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SEP-0794-2021 r � . SEPTIC DISPOSAL PERMIT office Use Only APPLICATION Permit#: 'b�— 20 Z) 7airee r3F CZueinsFIury LJ � !!� Permit Fee:$742 Bay Road,Queensbury,NY 12 062022 _ Invoice#:P:518-761-8256 wwZuensbur Septic Variance? N UkA-SE) iflZl QL)EEN'SBURYFlood Zone? YNG&OO��S 19 Private Road #1 wetlands? Y Reviewed By: Project Location: off Cleverdale Road Tax Map #: 240.9-1-6 RESIDENCE INFORMATION: Year Built Gallons #of bedrooms: X gallons per =total daily flow per day bedroom Garbage Grinder Yes No 1980 or older 150 Installed? (choose one) ❑ ❑X 1981-1991 130 Spa or Hot Tub Yes No 1992-Present 110 5 110 550 GPD Installed? (choose one) ❑ ❑X PARCEL INFORMATION: Topography 0 Flat Rolling ❑ Steep Slope 3-8 % Slope Soil Nature ❑ Sand ❑X Loam ❑ Clay ❑ Other, explain: Groundwater At what depth? None Bedrock/Impervious material At what depth? 3.2 ft Domestic Water Supply ❑ Municipal ❑ Well X❑Lake (if well or lake, water supply from any septic system absorption is ft.) Percolation Test Rate: 8 per minute per inch (test to be completed by a licensed engineer/architect) PROPOSED SYSTEM INFORMATION: Tank size R3* gallons (min. size 1,000 gallons, add 250 gallons for each garbage cylinder or spa/hot tub Norweco Singulair R3 Enhanced Treatment Unit System Absorption field w/#2 stone Total length ft.; Each Trench ft. - Seepage Pit w/#3 stone How many: ; Size: Alternative System Bed or other type: 18' x 35' stone absorption bed design Holding Tank System Total required capacity? ; tank size ; # of tanks Septic Application Revised April 2021 4 • 1"? CONTACT INFORMATION: PLEASE PRINT LEGIBLY OR TYPE, PLEASE INCLUDE AN EMAIL • Applicant: Name(s): Morgan & Evan Stritsman Mailing Address, C/S/Z: 240 Town Office Road Troy NY, 12180 Cell Phone: 518-859-0467 Land Line: Email: mostrits@gmail.com estritsman@bestfire.com 0 Primary Owner(s): Name(s): Same as above Mailing Address, C/S/Z: Cell Phone: Land Line: Email: ❑ Check if all work will be performed by property owner only • Contractor: Contact Name(s): Ivan Bell (IBS Septic & Drain) Contractor Trade: Excavator/ Septic Installer Mailing Address, C/S/Z: 2 Lower Warren St, Queensbury NY 12804 Cell Phone: 518-798-8194 Land Line: Email: mbeckwith@ibsseptic.com "Workers' Comp documentation must be submitted with this application" Engineer(s): Name(s): Nicholas Zeglen (EDP) Mailing Address, C/S/Z: 900 Route 146 Clifton Park NY Cell Phone: 518-383-8345 Land Line: Email: nzeglen@edplip.com Contact Person for Compliance in regards to this project: Nick Zeglen (EDP) & Ivan Bell Cell Phone: Land Line: (BS Septic & Drain) Email: 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. 4. If, for any reason, the building permit application is withdrawn, 30% of the fee is retained by the Town of Queensbury. After 1 year from the initial application date, 100% of the fee is retained. 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: Evantritsman SIGNATURE: DATE: 41617022 Septic Application Revised April 2021 TOWN OF QUEENSBURY 742 Bay Road, Queensbuny, NY. 12804-5902 Septic System Checklist f�—Plan to scale �Received Deep hole perc test results from engineer/Architect if applicable(Town Approved Engineers and Architects;June 30 to April 15 Town Engineer for unapproved Engineers and Architects) J:!/S All wells on property wn R-64Vul"� OTI Le„Lo wo, q ater line shown Municipal or well 10'separation to any part of system 'Ag Setback to property lines show 10'or more for any part of system vexr a-,-Vv -�, C , r k-16 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 for0',Separation required (field verification required) 'W—Septic tank sized for number of bedrooms and add 250 gals for Jacuzzi tubs/garbage grinder each /0 Leech Field 20'from foundation 100'from any well 10'from water line Seepage pit 150'from well 50'from septic tank 1 f✓�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.3,E"within 1000' of Lake George UJ-Qi3 Leech field 100'from watercourse or wetland T/ Toe of mound or bottom of retaining wall 10' from property line 100'from well 20' from / /J Foundation V/'e,f Provide Engineer/Architect stamp for bed or design systems ►7A—Department of Health Approval for all mobile home park new systems Flood Plain requirements fSLO 2' above established flood elevation to bottom of system a6 All tanks anchored or 2' above flood elevation Revised 4/15/2021 L SERVICE PRO CONTROL CENTER WITH MCD TECHNOLOGY SUBSCRIBER MONITORING AGREEMENT GUIDE INTRODUCTION - Tract-property's real estate tract number Subdivision-subdivision where property is located To initiate Service Pro remote monitoring, the Subscriber . Home Telephone-property owner's phone number Monitoring Agreement must be completed and signed by e Lot-property's real estate lot number the property owner. The agreement is a one page,five part e Block-property's real estate block number carbonless form. Remote monitoring will begin when the - Cell Phone-property owner's cell.phone number Singulair system is started up,the Service Pro control center e PCT-property's real estate precinct is commissioned and three copies of the signed agreement - Section-property's real estate section number are received by Norweco. All of the information on the - Mailing Address-property owner's mailing address agreement should be used to complete the new subscriber - City-name of city where property owner is located account page on the Service Pro website and register the - State-name of state where property owner is located Singulair aerator warranty. . Zip Code-zip code where property owner is located COMPLETING THE AGREEMENT O Section Two-System Information System Start-U p Date-date the The Service Pro subscriber Singulair system is started up and S"Vicmonitoring agreement has five SERVICE PRa SCIUSEE MCWORINGA aINc. susscR�e�RroD�RTONINeaeaeeaaeW the Service Pro control center is sections. Fill in each section using commissioned a ball point pen. Press firmly and ,, , °" _w - Installation Type - check print clearly in block letters. z residential or commercial p --- - -- - Singulair System Model - check ce»aw rGr axon NOTE: Bold titles in this guide one system model identify required information fields - Aerator Serial Number - enter ..�__ ....-.....�,�,tr� that must be filled in before remote �e�g eNaN ° D Yam. «tea ° , a Dom, aerator serial number tl TNrbA3flR CiN.'.r3' 1DMi9 OTNra2y,'g3Pp Drr,:lracau monitoring can be activated. .� N gem - Control Serial Number - enter a _bro Dod05»Wl,wm base bm Service Pro serial number Pwq 3Eo.2 tlyee tlf U-u::ecN.z, 1 Section One - Subscriber ° r " Control Model-enter Standard or Ney¢t:pl rreZvmb: at— Dlrx.+sa befxrW b9asbttb blY rrmn-s Information ISC(Integrated System Control) Ccrrfco Vrovldor InfommHon - Name -first and last name a Effluent Disposal Method - Aa3+aa of property owner W. describe method of effluent • Email Address - email F, � _ disposal address of property owner , - Pump Station - pump station • Street Address - number installed, check yes or no and street name where - Disinfection System-disinfection property is located installed, check yes or no • County - name of county TERMS ANDCONDIT1CW5 a Dechlorination System - where property is-located ,"�YF � ° 4s� rmrNT ,,. dechlorination installed, check - City - name of city where Aa •�A N � � &°�•8w �� yes or no ABmmMAnAi#aMa'W1'.iM1.:CV „„„„„w„,„.....lK*de'aRWc'ddM.`7t1DSCRiNR'S{NSTAIfAr:Q'7CC. property y zn,Reeass�avxa: :,a :.sa>,scxwr , ,NraRrn,nransa.,�xnnnRxm��,AcxrFc� , Auxiliary One - check box if r0 ert IS located Mawrc:mea>kc..�sa,,�,�*s��:��s�• ro>�r�ar. .�,.� c�,r •�,rv� amxsrmenas7sea iSB.«MCGts!dm,'au.^Cr�iG NG'®�nromeeaconms�o�Y - State-name of state whereA98YDTE:Tne c uarenwrh N7�*msU «�reY g �as Service Pro auxiliary alarm one is lgenq-D.NQW, d:C+GttY'stMWlBwe+FSSY' f BGACNy'G�Cht03tlj18oT5HIxtMcat n°SYAFR b3 t PaN>1Y['9W WI�mGA'xashY 9W#n NOx. a. stKlml4AtU.YaF1aUUM+PCtZM9:rt12+'IaN.".0 ImM4 property is located in use and list what is being . Survey- real estate survey SOWECTTO74RMSANOCONCITIONSOK REVERSE SDE monitored number of property -- .-M"m. ftdr 2$— . Auxiliary Two-check box if Service • Abstract - real estate Pro auxiliary alarm two is in use abstract number of property Z _, k and list what is being monitored • Zip Code-zip code where . Auxiliary Three- check box if property is located Service Pro auxiliary alarm three - Country-name of country where property is located is in use and list what is being monitored SUBSCRIBER MONITORING AGREEMENT GUIDE (Cont.) . Inspection Frequency - Singulair system annual ®5 Section Five—Terms and Conditions inspection frequency. Check the box that lists the 1. Print property owner's name on the first blank line inspection requirements(monthly,every 3 months,every immediately right of the word undersigned. 4 months,etc.)of the Singulair Owner Protection Service 2. Print distributor's company name on blank line Program. immediately right of the words Installation Co. 3. Print the first and last name of the property owner NOTE: Be sure to properly identify the auxiliary equipment on the blank line immediately to the right of the alarm lights on the Service Pro control center using the labels word Subscriber. provided. The auxiliary alarm light labels must match the 4. Print the current calendar day number on the blank auxiliary descriptions on the monitoring agreement. line immediately right of the words executed this. 5. Print the calendar month on the blank line Section Three—Service Provider Information immediately right of the words day of. .Company Name-service provider's company name 6. Print the last two digits of the year on the blank line .Contact-contact person for service provider immediately right of the number 20. .Address:service provider's mailing address 7. The property owner must sign their name on the .City-name of city where service provider is located blank line immediately under their printed name. .State-name of state where service provider is located 8. If applicable,the property owner shall print their title .Zip Code-zip code where service provider is located on the blank line immediately right of the word Title. .Country-country where service provider is located 9. Print the distributor's company name on the blank .Office Telephone-service provider's office number line immediately right of the words Subscriber's .Cell Phone-service provider's cell phone number Installation Company. .Fax Number-service provider's fax number 10. The distributor's representative must sign their first .Email Address-service provider's email address and last name on the blank line immediately below the distributor's company name. OSection Four—Distributor Information 11. Print the title of the distributor's representative who .Company Name-distributor's company name has signed the agreement, on the blank line .Contact-contact person for distributor immediately right of the word Title. .Address-distributor's mailing address .City-name of city where distributor is located FINAL INSTRUCTIONS .State-name of state where distributor is located .Zip Code-zip code where distributor is located Once all information fields have been completed and the .Country-country where distributor is located agreement has been signed, mail the top three copies to .Office Telephone-distributor's office number Norweco. The fourth copy is kept by the distributor. The .Cell Phone-distributor's cell phone number fifth copy is given to the property owner. All information from .Fax Number-distributor's fax number the monitoring agreement must be entered into a new .Email Address-distributor's email address subscriber account page on the Service Pro website. To add a new subscriber to the website, complete all of the he"Ad Subscriber"steps in t d New Subscri section of the Service Pro Getting Started Website Instructions. Permanent record retention and remote monitoring of the Singulair system will begin when the following steps have been come The system is started up and the Service Pro control . bG� ezirr^,cesa. rx tcw'a x--ccsr center is commissioned The"Add New Subscriber"section of the website h S I distributor has been completedby ingu ai"r or 4 service provider r -_-2 tt Three copies of the signed Service Pro Subscribe ;:,..,;, Monitoring Agreement are received by Norweco iaa?IEwC MkN+va:'..........�?Y.:......`..._..m._..,........._fi4'?:?.-..,.".i`.......... ___........__._._..�....... :..... r :A7'f.; .x,.....si.Faxrsk IZ�"+•Gta ri &9...«....,.........M... l4tsk rlxtwtY M: .. R<k w:6^>dr�k�Yt .; 6Ti��.iSM1'P���'ai.. - P, rjb&mrb6 Sn'�Mr ��G1 '6?Jlm',-`�.'+wy?.itx..3;7`�E ne:F3 .�,:.L SM - •.! �� \lseroaritetst SY+M*j idM ..,....: �a41N'ee'�t 4 - Ectacuc Q M-ysnHruA ..5i N r '>'� •y -��9.e a YL• �" NORWECO,•1NC- �®:.. .': .. .s. . M. „NQRWALK`�0HIO' . - nor ec :r. U:S:A:.4485Z er www.norweco.com - >'• ••'; '"" eitreatmentar CO Engloeering;t, ADD NEW SUBSCRIBER SCREEN ©MCMXCIX NORWECO.INC.NORWALK,OHIO U.S.A. k?�N � E�VICE � � 2Q�� SERVICE PRO MONITORING, INC. SUBSCRIBER MONITORING AGREEMENT QUEENSBURY Subscriber InformationG&_ °ODES__ s Name: IAA LTIG 0 g I-L SmCA IQ Email Address: N 10 t S q MQ I (,Ca Street Address: C 19 KNO-K, (ZQQd Af I County: USA City:0Uf:�f tAGW iZ\ State: -f-W YQI? Survey: Abstract: Zip Code: I-ZW4— Country: U S n Tract: Subdivision: Home Telephone: Qp Lot: Block: Mobile Telephone: rJ( D �51 0,9 (2`1 PCT: Section: Mailing Address: �q �2iVa Le Roaj j;�A- City: Que-CN,:5 State: Zip Code: I Z804 System Information , / Installation Date: 519 /22- Installation Type: I6/ Residential ❑ Commercial Singulair System Model: ❑ 960-500GPD ( ❑)960-750GPD ❑ 960-1000GPD ❑ 960-1250GPD �❑ 960-1500GPD ❑TNT 500GPD Aerator Serial Number: Control Serial Number: Control Model: Effluent Disposal Method: rcucyl kaeCI Pump Station: Uyes no Disinfection: ❑ yes "IN no Dechlorination: ❑ yes �(no ❑Auxiliary One ❑Auxiliary Two / ❑Auxiliary Three Inspection Frequency: ❑ 1 month ❑ 3 months ❑ 4 months 6 months ❑ 12 months Service Provider Information Company Name: I SS S-e j1 C CI N('1 M0 i ICI Contact: Address: � 1-r� Aky— I/\((jP—&bj �,9 City:�� �5 U�� State:_��` \ U�r—Zip Code: IZR04# Country:: Q! ;4 Office Telephone: 5 l�) 8194 Mobile Telephone: 6710 3 "I,,—! A S Fax Number: [ �1 Z (7j Email Address:� h 1 l i wNtI(, coM Notification Method: XOffice Telephone ❑ Mobile Telephone ❑Text Message ❑Fax ❑ Email Distributor Information i! /� 11 Company Name: 1_9S cS-Pi�h G C N\lC[ �)1ontact: I Va KI P-P, 1 Address: CS-} /`��'/ �/t City: � � SdCAJ(2 I State: hA-e�( Y WK Zip Code: IZ-00A Country: US'�i Office Telephone: �[J, (,S3 -7� 8 6 ` �i Mobile Telephone: �J f U 3 ( O Fax Number. c U 32 1Email Address: I 1 h S &C Cr C•(-()M Notification Method: Office Telephone ❑ Mobile Telephone ❑ Text Message ❑Fax ❑ Email TERMS AND CONDITIONS Note to subscriber: You,the subscriber,may cancel this agreement at anytime prior to midnight of the third business day after the date of this transaction. WHEREAS,the undersigned ,hereinafter called SUBSCRIBER,has heretofore entered an agreement with its Installation Co. ,hereinafter called SUBSCRIBER'S INSTALLATION CO., on/f hoc nn fhic Anfc nnfcrnrl intn on onmmnmonf ieiifh CDD\/If`G DQn hAnK11TnP1n1f_ 1K1(' nr itc occinnc horoin rollo`f CDD\/If`D DWI SUBSCRIBER MONITORING AGREEMENT IT IS THEREFORE AGREED for inconsideration of such agreement that: 1. Introduction.Subscriber has contracted with SERVICE PRO MONITORING,INC.("SERVICE PRO")for monitoring services at the location indicated on Pagel of this Agreement. 2 SERVICE PRO's Duties.Subscriber agrees and acknowledges that SERVICE PRO's sale and only obligation under the Agreement shall be to monitor signals sentfrorn Subscribers premises via communications media including,but not limited to,telephone lines,cellulardevices,satellite technology,and/or radio telemetry and received by means of a monitoring system(hereinafter"System")and to respond thereto by notifying the party(or parties)Identified by Subscriber.SERVICE PRO is NOT responsible and Subscriber assumes full responsibilityforthe working order,repair,maintenance and service of any and all equipment at Subscriber's premises and for any and all communications media used to transmit signals to the monitoring facility.Upon receipt of a signal,SERVICE PRO shall WITHOUT WARRANTY attempt to notify the party(or parties)that has been identified by Subscriber as the proper party to notify under the circumstances encountered. 3. Waiver of Warranty:Exculpatory Clause.Subscriber understands that SERVICE PRO offers several levels of protection services and that the level described has been chosen by Subscriber after considering and balancing various levels of protecdon afforded and their related costs.it is understood and agreed that:SERVICE PRO is not an insurer.That insurance,if any,shall be obtained by Subscriber covering real or personal property loss or damage and personal injury,including death.The payments hereunder are based solely on the value of the monitoring services as described herein and are unrelated to thevalue ofany ofSubsaiber's properly,orthe property of otherslocated at Subscriber's location,the value of which is known only by Subscriber.SERVICE PRO is not liable forlosses caused by the malfunction or non-function of the system or equipment or the monitoring,repairing,signal handling or dispatching services even if due to SERVICE PRO's negligence or failure toperform.Subscriber isawarethat circumstances where service may not work include but are not limited to a propersurge suppression system orwireless backup system not being employed. SERVICE PRO MAKES NO GUARANTEE OR WARRANTY,INCLUDING ANY IMPLIED WARRANTY OF MERCHANTABILITY OR FITNESS FOR A PARTICULAR PURPOSE,THAT THE SERVICES OR EQUIPMENT SUPPLIED WILLAVERT OR PREVENT OCCURRENCES,ORTHE CONSEQUENCES THEREFROM,WHICH THE SERVICES OR EQUIPMENTARE DESIGNED TO DETECT.SERVICE PRO MAKES NO WARRANTYOFANY KIND,EXPRESS OR IMPLIED THAT THE EQUIPMENT SUPPLIED,ORANY HARDWARE,SOFTWARE OR NETWORKS USED IN CONNECTION WITH THE SYSTEM SHALL CORRECTLY HANDLE THE PROCESSING. 4 Third Party Indemnification.Since the parties agree that Subscriber retains the sole responsibility for protecting against losses to its own property and the property of others located on its premises and for the life and safety of all persons on its premises,Subscriber agrees to indemnify,defend and hold harmless SERVICE PRO,its officers,employees,agents,subcontractors,suppliers,or representatives from and against all claims,lawsuits,and losses,induding attorney's fees,by persons not a parry to this Agreement,alleged to be caused by the Inn proper operation of the monitoring system,whether due to malfunctioning or non-functioning of the System orthe negligent performance or nonperformance of the monitoring services or other installation,maintenance,or other services by SERVICE PRO,or its officers, employees,agents,subcontractors,suppliers,or representatives. S. LfmitationofLiabflity:LiquidatedDamages.Subscriberacknowledgesthatitisimprarbcalandextremelydifficulttofxactualdamages,Ifany,whichmayproximatelyresultfromfaiilureonthepartofSERVICE PRO to perform any of its obligations or responsibilities herein,including,but not limited to its monitoring service,Installation or maintenance,the failure of the System to operate properly,by active or passive negligence,or byfailure to perform any ofthe obligations herein,because of among otherthings:(a)the uncertain amount or value of Subscribers property or the property of others kept at the monitored location which may be lost,destroyed,damaged or otherwise affected by occurrences which the System and/or services are designed to detect;(b)the uncertainty ofthe response time of any individual or entity should any of these parties be dispatched as a result of a signal being received or an audible device sounding;(c)the inability to ascertain what portion,if any,of any loss would be proximately caused by SERVICE PRO's failure to perform or by its equipment's or System's failure to operate;or(d)the uncertain nature of occurrences which might cause injury or death to Subscriber or any other person. THEREFORE,SUBSCRIBER ACKNOWLEDGES AND AGREES THAT IFANY LOSS OR LIABILITY IS ALLEGED AGAINST SERVICE PRO,IRRESPECTIVE OF CAUSE,INCLUDING,BUT NOT LIMITED TO,WHETHER THE LOSS OR LIABILITY IS CAUSED BY SERVICE PRO'S OWN NEGLIGENCE,SUCH LIABILITY SHALL BE LIMITED TO AN AMOUNT EQUAL TO THE ANNUAL MONITORING FEE OR FIVE HUNDRED(500.00)DOLLARS,WHICHEVER IS LESS. This sum shall,be paid and received as e'Ither(1)liquidated damages and notes a penalty,or(2)as a limitation of llablity approved and agreed upon bythe parties.The payment of this amountshall be SERVICE PRO's sole and exclusive liability.Under no circumstances shall SERVICE PRO be liable to Subscriber for consequential damages of any nature in excess of such amount,including,without limitation,to real or personal property,loss of property or revenue,cost of capitol,costs of purchased or replaced goods,other economic loss or damages forpersonal injury or damages however occasioned,and whether alleged as caused by the installation,repair,design,sale,lease or falure of the monitoring equipment or service orthe performance or nonperformance of obligations and responsibilities under this agreement or breach of warranty or negligence,active,passive,joint,several or otherwise,strict liability,tort,orotherwise by SERVICE PRO,its officers,employees,agents,subcontractors,suppliers,or representatives. a Subscriberagrees to obtain insurance coverage adequate to protect Subscribers interest in light ofthe limitation offiability stated in thisAgreement.If SubscriberwishLs SERVICE PRO to increasethe amountofthe above limitation of liablityorliquidated damages,Subscriber may inquire about obtaining an Increase to this amount in exchange for the payment of an additional monthly charge,but such additional monthly charge shall not be construed as responsibililyto obtain and maintain Insurance.The foregoing shall survive the termination or expiration of this Agreement. SERVICE PRO assumes no responsibility for anyloss In excess of such amount. 6 Subscriber's Duties.In addition to Subscribers duty to indemnify,defend,and hold SERVICE PRO,is officers,employees,agents,subcontractors,suppliers,or representatives harmless as provided above: (a)Subscribershall cooperate with SERVICE PRO in the installation,operation,and maintenance ofthe system and agrees to follow all instructions and procedures which maybe prescribed for the operation ofthe System,the rendering of services and the provision of monitoring for the premises.(b)Subscribershall pay all charges made by any telephone company or otherutlity,or communications organization for installation,leasing,and service charges oftelephone lines orother communications technologies connecting Subscribers premises to SERVICE PRO.Subscriber acknowledges that notification signals from Subscribers premises to SERVICE PRO are transmitted over Subscribers communications service and that in the event the communications service is out of order,disconnected,paced on"vacation", or otherwise interrupted,signals from Subscribers system will not be received by SERVICE PRO during any such interruption and will not be known to SERVICE PRO.Subscriber agrees that in the event the equipment orsystem continuously transmits signals reasonably determined by SERVICE PRO to be false and/or excessive in number,Subscribershall be subject to the additional costs and fees incurred by SERVICE PRO in receiving and/or responding to the excessive signals. 7. Authorized Personnel&Emergency Information.Subscriberagrees,to furnish a written list ofthe names and telephone numbers Cf2ll persons to be notified in the event of a notification signal.Subscriber agrees to provide all changes,revisions and modificationsto the above to SERVICE PRO in writing ina timely manner.Subscriber shall furnish to SERVICE PRO certain emergency information and shall keep it current by providing SERVICE PRO with any changes in writing,providing the required identifying information Ina timely manner. & Assignees and/or Subcontractors of SERVICE PRO.SERVICE PRO shall have the rightto assign this Agreementin whole or in part to any other person,firm,or corporation and shall have the further right to subcontract any surveillance,monitoring,maintenance,emergency response,or other services which it maybe required to perform hereunder.Subscriber acknowledges that this Agreement,and particularly those paragraphs relating to SERVICE PRO's maximum liablity and third party indemnification,shall inure to the benefit of and are applicable to any assignees and/or subcontractors of SERVICE PRO,and that they bind Subscriber W th respect to said assignees and/or subcontractors with the same force and effect as they bind Subscriber to SERVICE PRO. 9. Assignment by Subscriber.Subscriber acknowledges that the sale or transfercif'Subscriber's premises shall not relieve Subscriber olduties and obligations underthis Agreement unless SERVICE PRO agrees in writing to the transfer of the Agreement. 10. Taxes,Fees,Fines,Licenses and Permits.(a)Subscriberagrees to pay all sales tax,use tax,property tax,utility tax,and othertaxes required in connection with the equipment and services listed,including telephone company line charges or other communications technologies,If any.SERVICE PRO shall have the right,at any time,to pass along to Subscriber any increases in the monthly charges which hereafter may be imposed on SERVICE PRO by utility or government agencies relating to the service(s)provided underthe terms of thisAgreement,and Subscriber hereby agrees to pay the same.(b)Subscdberagrees to assume all responsibility foranyfalse notifications or signals given by the System.Subscriberw ll indemnify,pay and defend SERVICE PRO and its authorized contractors and subcontractors and hold each of them harmless from and against any responsibility or liability for payment of associated fines,penalties or other costs.(c)Subscriber shall comply with all laws and regulations relating to the equipment and its use and shall promptly paywhen due all sales,use,property,excise and othertaxes and all license and registration fees now or hereafter imposed by any government body or agency upon the equipment or its use.If Subscriber fails to maintain any required licenses or permits,SERVICE PRO shall not be responsible for performing the services and may terminate the services with notice to Subscriber. 11. Increase in Service Charges.SERVICE PRO shall have the right to Increase the Service Charges provided for herein by giving Subscriber thirty(30)days written notice in advance ofthe effective date of such increase.Charges for time and material services are based upon SERVICE PRO'service rates in effect at the time of the service,and are subject to change without notice. 12 Delay or Interruptions.SERVICE PRO assumes no liabiityfordelayIntheinstallationsoftheSystemorforinterruptionofmonitorngservicesduetostrikes,riots,floods,storms,earthquakes,fire,power failures,insurrections,interruption ofavailability,of telephone cable,cellular,satellite,or radio service or any communications service through any other medium,malfunction or unavalablity of the system related to data handling problems,delayof response time,acts of termdsm,acts ofwarwhetherthrough direct orindirect actions,irrespective of cause,acts of God,erfor any othercause beyond the control of SERVICE PRO,and will not be required to provide installation,monitoring services or other services to Subscriberwhile interruption of service due to any such cause may continue.SERVICE PRO assumes no liability fordelay of installation orservices due to noncooperation of Subscriber or his agents in providing access to that area of installation orservice on any device or devices of Subscriberor ofothers to which SERVICE PRO's equipment is attached.SERVICE PRO shall not be obligated to perform any monitoring service hereunder during anytime when the communications equipment and/or service shall not be working. 13 Outside Charges.Subscriber understands and accepts that SERVICE PRO specifically denies any responsibliftyfor charges associated With the notification or dispatching ofanyone,including,but not limited to any government personnel oragencles,and ffthere are any charges Incurred as a result of said notification or dispatch,said charges shall be the responsibility of Subscriber,whether requested or not and whether such entities were correctly or incorrectly notified by SERVICE PRO,its agents,or subcontractors. 14 Cancellation.This agreement maybe cancelled by SERVICE PRO at anytime,upon a ten(10)day written notice,if false notifications and/or"runaway"signals continue to occur. 15. Default/Tertnination. In the eventSubscriberfatistopayanyamount,Subscriberabusestheequipmentortheuseofthemonitoringfacility,Subscriberfallstocomplywithanyofthetermsandconditions hereof.Subscriber makes an assignment for the benefit of creditors,an order for relief is entered against Subscriber under any chapter ofthe National Bankruptcy Code,as amended,a receiver or trustee is appointed for all,or substantially all,the assets of Subscriber,or there is a dissolution or termination of existence of Subscriber,or if Subscriber is in default underthis Agreement and such default continues for ten(10)days afterSERVICE PRO gives Subscriberwritten notice of such default,in addition to any other remedies provided bylaw,SERVICE PRO may pursue anyone or more ofthe following remedies, which are cumulative and nonexclusive:(a)Terminate all services subscribed for hereunder by giving ten(10)days written notice to Subscriber,without terminating this Agreement,and recover all amounts due to SERVICE PRO;(b)Take possession of all Service Pro owned equipment wherever situated and for such purpose enter upon Subscriber's propertywithcut liability for so doing;(c)By notice to Subscriber, declare immediately due and payable all moneys to be paid by Subscriber during the Primary Term or,ifthe Primary Term has then expired,declare immediately due and payable all moneys to be paid during any Renewal Tenn then in effect,and Subscriber shall in any event remain fully liable for reasonable damages as provided bylaw and for all costs and expenses incurred by SERVI CE PRO on account of such default including all court costs and reasonable attorney's fees.The waiver by SERVICE PRO of a breach of any obligation of Subscribershall not be deemed a waiver of such obligation or any subsequent breach ofthe same orany other obligation.The subsequent acceptance of payment hereunder by SERVICE PRO shall not be deemed a waiver of any prior existing breach,regardless of SERVICE PRO's knowledge of such prior existing breach at the time of acceptance of such payments. IF; nOnerr}nfTcrmc Rhni old theca arim a mntlirt nfrnrmc nr mndirinnc hahuaan fhic anrcwmvnt an.i a nurrhaeo nrrior it is anrawi 1haHhic rnntrarf chat/hP cunrama anri hinr7inn Office Use Only SEPTIC VARIANCE Permit#: APPLICATION Permit Fee:$ Tolm of[Zrecnsbury Invoice#: 742 Bay Road,Queensbury,NY 12804 P:518-761-8256 www.gueensbury.net Approvals: Submittal: 1 (one) original.& 8 copies of the completed application package Contact Information: . PLEASE PRINT LEGIBLY OR TYPE, PLEASE INCLUDE AN EMAIL Property Owner(s): Morgan Stritsman Owner's Agent: Environmental Design Partnership Address: 240 Town Office Road Address: 900 Route-146 Clifton Troy NY, 12180 Park NY, 12065 Phone#: 518-859=0467 Phone#: 518-371-7621 Email: mostrits@gmail.com Email: nzeglen@edpl1p.ccntE C E 0 W cdemyer@edpllp.c Site Information: APR 12 2022 19 Private Road#1 off of Cleverdale Site Address: Road Tax ID#: 240.9=1-6 TOWN OF QUEENSBURY BUILDING &CODES Directions to Site.-From 9L turn onto Cleverdale Road,First Left onto Private oa , Stay Right and last property on the left. Distance from well on property to septic system (if applicable) 71 feet Is it possible to install a conforming septic system on this property? ❑Yes ❑x No If YES, please explain and attach a diagram: Does the proposed system meet setback requirements for distance from wells &septic systems on neighboring properties? [-]Yes ] No If NO, please explain: Is the proposed system to be installed under a parking area? ❑Yes ❑x 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.): V-1A:WASTEWATER ABSORPTION FIELD TO LAKE 84'REQUESTED VS THE 100'REQUIRED Septic'Variance Application Revised January 2021 r . List the names, parcel addresses, and tax map numbers of all adjoining property owners. You may obtain this information from the Town of Queensbury's Assessor's Office: North N a m e Katherine W Corney. Address 49 Cleverdale Road Tax Map ID 240.5-1-1 South Name Peter Iwanyckyj Address 17 Cleverdale Road Tax Map ID 240.9-1-5 East Name Raymond H. Kraft Address Cleverdale Off Rd Tax Map ID 240.9-1-16.12 . . West Name Address Tax Map ID OWNER STATEMENT I/We do hereby relieve the Town of Queensbury from any liabilities on the plumbing and septic system located at: I/We realize that putting the well, septic tank or leaching system less than the required feet from the may increase the risk of pollution. Owner—Print Name: Evan Stritsman Owner—Signature: Date: 10/26/2021 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: I/We realize that putting the well, septic tank or leaching system less than the required feet from the may increase the risk of pollution. Neighbor/Tenant—Print Name: Neigh bor/Tenant-Signature: Date: Septic Variance Application Revised January 2021 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: S®fi,pFzL{CbldhlMop a � c- - 'ir.G140TI irg � i4'1 If ice•Sy—"+y f flip " f.�\ _ 3 �,•+L -, • ±'T�' R. rs... i'`'•. �y;,J.yF FarrdgY.si. fi e u 1Oren Gut+a: q perc.•rn,Ro 12 1 ,. rr Ttrtin L`u>ea �tsj,giep •vf'•. ,Jt Septic Variance Application Revised January 2021 y 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: Evan&Morgan Stritsman Environmental Design Partnership Designates: as agent regarding the Septic Variance for . Site Address: 19 Private Road#1 Queensbury NY Tax Map#: 240.9-1-6 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: Evan Stritsman OWNER—SIGNATURE: DATE: I()/ /P0P1 AGENT—PRINT NAME: Nick Zeglen AGENT—SIGNATURE: DATE: 10/26/2021 Septic Variance Application Revised January 2021 ENVIRONMENTAL DESIGN PARTNERSHIP, LLP 900 Route 146 Clifton Park,NY 12065 (P)518.371.7621 edpllp.com Shaping the physical environment April 12, 2022 Mr..J.ohn O'Brien Director Town of Queensbury Board of Health. 742 Bay RoadFR7 Queensbury, NY 12804 APR 12 2029 Regarding: Stritsman Residence— 19 Private Road#1 TOWN OF QDEENSBURY Septic Disposal Variance Application BUILDING&CODES Dear.Mr. O'Brien: On behalf of the applicant, Morgan and Evan Stritsman, please find attached application materials for Septic Disposal Variance at their property located at 19 Private Road#1. The project was granted Sewage Disposal Variances (BOH 80, 2021) by the Town Board of Health on December-6th, 2021 and Septic Disposal Permit was submitted and granted April 6, 2022. The contractor for the project was on-site to begin construction on April 11 th, 2022 and during preliminary stake out it was determined that the proposed system required an additional variance not listed as part of the original application. Due to the nature of the shoreline contours on the.southern neighboring parcel,rthe southwest corner of the proposed septic field is 84 feet from the neighboring shoreline in this location. This setback is 16 feet less than the required shoreline setback of 100 feet. This application requests relief for this additional setback. We respectfully request that this item be placed on the April 18th Town Board Agenda. Please do not hesitate to reach out to me if you have any questions. Sincerely, Nicholas Zeglen, P.E. Environmental Design Partnership cc: i ' Office Use Only SEPTIC VARIANCE Permit#: 3 ti'OIFW- 2VZL APPLICATION Permit Fee: $ ?bwn o£f1_zrccnsI;uzy Invoice#: t?*Z) 742 Bay Road,Queensbury,NY 12804 P:518-761-8256 www.gueensbury.net Approvals: Submittal: 1 (one) original &8 copies of the completed application package Contact Information: PLEASE PRINT LEGIBLY OR TYPE, PLEASE INCLUDE AN EMAIL Property Owner(s): Morgan Stritsman Owner's Agent: Environmental Design Partnership Address: 240 Town Office Road Address: 900 Route 146 Clifton Troy NY, 12180 Park NY, 12065 Phone#: 518-859-0467 Phone#: 518-371-7621 @ Email: mostrits@gmail.com" Email: nzeglen@edpllp.com, ®� cdemyer@edpllp.com Tpw ,�N Q ���� ►� Site Information: 19 Private Road#1 off of Cleverdale �� Site Address: Road Tax ID#: 240.9-1-6 Directions to Site:From 9L turn onto Cleverdale Road, First Left onto Private Road#1, Stay Right and last property on the left. Distance from well on property to septic system (if applicable) 71 feet Is it possible to install a conforming septic system on this property? ❑Yes ❑x No If YES, please explain and attach a diagram: Does the proposed system meet setback requirements for distance from wells&septic systems on.neighboring properties? ❑Yes K] No If NO, please explain: Is the proposed system to be installed under a parking area? ❑Yes ❑x 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.): V-1:WASTEWATER ABSORPTION FIELD TO WELL 7P REQUESTED VS THE 100'REQUIRED V-2:ENHANCED TREATMENT UNIT TO FOUNDATION 4'REQUESTED VS.THE 10'REQUIRED V-3:PUMP TANK TO FOUNDATION 3'REQUESTED VS.THE 10'REQUIRED V-4:WASTEWATER ABSORPTION FIELD TO FOUNDATION 11'REQUESTED VS.THE 20'REQUIRED V-5:WASTEWATER ABSORPTION FIELD TO PROPERTY LINE T REQUESTED VS THE 10'REQUIRED Septic Variance Application Revised January 2021 List the names, parcel addresses, and tax map numbers of all adjoining property owners. You may obtain this information from the Town of Queensbury's Assessor's Office: North Name Katherine M. Corney Address 49 Cleverdale Road Tax Map ID 240.5-1-1 South Name Peter Iwanyckyj Address 17 Cleverdale Road Tax Map ID 240.9-1-5 East Name Raymond H. Kraft Address Cleverdale Off Rd Tax Map ID 240.9-1-16.12 West Name. Address Tax Map ID OWNER STATEMENT I/We do hereby relieve the Town of Queensbury from any liabilities on the plumbing and septic system located at: I/We realize that putting the well, septic tank or leaching system less than the required feet from the may increase the risk of pollution. Owner—Print Name: Evan Strltsman Owner—Signature: Date: 10/26/2021 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: I/We realize that putting the well, septic tank or leaching system less than the required feet from the may increase the risk of pollution. Neighbor/Tenant—Print Name: Neigh bor/Tenant-Signature: Date: Septic Variance Application Revised January 2021 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: Ta .- rj ..Cii`$k ti• fy ; PI }Z� f I —Ti — R" rrnR° 'Fi rr - YmLllkoa Septic Variance Application Revised January 2021 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: Evan&Morgan Stritsman Environmental Design Partnership Designates: as agent regarding the Septic Variance for Site Address: 19 Private Road#1 . Queensbury NY Tax Map#: 240.9-1-6 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: Evan Stritsman OWNER—SIGNATURE: DATE: 1w6/p0p1 AGENT—PRINT NAME: Nick Zeglen AGENT—SIGNATURE: DATE: 10/26/2021 Septic Variance Application Revised January 2021