BOTH-000263-2016 TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5904 (518)761-8201
a
Community Development-Building&Codes (518)761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: BOTH-000263-2016 Date Issued: Monday, July 18, 2016
This is to certify that work requested to be done as shown by Permit Number BOTH-000263-2016
has been completed.
Tax Map Number: 239.16-1-10
Location: 15 SIGN POST RD
Owner: Sarah Landers
Applicant: Onsite Engineering
This structure may be occupied as a: Septic Alteration
Clarus ZF450 Fusion to replace existing septic tank By Order of Town Board
NSF Standard 40 approved Class I system with a daily design flow of 450 gpd TOWN OF QUEENSBURY
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.
. .NI TOWN OF QUEENSBURY
I
742 Bay Road,Queensbury,NY 12804-5904 (518)761-8201
Community Development - Building & Codes (518) 761-8256
BUILDING PERMIT
Permit Number: BOTH-000263-2016
"rax Map No: 239.16-1-10
Permission is hereby granted to: Onsite Engineering
For property located at: 15 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
Owner Name: Sarah Landers Septic Disposal $0.00
Owner Address: 4 Ho Hum LN Total Value $O.00
Saratoga Springs,NY 1.2866
Contractor or Builder's Name I Address. Electrical Inspection Agency
Ellsworth& Son Excavating
76 ELLSWORTH LN
Lake George,NY 12845
Plans&Specifications
Septic Alteration
Clarus ZF450 Fusion to replace existing septic tank
NSF Standard 40 approved Class I system with a daily design flow of 4517 gpd
$ 40.00 PERMIT FEE PAID -TI IIS PERMIT EXPIRES: Monday, May 8,21717
(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 Town o' ns:j4X2016
SIGNED BY: for the Town of Queensbury.
Director of Building&Code Enforcement
SEPTIC DISPOSAL PERMIT
Office Use Only
DAT neived
Tax'M JI �� P
TAX MAP� m� errr itgk '0.y � - 1
5+fir pt er
LocA TION OF INSTALLATION �C 1�d�!`ca✓ a t
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APPLICANT A'DD I a AS' V A�9rn�� PHONE E-MAIL
ADDRESS P 0. sox I0.LdJ
INSTALL ERIBU1LDER: SI/5 wo � �`�-SRL_�,� �"'� PP-ONEI E-MAIL
ADDRESS: t GU
WNER ?Ge✓ [qtr [t ✓ PHONE IE-MAIL ` 1 �" 49 Z-
Address thM vwP_ ti IT% ms
CONTACT PERSON FOR BUILDING&CODESCOMPLIANCE: ERI(-Rt(" M!�1� a�� PH'O'NE 31/r ?S-191-et
RESIDENCE INFORMATION
Year Built #of bedrooms X Gallons per bedroom =Total Daily Flow
1960 or older ? C Garbage grinder installed _ Y 'XN
1931-1991 Spa or Hot Tub installed Y Lys,N
1992-Present
PARCEL INFORMATION
Topography _ Flat rolling _ Steep slcope 1' %slope
Soil Nature -Sand Loam ®Clay Cather 6r&w
Groundwater At what depth? l0i
Bedrock/Impervious.Material At what depth? —
Domestic Water Supply LAKE Municipal —Well (if well,water supply from any septic system absorption is ft.)
Percolation Test Rate: ' M 0 per minute per inch(test to be completed by licensed engineering I architect)
PROPOSED SYSTEM FOR ALE01 CONSTRUCTION
Tank Size jE'rV- _gallons(minimum size 1,000 gallons,add 250 gallons to size for each garbage grinder or spa or hot tub)
System Type Absorption field with #2 stone Total length ft., Each trench x
Seepage Pit with#3 stone Now many: ; size
Alternative System Bed or other type?
Holding Tank System Total required capacity? _ Tank size_ _.. #of tanks
Nates: 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 excepbons.
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 know 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 unitary Sewage Disposal Ordinance.
Print fume: �& I A.Vwe date:
Signature: - , ,t.,."'- Cate: � "� ..._.....
Town of Queensbury Building& Codes Septic Disposal Permit July 2014
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ENGINEERING PLLC
July 1, 2016
Town of Queensbury 91 Q I n r
Attn: Mr. John O'Brien, Codes
742 Bay Road
Queensbury, New York 12804
www.jkobrien93ca,yahoo.com
Re: Onsite Wastewater Treatment`System Installation
Landers Cottage
15 Sign Post Road.
Lake George,New York 12845
Town of Queensbury
Dear Mr. O'Brien:
The undersigned completed final observation of the above-referenced onsite wastewater
treatment system on July 1, 2016. Construction observation was completed during the
construction phase. The installation was completed in substantial conformance with the
intent of the design drawings dated April 16, 2016.
Do not hesitate to contact me at(315)254-6891 if you have any questions.
Sincei'el
Eric E. Murdock, P.E.
cc: Mrs. Landers, Owner
P.O, Box 6265, Syracuse, New York 13217 • Phone (315) 254-6891
www.on site-engineering .us
SALES & SERVICE, LLC
FUSION INSPECTION& MAINTENANCE AGREEMENT
Property Location: 15 Sign Post Road, Lake George,New York, 12845
Owners Name: Landers
Address:
Phone Number: (518)623-2862
Term: 2 Years; 7/13/16—7/13/18
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 perforin 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.
Y 6 V
wn Date
P.O. Box 6265, Syracuse, New York 1321 7 • Phone (315) 254-6891 • ericConsite-engineering.us