SEP-0710-2022 i
Office Use Only
Permit#: �`i''-��--1 0 - 2-02Z
SEPTIC DISPOSAL PERMIT APPLICATION Permit Fee: $ 85 ; invoice#: 5co►t
Town b>Q��r,sb�ry Septic Variance? 7J� s No
742 Bay Road,Queensbury,NY 12804
P:518 761-8256 www.gueensbury.net
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Tax Map ID#: ak or tap here to en t'Xt.
Project Location: 27 Sunset Lane, Lake George, NY 12845
• Applicant:
Name(s): Bill Levett
Mailing Address, C/S/Z: 27 Sunset Lane, Lake George, NY 12845C1ick or tap here to enter text.
Cell Phone: (315-382-3470) Land Line: ( )
Email: wslevett@gmail.com
• Primary Owner(s):
Name(s): Bill Levett
Mailing Address, C/S/Z: 27 Sunset Lane, Lake George, NY 12845
Cell Phone: (315-382-3470) Land Line: ( )
Email: Click or tap here to enter text.
❑ 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
Contractor Trade: Click or tap here to enter text.
Mailing Address, C/S/Z: 19 Boulevard, Queensbury,NY 12804
Cell Phone: (518-796-6521) Land Line: ( ) D
Email: daigleoffice@gmail.com Q 11n
NOV V �
• Engineer(s): TOWN ?8?�??
Name(s): Eric Murdock, PE eUl(D�QUF
Mailing Address, C/S/Z: PO Box 6265, Syracuse,NY 13217 LNG&co RY
Cell Phone: (315-254-6891) Land Line: ( ) DFS
Email: eric@onsite-engineering.us
Contact Person for Building & Code Compliance: Click or tap here to enter text.
Cell Phone: ( ) Land Line: ( )
Email: Click or tap here to enter text.
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.
1981-1991 130 Click ap here Click or tap Click or tap here to
to en er text. here to enter enter text. Garbage Grinder Yes No
text. Installed? (check one) ❑
1992-Present 110 Click or tap Click or tap Click or tap here to
here to enter here to enter enter text. Spa or Hot Tub Yes No
text. text. Installed? (check one) ❑
R
PARCEL INFORMATION:
Topography ® Flat Rolling ❑ Steep Slope %Slope
Soil Nature ❑ Sand ® Loam ❑ Clay ❑ Other(explain: )
Groundwater At what depth?Greater than 6'
Bedrock/Impervious material At what depth?Greater than 6'
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: QD
Tank size gallons (min. size 1,000 gallons, add 250 gallons for each garbage cyli der 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: Bill Levett
//I I 2g,22
SIGNATURE: CA VLAap4 g ext. DATE: Old or tap here to enter text.
Septic Application Revised February 2019
CL
TOWN OF QUEENSBURY
742 Bay Road, Queensbury, NY. 12804-5902
Septic System Checklist
IPlan to scale
Received Deep hole pert test results from engineer/Architect if applicable(Town Approved Engineers and
Architects;June 30 to April 15 Town Engineer for unapproved Engineers and Architects)
All wells on property and adjacent properties shown
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/lake/wetland 10'from any waterline
Septic 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)
Septic tank sized for number of bedrooms and add 250 gals for Jacuzzi tubs/garbage grinder each
Leech Field 20'from foundation 100'from any well 10'from water line
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
distance from bottom of trench or system 24"to bedrock or mottling 36"within 1000'of Lake George
Leech field 100'from watercourse or wetland
Toe of mound or bottom of retaining wall 10'from property line 100'from well 20'from
Foundation
1 Provide Engineer/Architect stamp for bed or design systems
Department of Health Approval for all mobile home park new systems Flood Plain requirements
J3-2' above established flood elevation to bottom of system
All tanks anchored or 2' above flood elevation
Onsite Equipment, Inc.
P.O. Box 6265
Syracuse, NY 13217
315-254-6891
MAINTENANCE/SERVICE AGREEMENT
FOR CLARUS FUSION
Project Number: 3552022
Owners Name: Bill Levett
Property Location: 27 Sunset Lane, Lake George, NY 12845
Owners Mailing Address: 27 Sunset Lane, Lake George, NY 12845
Start Date: 12-5-22
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 two 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.
February 13, 2023
Town of Queensbury
Attn: Mr. John O’Brien
742 Bay Road
Queensbury, New York 12804
RE: Onsite Wastewater Treatment System Final Inspection
Levett Residence
27 Sunset Lane
Lake George, New York 12845
Dear Mr. O’Brien:
A Fusion Treatment Unit was installed on December 5, 2022 in accordance with the plans prepared by
Onsite Engineering, PLLC. dated November 25, 2022 at the above referenced site. The Fusion replaced
a legacy septic tank. The location of the treatment tank meets separation distance requirements so no
variance was needed from the Town. I have attached an As-Built Conditions drawing and a service
agreement for the Fusion.
The liquid level at the outlet of the Fusion is at the correct elevation suggesting that the dispersal field is
draining as expected. In the event that the system backs up because the dispersal field is under stress
and not taking the water, Onsite will prepare engineered drawings proposing a replacement dispersal
field and submit an associated variance request. The electrical inspection has been performed and the
Town has inspected the installation. Please consider this request to close out the existing permit.
Do not hesitate to contact me at (315) 254-6891 if you have any questions.
Sincerely;
Eric E. Murdock, P.E.
cc: Mr. Bill Levett, Owner