SEP-0615-2020i' _ ,,
Office Use Only
SEPTIC DISPOSAL PERMIT APPLICATION
Permit#: 5Ei'— D l015- 2020
Permit Fee:$Invoice#: 602.9
TOM]of Queensbury
Septic Variance? Yes V No
742 Bay Road,Queensbury,NY 12804
P:518-761-8256 www.queensbury.net
Tax Map ID#: 523400 239.20-1-20
Project Location: 2957 State Route 9L, Queensbury NY 12804
Applicant:
Name(s): Scott Sbrocco
Mailing Address, C/S/Z: 423Wyckoff Ave, Ramsey NJ 07446
Cell Phone: (917-560-6015) Land Line: ( ) o
Email: ssbrocco@optonline.net cOM0
7.
Primary Owner(s): rn
QName(s):Mountainside Grange LLC
ncMailingAddress, C/S/Z: 423 Wyckoff Ave,Ramsey NJ 07446
Ill
Cell Phone: (917-560-6015) Land Line: ( ) mti::: :3'
Email: ssbrocco@optonline.net
0 Check if all work will be performed by homeowner only
Contractor: Workers' Comp documentation must be submitted with this application
Contact Name(s): Daigle Construction (Nick Daigle)
Contractor Trade:Excavation & General Contracting
Mailing Address, C/S/Z: Click or tap here to enter text.
Cell Phone: (518-796-6521) Land Line: ( )
Email: daigleoffice@gmail.com
Engineers):
Name(s): Onsite Engineering(Eric Murdock)
Mailing Address, C/S/Z: PO Box 6265, Syracuse NY 13217
Cell Phone: (315-254-6891) Land Line: ( )
Email: eric@onsite-engineering.us
Contact Person for Building & Code Compliance:Nick Daigle
Cell Phone: (518-796-6521) Land Line: ( )
Email: daiglenick@yahoo.com
Septic Application Revised February 2019
RESIDENCE INFORMATION:
Year Built Gallons #of bedrooms: X gallons per =total daily flow
per day bedroom
1980 or older 150 Click or tap here Click or tap Click or tap here to
to enter text.here to enter enter text.
text.Garbage Grinder Yes No
1981-1991 130 Click or tap here Click or tap Click or tap here to Installed? (check one) LEI
to enter text.here to enter enter text.
text.Spa or Hot Tub Yes No
1992-Present 110 4 110 440
Installed? (check one) El
PARCEL INFORMATION:
Topography Flat Rolling Steep Slope Slope
Soil Nature Sand Loam Clay Other(explain:
Groundwater At what depth?7 feet below grade
Bedrock/Impervious material At what depth?No bedrock 0"-72"
Domestic Water Supply Municipal ® Well (if well,water supply from any septic system absorption is_110 ft.)
Percolation Test Rate:_4-5 per minute per inch (test to be completed by licensed engineer/architect)
PROPOSED SYSTEM FOR NEW CONSTRUCTION: Replacement Septic System
Tank size 1,250_gallons(min.size 1,000 gallons, add 250 gallons for each garbage cylinder or spa/hot tub plus Clarus
Fusion 450 gpd
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: ETU and Presby
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:Scott Sbrocco
SIGNATURE: 1, 2_-.-
e/.7r,Ati3' DATE:09/21/20
Septic Application Revised February 2019
TO fY 11J d Qf OF ® fed�1 SB R Y
742 Bay Road, Queensbury, NY. 72804-5902
Septic System Checklist
•��Plan to scale
WReceived Deep hole perc test results from engineer/Architect if applicable(Town Approved
^Engineers and Archftects)pone 30 to Apd!15 Town(Eagincer fb® unapproved Engineers and Architects)
`�_-zll wells on property and adjacent properties shown
tr�water line shown Municipal or well 10'separation to any part of system
_U�etback.to property lines show IT or more for any part of system
`n Septic tank and pump stations 0'from foundation 50'from any well/lake/wetland 10'from;any
waterline
t'i4Se.ptic tank to foundation crawl space/slab on grade,grade in crawl space must be above to.p of
-septic tank for 0',Separation-required (field verification required)
4�Septictank sized for number of bedroonls and add 250 gals for Jacuzzi tubs/garbage,grindereach
Leech Field 20'frond foundation-100.'from any well 10'from water line
v�Seepage pit 150'from well 50'from septic.tank
!�1Seepage Pits 3-times diameter apart
Septic tank and pump stations over-30 gallons-50'from watercourse or-wetiand
A4 Udistahce from bottom of trench or system 24"to bedrock or mottling 36"within 1000'of lake
t� george
Leech field 100'from watercourse or wetland
Toe of mound or bottom of retaining wall IV from property line.100'from well 20'from
Foundation
Ll d :Provide Engineer/Architect.stamp for bed.or design systems
,.ijjk�®epartment of Health Approval for all mobile home park new systems
Road Plain requirements
2'above established flood elevation to bottom of system
All tanks-anchored or 2' above,flood elevation
"Home of Natural Be:auty ... A, Good Place to Live "
N T
ENGINEERING , PLLC
February 15, 2022
Town of Queensbury
Attn: Mr. Mark Smith, Codes
742 Bay Road
Queensbury,New York 12804
MarkS@queensbury.net
RE: Onsite Wastewater_ Treatment System Final Inspection
Sbrocco Cottage
2957 State Route 9L
Queensbury,New York 12801
Dear Mr. Smith:
The undersigned completed final observation of the above-referenced onsite wastewater treatment system
on February 14, 2022. Construction observation was completed during the construction phase. The
installation was completed in substantial conformance with the intent of the design drawings dated June
20,2020.
Do not hesitate to contact me at(315) 254-6891 if you have any questions.
Sincerely;
'ge so.w.'a !-
Eric E. Murdock,P.E.
4 CEO SeUR
IFS Y
o'NSITE ENGINEERING I PO BOX, 6265, SYRACUSE, NEW YORK 1a217 TEL 315.254 .6891
PROTECTING OUR LAKES AND RIVERS I WWW • ONSITE - ENGINEERAN'G . US
Onsite Equipment, Inc.
- • - ; P.O. Box 6265
• Syracuse, NY 13217
• • • 315-254-6891,
��nn
e
OHNM
MAINTENANCE/SERVICE AGREEMENT
FOR CLARUS FUSION ,
Project Number: 318120821 202,0
Owners Name: Scott Sbrocco
_ Property Location: 2957 State Route 9L, Lake George, NY 12845
Owners Mailing Address: 2957 State Route 9L, Lake George, NY 12845
Email: ssbrocco@optonline.net D _ .E 0
Phone Number: 917-560-6015 MAR 0 4 2022
Term: 4 Years; 12-8-21 thru 12-8-25
TOWN OF QUEENSBURY
Start Date: December 8, 2021 _BUILDING& CODES
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.