PT-0500-2022 Property Transfer Sewage Disposal Information Form
Date:.
Town of Queensbury
742 Bay Road,Queensbury,NY 12804
P:518-761-8256 www.gueensbury.net
(Name of Owner/Applicant)
Re: Onsite Wastewater Treatment System Inspection Information Request for:
Vi $%A-A*- (2~&66o*� NY asotj
(Site Address for Inspection)
Thank you for requesting an inspection for the onsite wastewater treatment system (OWTS) located on the
property referenced above: We look forward to completing a thorough'inspection for you. You can help us do
the best job possible by providing some advanced information about the site. Prior to our inspection,we request
this completed application, a site map indicating the location of the septic components and confirmation the
pre-inspection preparation (see the last page of this packet) will be completed prior to our arrival.
Enclosed is a Septic System Inspection Information form, which must be completed, signed and returned to
this office, with the appropriate fee(s) and documentation, prior to scheduling an inspection.
Please note the Town of Queensbury's fee for this service is$275. Be advised that all fees must be paid prior to
scheduling the inspection. We require 48 hours notification prior to scheduling the inspection.
If the purchaser is requesting an exemption, please submit this application along with a notarized letter stating
the septic system will be inspected or repaired/replaced within 6 months from the date of the Property
Conveyance or June 1st of the current, or following year (whichever comes first), a map locating the septic
system and payment totaling $2275 ($2000 refundable deposit plus $275 permit fee). The deposit is forfeited
if the owner fails to complete the repairs or installation as stated above.
If you have any questions,-please call.
Phone: (518) 761-8256 Email: kated@queensbury.net
Thank you.
Sincerely,?
John O'Brien, Director
Building and Code Enforcement
Town of Queensbury
Property Transfer Packet Revised July 2022
Office Use Only
Permit#: ►
rm*,n ofQucc�nsh n Fee:_$ •Z�5
742 Bay Road,Queensbury,NY 12804 q
P:518-761-8206 or 518-761-8205 Invoice#: Z� 1
www.gueensbury.net
SEWAGE DISPOSAL SYSTEM INSPECTION INFORMATION
Individual Residential Wastewater Treatment System
CONTACT INFORMATION (please print legibly or type and include an email address)
Property and Owner Information: (Please attach property survey or tax parcel map)
Property address for inspection: 2 �/ Ak `N4±f= Y-JL• Q PY
Tax map number: 16 - 19
Property owner: tS4."� /
Mailing Address (c/s/z):
Cell #: Land Line #:
AUG 12
Email: 4
12
TO CrY ' -`eshjsBU
f'vC e� CQi,p�.S�Y
Applicant (if different than above): !` �Y
Mailing Address (c/s/z): OZ I`l C=' k-e-K
Cell #: 5 12S) 5A - 2-°A104 Land Line#:
Email: 41A @ CAaA - CQ,,uN
❑ Proposed Owner ❑ Realtor ❑ Attorney WOther (explain: )
Septic Contractor: OAS; f-•AA-wc4®6
Mailing Address (c/s/z):
Cell #: Land Line#:
Email: _Vr1c VS
Reason for Inspection Request:
❑On the market ❑ Future Iisting,6Sale Pending ❑ Deed Transfer ❑Other:
Property Transfer Packet Revised July 2022
HOUSEHOLD INFORMATION
"PLEASE SEE SEPARATE PAGE FOR EXEMPTIONS"
# Bedrooms { # Bathrooms I— # Kitchens I Jacuzzi tub(s).A Garbage grinderA/A
Onsite Wastewater Treatment System:
How many systems are on the property?
Year system(s) installed: Tank 201b Size of Septic Tank �v�;o� �1:�_ 450 CIX ens V#41
Type of Absorption System: T-:: svto Vt., 11_�O
Are all system components wholly within the property boundaries? Yes ❑ No
Are system plans available? E6 Yes ❑ No
Does the ( p p
multiple s) serve s stem properties? ❑ Yes �o
Y
If yes, describe
Maintenance:
Service agreement? Yes ❑ No; If yes, business' name
Date of last inspection rJ 3I Z2-N/A ❑ Date tank last pumped N/A
Frequency of pumping N/A Wo,
.List known repairs/replacements, with dates:
Date Type of Repair/Replacement
Operation:
System problems? ❑ Yes [0/;�lo
Sewage odors? ❑ Yes i o
El surface discharge(s)? Yes 5o
❑Back-up of toilets? Yes [Ko
❑Back-up of any other fixtures? (e.g. slow drains) Yes Z�o
Seasonal ponding or breakout of leach field? ❑ Yes [ No
Property Transfer Packet Revised July 2022
t
i
Statement of Acceptance of Conditions:
I agree to:
• Ensure that the septic tank(s), distribution bofles), and/or seepage pit(s), if any, will
be uncovered prior to the requested inspection time;
• Have a septage hauler on site (to pump the tank after*the inspector verifies flow
from fixtures);
➢ Tank must be pumped in presence of inspector
• Have an authorized representative present at the site;
• Allow the inspector to verify information provided above, and to conduct an
inspection of the indicated onsite wastewater treatment system(s), including all
system components and interior plumbing in crawl spaces and basements.
To the best of my knowledge, the information provided above is accurate and I acknowledge
the following:
After 1 year from date of submission and there is no activity on this permit, the permit will
expire and will be subject to submission of a renewal application and payment of the renewal
fee based on the current fee schedule. All fees must be paid PRIOR TO SCHEDULING any
inspections. In addition, if the permit is withdrawn 30% of the fee is retained by the Town of
Queensbury.
Signature of property owner or authorized agent:
Affiliation: ❑owner agent ❑ other:
Please print name: N'e-6'41
Signature: Date: �� �"�"
Prior to scheduling with the Town of Queensbury, you MUST:
1. Schedule a sewage hauler to be on site to pump tank while inspector is on site.
Hauler should arrive 30-45 minutes after scheduled time with the Town of Queensbury's
Code Enforcement Officer.
2. Expose inlet and outlet of septic tank, and/or pump station, expose d-box, expose
any seepage pit covers.
3. Excavate test hole in leach field if there is no d-box:
Property Transfer Packet Revised July 2022
239.16-1-18 PT-0500-2022
Estate of William & Mary Ann Green
24 Burnt Ridge Rd
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Property Transfer -- sale pending
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ie z FIGURE 2 — REPLACEMENT ONSITE WASTEWATER TREATMENT SYSTEM FILE NUMBER
EEM2015-034
FIGURE 3 — SELECTED DETAILS DATE
-E FIGURE 4 — SYSTEM SPECIFICATIONS & GENERAL NOTES 07-01-2015
FIGURE N0.
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BASIS OF DESIGN
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THIS PLAN INCLUDES INFORMATION PERTAINING TO REPLACING''AN`, ',,•'. N' m
EXISTING METAL SEPTIC TANK.WITH:AN.ENHANCED'TREATMENT•'UNIT'`'
AT AN EXISTING 4 BEDROOM COTTAGE-'THIS.SYSTEM,'WILL HANDLE
ALL THE WASTEWATER GENERATED AT THE-COTTAGE. NO'ADDITIONAL ' z,v 'o a
BEDROOMS ARE BEING PROPOSED. �• a
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THIS DESIGN SPECIFIES 'THE INSTALLATION OF-A CL4RUS FUSION-. W Z' o
ZF450 ENHANCED TREATMENT,UNIT.. THE FUSION ZF 450•'IS.AN NSF.'.
�+ STANDARD,40:APP.ROVED CLASS-1 SYSTE61''NITH'.A,'450.'GPD:, 01: co
TREATMENT.CAP.ACITYs EFF.LUENT!FROM'-THE'FUSION:WILL'FLOW,BY Z)
GRAVITY THROUGH-AN:ULTRAVIOLET LIGHT-AND,.CONTINUE TO Z.U w.
EXISTINGDRY WELL.• Alim, W. W v
BASIS OF DESIGN: DESIGN FLOW 110 GALLONS PER BEDROOM'X'4 UJ w
BEDROOMS = '440 GALLONS PER DAY; NO GARBAGE GRINDER. N0.` ,,;: m.
+-BEDROOM ADDITIONAL BEDROOMS SHALL' BE-ADDED. m
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DWELLING.• DRINKING:WATER-IS SUPPLIED•TO.
'THE COTTAGE FROM LAKE GEORGE
PIO ONSITE`DRINKING,WATER.SUPPLY.WELLS:ARE KNOWN`TO'BE, i._:;-•?': o 0
INSTALL FUSION:.ZF450>UNIT' r _=' LOCATED'WITHIN-100' FROM•THE'EXISTING SEPTiG.SYSTEM_
SEE'SPECS & DETAILS,-
CONSTRUCTION SHALL BE UNDER THE SUPERVISION OF.THE ':_ "'''-` '`•: .�
o UV LIGHT'. `. PROFESSIONAL:ENGINEER CERTIFYING THAT, THE SY.STEM'WAS. o LZ LLJ
o DISINFECTION UNIT: INSTALLED-IN SUBSTANTIAL ACCORDANCE..WITH THE 'APPROVED.',, ;, '-' nI
SEE•SPEC.S'& DETAILS,: DOCUMENTS. THESE PLANS HAVE BEEN`PREPARED:FOR`.THE,USE-BY' �-
,,'p - ,,`..',• = THE CURRENT-PROPERTY OWNER. UNAUTHORIZED'•AL-TERATIONOR:,;` se
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ADDITION-OF THESE PLANS`IS:A.VIOLATION"OF•THE•-NEW YORK:STATE`,'_„ `'''0'�.';,,':,
liT EXISTING: d' EDUCATION LAW ARTICLE'r145, SECTION'7209:, r:.: W'
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PROJECT LOCATON WILLIAM GREEN;RESIDENCE m 24 BURNT RIDGE ROAD QUEENSBURY,..NEW YORK �I-12804 I V S f. ,T
TOWN OF QUEENSBURY ,COUNTY•QF;.WARREN- ENGINEERING PLLC
W,m I n O E OWNER ADDRESS
cn 38 FORT AMHERST'ROAD; ''` SYRACUSE;NY='(315)25+=6891
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QUEENSBURY,:`NY 1Z8O4 DESIGNED eY 'EEM,' - APPROVED;EiY.',EEM
`� SELECTED. DETAILS " DRA"9 BY'".ER�C E. MURDocK P.E.
GENERAL CONSTRUCTION NOTES
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GRADE ALL ELECTRICAL WORK SHALL BE COMPLETED BY A QUALIFIED ELECTRICIAN IN COMPLIANCE WITH Ucow
THE NATIONAL ELECTRIC CODE, STATE CODE, AND LOCAL CODES. J cD ,'j
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NO ROOF DRAINS, FOOTING DRAINS, OR WATER SOFTENING BACKWASH SHALL BE CONNECTED TO d N• m
m ELECTRICAL JUNCTION BOX THE SYSTEM.
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ANY CURTAIN DRAINS MUS1 BE 15 FEET FROM THE DISPERSAL FIELD. Z y a o
\-4"0 SCHD 40 RISER ® �
LANDSCAPE - INSTALLER SHALL, TO THE EXTENT PRACTICAL, LIMIT,DISTURBANCE TO THE < c�
m EXISTING VEGETATION INCLUDING MATURE TREES. SOME TREE REMOVAL MAY BE NECESSARY / W Z o
a HOWEVER, NO TREES SHALL BE REMOVED WITHOUT THE OWNERS EXPLICIT CONSENT. ALL a���ddd/i) W Lil a:
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AREAS DISTURBED BY THIS CONSTRUCTION SHALL BE COVERED WITH A MINIMUM OF 4-INCHES z O
INLET OUTLET_ OF TOPSOIL AND PROPERLY SEEDED TO GRASS AND MULCHED. o U
SETTLING OF FINISHED LANDSCAPING IS LIKELY TO OCCUR AND MAY REQUIRE REGRADING IN A zR. W < v
YEAR.
4'0 SCHD 40 TYP. w w
SILT FENCE AND STRAW BALES SHALL BE INSTALLED AS NEEDED TO PREVENT SOIL FROM
DISINFECTION WASHING OFF-SITE.
CHAMBER j m
THE CONTRACTOR SHALL CALL DIG SAFELY NEW YORK (1-800-962 L7962) AND HAVE THE
PROPERTY OWNER LOCATE ANY ON-'SITE UTILITIES PRIOR TO INITIATION OF ANY CONSTRUCTION o 0
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 o Z W
THE EQUIPMENT MANUFACTURES RECOMMENDATIONS OUTLINED IN THE HOMEOWNER'S MANUAL 00 W
clj(CLARUS DOCUMENT CL0056, DATED 2012). ONSITE SALES & SERVICE, LLC. HAS BEEN TRAINED � O
UV LIGHT_DISINFECTION UNIT DETAIL
TO PERFORM INSTALLATION, OPERATION & MAINTENANCE BY THE EQUIPMENT MANUFACTURE Y Q z
AND IS AN AUTHORIZED SERVICE PROVIDER. �
NTS ALL SYSTEM COMPONENTS SHALL BE INSTALLED, OPERATED, AND MAINTAINED IN ACCORDANCE } W
WITH EQUIPMENT MANUFACTURES RECOMMENDATIONS, DESIGN DRAWINGS, AND ALL STATE AND w w
SYSTEM SPECIFICATIONS LOCAL REGULATIONS. 6 Z z O 0 d, W
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CONSTRUCTION SHALL BE UNDER THE SUPERVISION OF THE PROFESSIONAL ENGINEER 2 x � CC N (J
INSTALL FUSION ZF 450 AT THE LOCATION SHOWN ON FIGURE 2 IN ACCORDANCE WITH CERTIFYING THAT THE SYSTEM WAS INSTALLED IN SUBSTANTIAL ACCORDANCE WITH THE (n'= O (-
MANUFACTURES WRITTEN INSTALLATION INSTRUCTIONS FOUND IN CLARUS DOCUMENT w DO (n >
APPROVED DOCUMENTS. p U
CL0056, DATED 2012. TREATMENT TANK SHALL BE PLACED ON 6"LAYER OF WASHED Z W Z (q
BROKEN STONE (1/4 - 1/2 INCH DIAMETER) LEVELED TO WITHIN 1/8-INCH SIDE TO SIDE NO GUARANTEE AS TO THE FUNCTIONALITY OR LIFE EXPECTANCY OF THE OWTS IS WARRANTED w w _ > :"
AND END TO END. TANK EXCAVATION SHALL EXTEND 12-18" LONGER AND WIDER THAN OR IMPLIED BY THE ENGINEER. W� m O
TANK. FUSION 450 TANK MEASURES 851 X 44"W X 62�H_ SUITABLE GRANULAR 0 of Q F-
MATERIAL SHALL BE PLACED ON THE SIDES OF THE FUSION UNIT TO BRING THE THIS SEPTIC SYSTEM IS DESIGNED FOR USE WITH BIODEGRADABLE PRODUCTS ONLY. USE OF < DO I m Q
SURROUNDING GROUND TO GRADE. INSTALL THE FUSION WITH ONE 6-INCH RISER TO ANY OTHER PRODUCTS MAY CAUSE PREMATURE FAILURE. < o D7 G' Z U
BRING THE LIDS TO GRADE. =X Z O W
CORRECTING MATERIAL/PRODUCT DEFICIENCIES IS THE RESPONSIBILITY OF THE J w W �'- W
INSTALL ONE DEDICATED 115 VOLT, 20 AMP ISOLATED ELECTRIC CIRCUIT FROM THE MAIN MANUFACTURE/SUPPLIER. WORKMANSHIP IS THE RESPONSIBILITY OF THE INSTALLER. THE 0 W 00 O V
ELECTRICAL SERVICE TO FUSION PANEL. INSTALL A GROUND FAULT INTERRUPTER (GFI) UNDERSIGNED ENGINEER DOES NOT GUARANTEE OR WARRANTEE EITHER-OF THE ABOVE. O Q r�OrW
EXTERIOR OUTLET INSIDE THE RISER WHERE THE COMPRESSOR IS LOCATED. ir 0-
THE ENTIRE WASTEWATER TREATMENT SYSTEM INCLUDING TANKS, PIPING, RISERS, COMPONENTS, F_ L
FUSION EFFLUENT SHALL BE PIPED THROUGH A 4" DIAMETER SCHEDULE 40 PVC WITH AND LIDS SHALL BE INSTALLED WATER-TIGHT. THE SYSTEM MAY BE TESTED FOR WATER o x O :E
SOLVENT-WELDED JOINTS, LAID AT MINIMUM GRADE OF 1/8 INCH PER FOOT INTO A TIGHTNESS. CONTRACTOR WILL RE-INSTALL ANY EQUIPMENT/COMPONENT THAT IS NOT FOUND Q Do W
CLARUS MODEL 5250-0004 ULTRA VIOLET LIGHT DISINFECTION UNIT. INSTALL THE ULTRA TO BE WATER TIGHT. TANKS SHALL BE INSTALLED AS NEEDED (TO BE DETERMINED BY THE aJ
VIOj'VTF� DISINFECTION UNIT IN ACCORDANCE WITH THE MANUFACTURES WRITTEN INSTALLER) TO RESIST BUOYANCY. N 0 U)
RE5. w
nnU OSPECIFIED EQUIPMENT AND MATERIALS MAY BE REPLACED WITH ENGINEER-APPROVED
RD S. EQUIVALENT EQUIPMENT OR MATERIALS. PROPOSALS FOR PRODUCTS SEEKING °y�e�a o���
n APPROVED-EQUAL-STATUS SHALL BE SUBMITTED TO THE ENGINEER FOR REVIEW. FILE NUMBER
�)999Z
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EEM2015-034
'= d x THESE PLANS HAVE BEEN PREPARED FOR THE USE BY THE CURRENT PROPERTY OWNER. DATE
W UNAUTHORIZED ALTERATION OR ADDITION OF THESE PLANS IS A VIOLATION OF THE NEW YORK 07-01-2015
v STATE EDUCATION LAW ARTICLE 145, SECTION 7209. FIGURE NO.
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ROFESS0
TOWN OF QUEENSBURY
742 Bay Itoad,Queensbury,NY 12804-5902 (518)761-8201
Community Development-Building&Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20150296 Application Number: A20150296
Tax Map No: 523400-239-016-0001-018-000-0000
Permission is hereby granted to: WILLIAM&MARY ANN GREEN
For property located at. 24 BURNT RIDGE Rd
in die 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: WILLIAM& MARY ANN GREEN
38 FORT AMHERST Rd Septic Alteration Residential
QUEENSBURY NY 12804-0000 Total Value
Contractor or Builders Name/Address Electrical Inspection Agency
i
Plans&Specifications
BP 2015-296
Residential Septic Alteration Year 1920 camp - 4 bedrooms
$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 date.
Dated at the To of Q jnsb ;4 WayJuly09,2015
SIGNED BY for the Town of Queensbury.
Director of Building&Code Enforcement
SEPTIC DISPOSAL APPLICATION Office Use Only
Received
DATE: rl e aJ Igo I< Tax Map ID
i TAX MAP ID: a 3� { - _ g Permit No. { - (o
j Permit Fee
i ZONE:
APPLICANT t (��yt r'Pe r) PHONE/E-MAIL Ceu
Ek ADDRESS 4 &Ln±
f INSTALLER/ PHONE/E-MAIL
BUILDER
OWNER
ADDRESS 3 r t4h-,1�ersfi 1 I-dgohl
CONTACT PERSON FOR BUILDING&CODE COMPLIANCE: l L
PHONE/E-MAIL
4 _
RESIDENCE INFORMATION
Year Built q #of bedrooms X gallons per bedroom =total Daily flow
1980 or older /I- Garbage grinder installed Yes —No
1981-1991 Spa or Hot Tub installed Yes No
1992-Present
PARCEL INFORMATION
Topography Flat rolling Steep slope %Slope
Soil Nature Sand Loam Clay Other
Groundwater At what depth:
Bedrock/Impervious material At what depth:
I Domestic Water Supply Municipal II, ' ,water supply from any septic system absorption is_ft.)
Percolation Test Rate: per minute per inch(test to be completed by licensed engineer/architect)
I
PROPOSED SYSTEM FOR NEW CONSTRUCTION
I Tank size I*b gallons(min.size 1,000 gallons,add 250 gallons to size for each garbage cylinder or spa or hot tub
i
I System Absorption field with#2 stone Total length ft.;Each Trench
Seepage Pit with#3 stone How many: ze
Alternative System Bed or other type: J 7
i
Holding Tank System Total required capacity? Tank size #of tanks
Notes: 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 exceptions.
i 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: W{`-L I to M L , E C1J DATE: _AI(SS
SIGNATURE: DATE:
Town of Queensbury Building&Codes Principal Structure Application Revised September 2014
Town of Queensbury Building &Code Enforcement
Office No. (518)761-8256
Septic Inspection Report
Inspection request received:
Name: t�zF P ,J Inspected on: Paodlor
Location: Z�1 -P��.JT R C�CE 9,V Arrive: m.l
Permit No.: 20 5 ' 9 Lo Inspector's Initials:-
Comm
ram
Soil Type: Sand I Loam I Clay
Type of Water: Municipal/Well Water
Waterline separation distance ft,
Well separation distance ft.
Other wells: ft.
Well Casing Length 50'+/- _Y_N_N/A
[150'to well required if NO].
Absorption.Field: Total length
Length of each trench ft.
Depth of trenches ft.
Size of Stone
Seepage Pits:: Number
Size: x
Stone Size:
Piping Size. Type
Building to tank
Tank to Distribution Box
Distribution Box to Field/Pit
Opening Sealed: _Y_N
End Cap. Y_N
Inlet/Outlet Pipes&Baffles _Y_N
Manholes 12"or less below grade _Y_'N R c�
[provide extension.collar if Yes] Y_N
Location/Separations
Foundation to tank ft.
Foundation'to absorption ft.
Separation of Pits ft.
Conforms as per Plot Plan _N
Engineer Repor(and As-Built Y_N
ETU Maintenance Contract provided _Y_N
Location of System on Property:
Front Rear Left Side Right Side Middle Front Middle Rear
System Use Statub/Approved
Partial Approved and needs to be re-inspected, please call the Building&Codes Office
Disapproved
Cenfin Inonan+inn Qnnnrf
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ENGINEERING PLLC «- - _- _.-.-__.-__�_
910Z 8. f !
July 1, 2016
Town of Queeiisbuiy
Attn'.'Mr. John O'Brien, Codes
742 Bay Road
Queensbury,.New York .12804,
www.j ko bd eri 93(crew aho o.co ni
Re: Onsite Wastewater Treatment System Installation
Green Cottage - .
24 Burnt Ridge Road j
Que.ensbury,New York 12804
Town of.Queensbury
Dear Mr. O'Brien:
The undersigned 'completed final obseivafion of the above:referenced onsite wastewater
treatment system on July 1, .20.1.6.. Construction observation was completed' during the.
construction phase. The in"stallation was completed in:substantial conformance with the
intent of the design.drawings dated July 1,22015.
Do not hesitate to contact me at(315)254-6891 if-you'have any questions.
$:incet+ ;
Eric E.Murdock,._P.E.
cc: Mr, Bill Green, Owner
P.O. Box 6265, Syro'cus,e, New York 13217 Rhone (315) 254-6891
www,.onsite-engi.neering.us
SALES & SERVICE, LLC
FUSION INSPECTION&MAINTENANCE AGREEMENT
Property Location,, 24 Burnt Ridge Road,Queensbury,-New York, 12804
Qwners Name:_ Bill Green
Address:
Phone Number: (518)260-0354
Terri: 2 Years; 7/1'/16—7/13/18
FUSION.SERVICE PROGRAM—AGREEMENT TERM
Glarus Environmental, Inc: (Clarus) the, manufacture of the_Fusion treatment driit re-' mrrreilds the Fusion- be
maintained every. 6 months by a.Clarus trained service:provider. This Fusion Inspection & Maintenance Agreement
(AGREEMENT) is between the.owner-and.Qnsite Sales& Service,.LLC. (OSS). Two years of scheduled maintenance
is included in.the.purchase'of the Fusion. After this two,year term.expires, the Fusiori,,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 .CLOOSCi). 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) drill be competed as needed. Completed inspection checklist wi11 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,additiona.l items is.,not 4olude&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.
Ov td O Date
P.O. Box 6265, Syracuse, New York 13217 m Phone (315) 254-6891 o eri'c.@onsite-eng.ineering.us