(s): 5ke7Lh Mailing Address, C/S/Z: _`G,S-Z A) Y 2fi Cell Phone: _( �'I ) -5-64o—6/0i. - Lan Line: _( ) Email: c,e ors - • Primary Owner(s): Name(s): c-.:� �QA rroeL C 0 Mailing Address, C/S/Z: Cell Phone:_( ) Land Line: _( ) Email: ❑ Check if all work will be performed by homeowner only • Contractor: Workers' Comp documentation must be submitted with this application Contact Name(s): I 1tt Contractor Trade: - Mailing Address, C/S/Z: Cell Phone: _( ) Land Line: _( Email: - in BUILDiNG&CQUS • Engineer(s): Name(s): z/2 t e- M Mailing Address, C/S/Z: Evx�, 3yy'cLGL7SSG/ ,V, ►32C�- Cell Phone:_( 3 6- ) ZS-4-- sq 1 Land Line: _( ) Email: Contact Person for Building & Code Compliance: }2sL Cell Phone: _(3ts- ) Zs' -- ��3�1 Land Line: _( ) Email: F's!''z US Septic Application Revised February 2019 RESIDENCE INFORMATION: Year Built Gallons #of bedrooms: X gallons per =total daily flow per day bedroom Garbage Grinder Yes 90 1980 or older 150 Installed? (circle one) 1981-1991 130 Spa or Hot Tub Yes Installed? (circle one) 1992-Present 110 f ��+� //0 PARCEL INFORMATION: 15e 4-"6 0"Z' Topography 10FI t Rolling Steep Slope %Slope Soil Nature _Sand _Loam Clay Other(explain: ) Groundwater At what depth? Bedrock/Impervious material At what depth? 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 for each garbage cylinder or spa/hot tub System Absorption field with#2 stone Total length ft.; Each Trench ft. 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 and 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 and. approved.The installed system must match the septic layout on file—no exceptions. 3. As-built drawings must be submitted prior to the inspection, if there has been a change to the submitted plans. 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: G�C- ��l7� DATE: fh?M SIGNATURE: ✓��f �/ G���',�� ' DATE: I r Septic Application Revised February 2019 TOWN-OF QUEENSBURY 742 Bay Road, Queensbury, NY. 12804-5902 Septic System Checklist LPlan to scale Received Deep hole perc test results from engineer/Architect if applicable J All wells on property and adjacent properties shown 3b�—� v� (a.v--, c/ Water line shown Municipal or well 10'separation to any part of system Setback to property lines show 10'or more for any part of system- -� Septic tank and pump stations 10'from foundation 50'from any well 10'from any waterline LSeptic tank.to foundation crawl space/slab on grade,grade in crawl space.must be above top of septic tank for 0',Separation required (field verification required) Leech Field 20'from foundation 100'from any well 10'from water line r . Seepage pit 150'from well 50'from septic tank Seepage Pits 3-times diameter apart Septic tank and pump stations over 30 gallons 50'from watercourse or wetland N Leech field 100'from watercourse or wetland �LToe of mound or bottom of retaining wall 10'from property line 100'from well 20'from T1�Foundation Provide Engineer/Architect stamp for bed or design systems Flood Plain requirements 2' above established flood elevation to bottom of system �i All tanks anchored or 2'above flood elevation "Home of Natural Beauty ... A Good Place to Live " SEPTIC VARIANCE Office Use Only Received: APPLICATION Permit#: � 7i»,vr a{Clixcnsturt Permit Fee: �- 742 Bay Road,Queensbury,NY 12804 P:518-761-8256 www.gueensburv.net Invoice#: Approvals: Submittal: I (one) original &8 copies of the completed application package Property Owner(s):Scott&Carol Sbrocco Owner's Agent:Click or tap here to enter text. Address:423 Wyckoff Ave Address: Click or tap here to enter text. Ramsey, NJ 07446 Click or tap here to enter text. Phone#:(917)560-6015 Phone#: Click or tap here to enter text. Site Address: 2952 State Route 9L Tax ID#: 239.20-1-13 Directions to Site:Click or tap here to enter text. Distance from well on property to septic system (if applicable)_N/A_feet Is it possible to install a conforming septic system on this.property? ® Yes ❑ No If YES, please explain and attach a diagram: Drawing attached does not meet property setback Does the proposed system meet setback requirements for distance from wells&septic systems on neighboring properties? ❑ Yes ® No If NO, please explain: Does not meet property line setbacks see drawing. Is the proposed system to be installed under a parking area? ❑ Yes ® No Section of the Sanitary" Sewage Ordinance from which you are seeking the variance(i.e. leaching system will be 89 ft. from well in lieu of required 100 ft.): Removing and replacing existing leaching system. Newfield will be 8' in lieu of required.10'from Easterly property line along State Route 9L and leaching system will be 5'in lieu of required 10'from Southern property line along Edward J. Holohan's property.4 e RECEIVED rt AUG-5 2020 QUEENSBURY CLE K'8 OFFICE ` Septic Variance Application Revised February 2019 List the names, parcel addresses, and tax map numbers of all adjoining property owners. You may obtain tax map numbers from the Assessor's Office as well as the names and addresses: North Name Thomas J Mastin Address 41 Bellwood Way,Castleton NY 12033 Tax Map ID 239.20-1-14 South Name Edward J. Holohan Address 363 Pinewood Ave,Troy NY 12180 Tax Map ID 239.20-1-12 East Name Mountainside Grange, LLC Address 423 Wyckoff Ave, Ramsey NJ 07446 Tax Map ID 23910-1-20 West Name N/A Lake George Address Click or tap here to enter text. Tax Map ID Click or tap here to enter text. OWNER STATEMENT I/We do hereby relieve the Town of Queensbury from any liabilities on the plumbing and septic system located at:2952 State Route 9L /We realize that putting the well,septic tank or leaching system less than the required_10 feet from the Property Line may increase the risk of pollution. Owner—Print Name:_Scott Sbrocco Date:_7/27/2020_ Owner—Signature: Date:_7/27/2020_ NEIGHBOR OR TENANT RELEASE STATEMENT (if applicable) I/We do hereby relieve the Town of Queensbury from any liabilities on the plumbing and septic system located at: 2952 State Route 9L I/We realize that putting.the septic tank or leaching system less than the required_10 feet from the property line may increase the risk of pollution. Neighbor/Tenant—Print Name: Date: Neighbor/Tenant-Signature: Date: Septic Variance Application Revised February 2019 PLEASE ATTACH THE FOLLOWING TO YOUR APPLICATION: 1. A location map showing the site within the Town of Queensbury 2. A plot plan showing existing and proposed features of the property, including: a. Lot dimensions b. North arrow and scale: 1 inch=40 feet c. Location &dimensions of existing and proposed buildings, showing setback distances and uses d. Parking layout to scale (if applicable) e. Physical features (street,steep slopes, lakes,wetlands, etc.) f. Location of all wells and septic systems on neighboring properties g. Adjacent ownerships h. All properties within 500 feet A sample plot plan and location are shown below: u �a {°N� Ai o + +oil Mv Septic Variance Application Revised February 2019 I AUTHORIZATION AND SIGNATURE PAGE This page includes the Authorization to Act as Agent form, engineering fee disclosure, authorization for site visits, other permit responsibilities and agreement to provide documentation required. Complete the following if the OWNER is using an Agent: Owner's Name: Click or tap here to enter text. Designates: Click or tap here to enter text. as agent regarding the Septic Variance for Tax Map#: Click or tap here to enter text. OWNER'S SIGNATURE: DATE: Engineering Fee Disclosure:Applications may be referred to the Town consulting engineer for review of septic design, storm drainage, etc. as determined by the Town Board of Health. Fees for engineering review services will be charged directly to the applicant. Authorization for Site Visits: By signing this page and submitting the application materials attached herein,the Owner,Applicant and his/her/their, agent hereby authorize the Town Board of Health, building and code Enforcement Officers and Town Engineer to enter the subject properties for the purpose of reviewing the application submitted. Please Note: Other permits may be required for construction or alteration activity subsequent to approval by the Town Board of Health. It is the applicant's responsibility to obtain any additional permits. Official Meeting Minutes Disclosure: It is the practice of the Town Board of Health to have a designated stenographer tape record the proceedings of the meetings resulting from the application, and.that the minutes transcribed from those tapes constitute the official record of all proceedings. If there is a discrepancy between such record and the handwritten minutes taken by the designated stenographer,the handwritten minutes shall be deemed the official record. I,the undersigned, have thoroughly read and understand the instructions for submission; agree to the submission.requirements and completed checklist: OWNER—PRINT NAME:Scott Sbrocco OWNER—SIGNATURE: ice' DATE:7/27/2020 AGENT—PRINT NAME: Click or tap here to enter text. AGENT—SIGNATURE: DATE: Click or tap here to enter text. Septic Variance Application Revised Fahrimry 7m o List the names, parcel addresses, and tax map numbers of all adjoining property owners. You may obtain tax map numbers from the Assessor's Office as well as the names and addresses: North Name Thomas J Mastin Address 41 Bellwood Way,Castleton NY 12033 Tax Map ID 239.20-1-14 South Name Edward J.Holohan Address 363 Pinewood Ave,Troy NY 12180 Tax Map ID 239.20-1-12 East Name Mountainside Grange,LLC Address 423 Wyckoff Ave,Ramsey NJ 07446 Tax Map ID 239.20-1-20 West Name N/A Lake George Address Click or tap.here to enter text. Tax Map lb Click or tap here to enter text. OWNER STATEMENT - I/We do hereby relieve the Town of Queehsbury.from any liabilities on the plumbing and septic system.located at:2952 State Route 9L I/We realize that putting the-well,septic tank or leaching system less than the required_10'feet from the Property Line may increase the risk of pollution. Owner—Print Name: Scott Sbrocco Date:_7/27/2020_ Owner—Signature: _ � -�1== Date:_7/27/2020 NEIGHBOR OR TENANT RELEASE STATEMENT if applicable) I/We'do hereby relieve the Town of Queensbury from any liabilities on the plumbing and septic system located at:2952 State Route 9L I/We realize that putting the septic tank or leaching system less than the required_10 feet from the property line may increase the risk of pollution. Neighbor/Tenant=Print Name: R%J)o..lJ� i� f�t.a —/ Date: 7fijZQ Neighbor/Tenant-Signature: Date: 0 septic variance Application Revised February 7(11a RESOLUTION APPROVING SCOTT AND CAROL SBROCCO'S APPLICATION FOR SANITARY SEWAGE DISPOSAL VARIANCES RESOLUTION NO.: BOH 39,2020 INTRODUCED BY: Mrs.Amanda Magee WHO MOVED ITS ADOPTION SECONDED BY: Mr. Anthony Metivier WHEREAS, Scott and Carol Sbrocco's (Applicants) filed an application for variances from provisions of the Town of Queensbury On-Site Sewage Disposal Ordinance Chapter 136 to install a replacement leaching system: 1. 8' from the easterly property line in lieu of the required 10' setback; and 2. 5' from the southern properly line in lieu of the required 10' setback; on property located at 2952 State Route 91,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, September 14th,2020, 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 .Y r 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 Scott and Carol Sbrocco for variances from the Sewage Disposal Ordinance to install a replacement leaching system: 1. 8' from the easterly property line in lieu of the required 10' setback; and 2 5' from the southern property line in lieu of the required 10' setback; on property located at 2952 State Route 9L in the Town of Queensbury and bearing Tax Map No: 239.20-1-13, and BE IT FURTHER, RESOLVED, that this Resolution is contingent upon there being sufficient barriers permanently placed and maintained to prevent parking over the infiltration bed,,which barriers must be approved by the Town's Director of Building and Codes Enforcement in advance of construction, 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 y 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 14''day of September, 2020,by the following vote: AYES : Mr. Ferone,Mrs. Magee,Mr. Strough,Mr. Metivier,Mr. Freer NOES : None ABSENT:None • • • , • • • • ENGINEERING , PLLC October 14, 2020 s 11 t " Town of Queensbury Attn: Mr. Mark Smith, Codes ®CT 14 2020 I Li 742 Bay Road Queensbury,New York 12804 TOWN OF Q11EENSBURY MarkS@queensbury.net BUILDING OOPS RE: Onsite Wastewater Treatment System Final Inspection Sbrocco Cottage 2952 State Route 9L f- 01o31- 20 Queensbury,New York 12801 Dear Mr. Smith: The undersigned completed final observation of the above-referenced onsite wastewater treatment system on September 24, 2020.. Construction observation was completed during the construction phase. The installation was completed in substantial conformance with the intent of the design drawings dated June 24,2020. Do not hesitate to contact me at(315)254-6891 if you have any questions. Sincerely; Eric E.Murdock,P.E. ONSITE ENGINEERING I PO BOX 6265, SYRACUSE, NEW YORK 13217 I TEL 315.254 .6891 PROTECTING OUR LAKES AND RIVERS I W W W _ O N S I T E - ENGINEER ! N G . U S . � c� c� a � • D Edmite Equipment, Inc. • • SEP 2 8 2020 P.O. Box 6265 • Syracuse, NY 13217 I . TOWN OF QUEENSBURY 315-254-6891 BUILDING&CODES MAINTENANCE/SERVICE AGREEMENT FOR CLARUS FUSION Project Number: 238-2019-70 Owners Name: Scott Sbrocco Property Location: 2952 State Route 9L, Lake George, NY 12845 Owners Mailing Address: 2952 State Route 9L, Lake George, NY 12845 Email: ssbrocco@optonline.net Phone Number: 917-560-6015 Term: 4 Years; 9-25-20 thru 9-25-24 Start Date: September 28, 2020 This Agreement will serve as acknowledgement that Onsite Equipment, Inc. (Onsite)will provide service on the Clarus Environmental, Inc. (Clarus) Fusion enhanced treatment unit at the above referenced property. Onsite will perform annual scheduled service checks of the Fusion for four years or until the first pump out is required. After this term, the owner must subscribe to the inspection and maintenance program. Applicable regulatory entity may be notified if the agreement is terminated at any time, regardless of the reason. Onsite will check the Fusion for proper operation and notify the owner of any deficiencies that need to be addressed. The cost associated with additional items including replacement of parts, pumping out accumulated foam/sludge or site grading is not included in this agreement Property owner agrees to operate the unit in accordance with the manufactures recommendations as presented in the Fusion Owner's Manual: Owner may transfer the benefits of this Agreement to any purchaser or other person who acquires the property where the fusion is located. Onsite is not responsible to redo any service checks delayed or prevented as a result of limited access to the site, no electricity at the Fusion panel, or as a result of an Act of God. Property owner agrees to operate the unit in accordance with the manufactures recommendations as presented in the Fusion.Owner's Manual. The undersigned agrees to the terms of this Inspection & Maintenance Agreement. • .. . "-- -=‘, 9/z_e/Z._C5Z-C Owner Date