2015-295 TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5904 (518)761-8201
at Community Development-Building&Codes (518)761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: P20150295-42115 Date Issued: Thursday, July 13, 2017
This is to certify that work requested to be done as shown by Permit Number P20150295-42115
has been completed.
Tax Map Number: 239.16-1-13
Location: 27 SIGN POST RD
Owner: Dale Campbell, Catherine Campbell
Applicant: Dale Campbell
This structure may be occupied as a: Septic Alteration
By Order of Town Board
TOWN OF QUEENSBURY
Issuance of this Certificate of Compliance DOES NOT relieve the n
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
*k.4
Vro742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development- Building&Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20150295 Application Number: A20150295
Tax Map No: 523400-239-016-0001-013-000-0000
Permission is hereby granted to: DALE& CATHERINE CAMPBELL
For property located at: 27 SIGN POST Rd
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: DALE& CATHERINE CAMPBELL
52 FREMONT Rd Septic Alteration Residential
N. TERRYTOWN,NY 10591 Total Value
Contractor or Builder's Name/Address Electrical Inspection Agency
Plans &Specifications
2015-295
Residential Septic Alteration
$40.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Saturday,July 09,2016
(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 da e.)
Dated at the T n of eenr4 sday,July 09, 2015
SIGNED BY for the Town of Queensbury.
Director of Building&Code Enforcement
PRINCIPAL STRUCTURE APPLICATION Office Use Only
DATE �p -Z q- / l Received
Tax Map ID
TAX MAP ID 2.39, Hi-- 1 -- ,3 J+JL 08 2u15 Permit No. Z0lam- 2�
NIJ V C Permit Fee 631¢5
ZONING Rec Fee
'` VI-Q Site Plan #
BUILDINGS, C.,
HISTORIC SITE Yes % No Subdivision #
SUBDIVISION NAME Lot#
TOWN BD. RESOLUTION 86-2013: $850 RECREATION FEE FOR NEW DWELLING UNITS, INCLUDING SINGLE FAMILY DWELLINGS,
DUPLEXES OR TWO FAMILY DWELLINGS, MULTIPLE FAMILY DWELLINGS, APARTMENTS, CONDOMINIUMS, TOWNHOUSES, AND/OR
MANUFACTURED&MODULAR HOMES, BUT NOT MOBILE HOMES. THIS IS IN ADDITION TO THE PERMIT FEE.
APPLICANT 0,4LE CA-MPBELL OWNER DA LC CA P6ELc_
ADDRESS Z- S 1 istAi F051— \ ADDRESS ; L 2 i2-c Hon)i PD
L4k-E L7hORure A/y 12F--I5 S LEE?'y t-*o I-Low b y 165/ /
PHONE/E-MAIL PHONE/E-MAIL ( 7-) z7-0 - CI-E`I
CONTRACTOR 6 LL5(Ale a"(it / So S COST OF CONSTRUCTION(ESTIMATED): $ /2 J SGc'
ADDRESS: 3-7 ELLS L BUILDING ADDRESS: 2,?- S11i.N resr RD LAue LrEoezv=e /1/41()
zscr s-
12545-
PHONE/E-MAIL (6-/S l z /�
CONTACT PERSON FOR BUILDING& CODES COMPLIANCE: 74LE (, A-)-1-?2,e LL. PHONE(et 2W-0789
TYPE OF CONSTRUCTION
Check all that apply Please indicate measurements as required below
New Addition Alteration lSt floor sq. ft. 2nd floor sq. ft. Total sq. ft. Height
Single Family
Two-Family
Multi-Family
(# of units_ )
Townhouse
Business Office
Retail - Mercantile
Factory - Industrial
Attached Garage
(# of )
Other
1
Town of Queensbury Building&Codes Principal Structure Application July 2014
If commercial or industrial indicate name of business
Proposed use of building or addition
Source of heat (circle one) Gas Oil Propane Solar Other
Fireplace: complete a separate application for Fuel Burning Appliances &
Chimneys
Are there structures not shown on plot plan?
Are there easements on the property? �J
Site Information
a. Dimensions or acreage of lot
b. Is this a corner lot? A./z,.
c. Will the grade be changed as a result of construction Yes x No
d. Public water or Private well
e. Sewer or Private Septic System pa vv A--c 5 CP-, 5--(5
Value of all work to be performed (labor or materials) $
DECLARATION:
1. I acknowledge no construction shall be commenced prior to issuance of a valid permit and will be completed
within a 12 month period.
2. If work is not complete by the 1 year expiration date the permit may be renewed, subject to fees and
department approval.
3. I certify that the application, plans and supporting materials are a true and complete statement / description of
the work proposed, that all work will be performed in accordance with the NY State Building Codes, local
building laws and ordinances, and in conformance with local zoning regulations.
4. I acknowledge that prior to occupying the facilities proposed, I or my agents will obtain a certificate of
occupancy.
5. I also understand that I /we are required to provide an as-built survey by a licensed land surveyor of all newly
constructed facilities prior to issuance of a certificate of occupancy.
I have read and agree to the above: PRINT NAME: � u T� DATE / /l
SIGNATURE: �� `� DATE 0'//5----
FOR
OFFICE USE ONLY
Operating Permit Issued: Yes No
Occupancy Type
Construction Classification
Assembly Occupancy Limit
Special Conditions
2
Town of Queensbury Building&Codes Principal Structure Application July 2014
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SITE LOCATION MAP
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BUILDING & i
Reviewed By:
Date:
INDEX OF DRAWINGS
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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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REPLACE EXISTING METAL
SEPTIC TANK WITH
O `3 BEDROOM FUSION ZF450 UNIT
W SEE SPECS & DETAILS
CO % DWELLING
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DRY WELL
OF LIGHT /
DISINFECTION UNIT
SEE SPECS & DETAILS
PROPERTY LINE
\\\ AS PER SURVEY TYP.
ONSITE WASTEWATER TREATMENT SYSTEM PLAN
1 " = 50'-0
BASIS OF DESIGN
THIS PLAN INCLUDES INFORMATION PERTAINING TO REPLACING AN
EXISTING METAL SEPTIC TANK WITH AN ENHANCED TREATMENT UNIT
AT AN EXISTING 3 BEDROOM COTTAGE. THIS SYSTEM WILL HANDLE
ALL THE WASTEWATER GENERATED AT THE COTTAGE. NO ADDITIONAL
BEDROOMS ARE BEING PROPOSED.
THIS DESIGN SPECIFIES THE INSTALLATION OF A CLARUS FUSION
ZF450 ENHANCED TREATMENT UNIT. THE FUSION ZF 450 IS AN NSF
STANDARD 40 APPROVED CLASS I SYSTEM WITH A 450 GPD
TREATMENT CAPACITY. GRAVITY FLOW CONTINUES TO AN ULTRA
VIOLET LIGHT FOR DISINFECTION, & INTO THE EXISTING DRY WELL.
DESIGN FLOW 110 GALLONS PER BEDROOM X 3 BEDROOMS = 330
GALLONS PER DAY; NO GARBAGE GRINDER. NO ADDITIONAL
BEDROOMS SHALL BE ADDED.
DRINKING WATER IS SUPPLIED TO THE COTTAGE FROM LAKE GEORGE.
NO ONSITE DRINKING WATER SUPPLY WELLS ARE KNOWN TO BE
LOCATED WITHIN 100' FROM THE EXISTING SEPTIC SYSTEM.
CONSTRUCTION SHALL BE UNDER THE SUPERVISION OF THE
PROFESSIONAL ENGINEER CERTIFYING THAT THE SYSTEM WAS
INSTALLED IN SUBSTANTIAL ACCORDANCE WITH THE APPROVED
DOCUMENTS. 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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SCALE: 1"= 30'
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NOTES:
1) DIMENSIONS Y AND •E' ARE TO THE BOTTOM OF THE 9M/WTLET PIPE
2) THE OVERALL HEIGHT DIMENSION •H• IS TO TINT TOP OF RE NARROW
ADAPTER RING. NOT THE RISER LI).
3) A RISER COVER COMES STANDARD. ADDITIONAL RISERS ARE
PURCHASED SEPERATELY.
ENCAVATNW DIMENSIONS
SYSTEM L I W I X II
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7-1MY
FUSION 450 - DIMENSIONS & EXCAVATION DETAILS
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AIR PUMP DETAILS
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033
INLET
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ELECTRICAL JUNCTION BOX
SCHD 40 RISER
,�Di7a1
4"0 SCHD 40 TYP.
DISINFECTION
CHAMBER
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'L 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 A
CLARUS MODEL 5250-0004 ULTRA VIOLET LIGHT DISINFECTION UNIT. INSTALL THE ULTRA
VIOLET I IGHT DISINFECTION UNIT IN ACCORDANCE WITH THE MANUFACTURES WRITTEN
RE W S.
,`p'�GE_MU40 O'P
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
WITH 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
EEM2015-033
DATE
06-29-2015
FIGURE NO.
4
ENGINEERING PLLC
October 21, 2015
Town of Queensbury
Attn: Mr. David Hatin, Director of Building&Code Enforcement
742 Bay Road
Queensbury,New York 12804 hI rE
is
RE: Septic System Installation JUL y 'i [Ull
Campbell Cottage _
21 Sign Post Road TOW ) OF QUEENSFU' }
Lake George,New York 12845
Dear Mr. Hatin:
The undersigned complcte,4 final observation of the above-referenced onsite wastewater
treatment system on Onwh6r 13, 2015. Construction observation was completed during
the construction phase. The installation was completed in substantial conformance with
the intent of the design drawings dated June 29,2015.
Do not hesitate to contact me at(315)254-6891 if you have any questions,
Sincerely;
Eric E. Murdock, P.E.
cc: Mr. and Mrs. Campbell, Owner
P.O. Box 6265, Syracuse, New York 13217 e Phone (315) 254-6891
SALES & SERVICE, LLC
FUSION INSPECTION&MAINTENANCE AGREEMENT
Property Location: 27 Sign Post Road, Lake George,New York 12845 , 1 t
Owners Name: Mr. and Mrs. Campbell L
i� ` W �I
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Address: 42 Fremont Road, Sleepy Hollow,NY 10591 i ) 3
Phone Number: (917)270-0789 1 1 EJ 2(I1� i�1
Term: 2 Years; 10/13/15— 10/13/17
TOWN OF OUEENq-
L_- 8U1LDIk,
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.
October 13,2015
Owner
P.O. Box 6265, Syracuse, New York 13217 • Phone (315) 254-6891 • eric®onsite-engineering.us