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PT-0441-2019Property Transfer Sewage Disposal Information Form Town of(Iueens ury Date: t) I 1 742 Bay Road,Queensbury,NY 12804 P:518-761-8256 www.oueensburY.net To: CtiAc=i . 1-1•S 1-6 tiloa Name of Applicant) Re: Onsite Wastewater Treatment System Inspection Information Request for: 0) I\ Aty),61kA POI ed, u S Site Address)U Thank you for requesting an inspection for the onsite wastewater treatment system 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 advance information to us about the site. Prior to our inspection, we request information regarding the property and the onsite wastewater treatment system (septic system) on that property. We also would like to confirm property access and that pre-inspection system preparation 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 prior to scheduling an inspection. Following completion of the inspection, you will be sent a System Inspection Site Report. The System Inspection Information Request and the System Inspection Site Report are standardized forms used by the Town of Queensbury. Please note the Town of Queensbury's fee for this service is $250. Be advised that all fees for services must be paid prior to the site inspection. We require 48 hours notification prior to inspections. If you have any questions, please call. You may FAX or email the completed Septic System Inspection Information form back to us. 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 within 6 months of the date of this application or June 1st of the current, or following calendar year (whichever comes first), a map locating the septic system and payment totaling$2250 ($2000 refundable deposit plus $250 permit fee). one: (518) 761-8256 Fax: (518) 745-4437 Email: kated@queensbury.net Thank you. Sincerely, rINSP 4 David Hatin, Director Building and Code Enforcement Town of Queensbury I rnnnrf.• I'rnncf r P.,,-4 n. 4... •..i A4•,r.1.1111U ECEOVE5 Permit#: fT—Q Lit--) Fig Fee:27 z QJ;e O 742 Bay Road,Queensbury,NY 12804 JUN 26 2013 10 Invoice#: t 7 3 tP:518-761-8206 or 518-761-8205 TOWN OFOUEENSBURY SEWAGE DISPOSAL S r%1'f t.IPSEINF MATION Individual Residential Wastewater Treatment System in e Property and Owher Information: Please attach property survey or tax parcel map) Property address: I I S rf,blx, L-v PLC. CLL 6 or eqc Tax map number: l 5410 °`06/' pe rt y owner: HSrt t A• A&cth to — s S'l-tt~.roa(YV rCkenU 1 .Trcc."Property rU r J a to Mailing Address(c/s/z): N 1w-`I'\-ticL ra-' ) Q U,€ S NJ BCLI Cell #: eO 3 Land Line#: Ki k Email: eri kloC U\ re cdlr € CIYYLC.Li C Household Information: Bedrooms L&Bathrooms Kitchens Onsite Wastewater Treatment System: us\tKowit\- ci,b1 How many systems are on the property? i- Year system(s) installed: Tank Size of Septic Tank Type of Absorption System: Are all system components wholly within the property boundaries? Yes 0 No Are system plans available? 0 Yes 0 No Does the system(s) serve multiple properties? 0 Yes No If yes,describe Maintenance: Service agreement? 0 Yes No If yes, vendor name Date of last inspection N/A 0 Date tank last pumped N/A 0 Frequency of pumping _ N/A Wco i vv (-64 4A EAU i I OM btS' u'a r`I'.E 4j 4 Pnuterty Transfer Packet V Revised March 2019 J List known repairs/replacements, with dates: Date Type of Repair/Replacement Operation: System problems? Yes No Sewage odors? Yes No Direct surface discharge(s)? Yes No Back-up of toilets? Yes No Back-up of any other fixtures? (e.g. slow drains) Yes No Seasonal ponding or breakout of leach field? Yes No Statement of Acceptance of Conditions: I agree to: Ensure that the septic tank(s), distribution box(es), 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. I agree to be responsible for inspection fee payment. Signature of property owner or authorized agent Please print name: Lbr, (\., Affiliation: owner agent Signature: Date: t 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. Pmner,. rr;inOfer Pact et Revised March 2019 June 26, 2019 Town of Queensbury Building and Code Enforcement 742 Bay Rd Queensbury, NY 12804 Dear Building and Codes: I am in the process of purchasing a property located at 211 Assembly Point Rd in the town of Queensbury. The closing is anticipated to occur within a few weeks time. Due to the age, we assume the septic system needs replacing and will do so in the fall of 2019. This will occur within 6 months of purchase. I have been in contact with Dennis MacElroy's office, Environmental Design Partnership, and they assure me that the new system should go in without a hitch. Sincerely, OUk Erin Steinbach 42 Amethyst Dr. Queensbury, NY 12804 518-222-6031 ERinsteinbachrealtor@gmail.com NOTARY STATE OF NEW YORK COUNTY OF WARREN Subscribed and sworn to before me on this old day of 07-02f LUCINDA FRENCH Notary Public, State of New York Warren Co.#04FR6256016 CoitimiUion Expires Feb.21,20 U r E i = 0 Onsite Equipment, Inc. i .. . P.O. Box 6265 MAR 2 0 2020t Syracuse, NY 13217 315-254-6891 TOWN OF QUEEN:BURY CDNO L BUILDINGCO©ES MAINTENANCE/SERVICE AGREEMENT FOR CLARUS FUSION Project Number:204-2019-103 Owners Name: Frank& Erin Steinbach Property Location: 211 Assembly Point Road, Lake George, New York 12845 Owners Mailing Address: 211 Assembly Point Road, Lake George, New York 12845 Email: erinsteinbachrealtor@gmail.com Phone Number: 518-222-6031 Term: 4 Years; 3-5-20 thru 3-5-24 Start Date: March 3, 2020 This Agreement will serve as acknowledgement that Onsite Equipment, Inc. (Onsite) will provide service on the Clarus Environmental, Inc. (Claws) Fusion enhanced treatment unit at the above referenced property. Onsite will perform annual scheduled service checks of the Fusion for four 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. The undersigned agrees to the terms of this Inspection & Maintenance Agreement. DO Owner Date All PROPERTYTRANSFERSEWAGEDISPOSALINSPECTIONLETTER SatisfactoryComplianceNotice 742BayRoad, Queensbury, NY 12804 P: 518-761-8256 www.queensbury.net Date: 29 April 2020 To: Erin Steinbach Applicant) Re: System Inspection Site Report for: 211 Assembly Point Rd., Lake George, NY 12845 Site Address) As requested, Ihave made an inspection of the wastewater system components serving the property referenced above. All system components have been found, and are noted in the System Inspections Findings Worksheet. Inspector’sobservations: System appears to have functioned adequately under past and present loading. There can be no assurance or guarantee of future performance for any period of time. Numerous factors, such as household water usage, leaking toilets, soil characteristics and seasonal ground water table fluctuation, as well as owner failure to manage and maintain the system, will affect its performance. Sincerely, David Hatin, Director Building & Code Enforcement Town of Queensbury Building & Code Enforcement January 2019 SEWAGE DISPOSAL SYSTEM EXEMPTION COMPLIANCE LETTER 14' Town of Queensbury 742 Bay Road,Queensbury, NY 12804 P: 518-761-8256 www.queensbury.net Date: 28 June 2019 To: Steinbach Family Trust Purchaser) Re: System Inspection Site Report for: 211 Assembly Point Rd, Lake George, NY 12845 Site Address) The purchaser of the above-referenced parcel has submitted to the Town of Queensbury an exemption request which includes a notarized letter stating the septic system will be inspected within 6 months of purchasing the property but no later than the end of December 2019. The purchaser has also submitted the refundable deposit of$2000, as well as paid the $250 inspection fee. Sincerely, j 4 David Hatin, Director Building & Code Enforcement Town of Queensbury Building&Code Enforcement March 2019 April 30, 2020 Erin Steinbach 211 Assembly Point Rd Lake George, NY 12845 Dear Kate Deck: Our new septic system has been installed at 211 Assembly Point Rd and the final inspection, which passed, was completed yesterday by John O’Brien. We request the $2000 deposit be refunded to the address above. Sincerely, Erin Steinbach