SEP-000253-2017 TOWN OF QUEENSBURY
4W 742 Bay Road,Queensbury,NY 12804.5904 (518)761-8201
Community Development-Building&Codes (518)761-8256
CERTIFICATE OF COMPLIANCE
Permit Nlnnber: SEP-000253-2017 Date Issued: Monday, June 12, 2017
This is to certify that work requested to be done as shown by Permit Number SEP-000253-2017
has been completed.
Tax Map Number: 302.18-2-36
Location: 137 GRANT AVE
Owner: Jason Kantrowitz
Applicant: Lou DeRidder
This structure may be occupied as a: Residential Septic Alteration
By Order of Town Board
TOWN OFQUEENSSBBURY/f ��
Issuance of this Certificate of Compliance DOES NOT relieve the (/ /1 �ot
property owner of the responsibility for compliance with Site Plan, GGGmmm""" YYY /I
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
Q_ W 742 Bay Road,Queensbury,NY 12804-5904 (518)761.8201
Community Development-Building&Codes (518)761-8256
BUILDING PERMIT
Permit Number: SEP-000253-2017
Tax Map No: 302.18-2-36
Permission is hereby granted to: Morning Star Excavation&Septic
For property located at: 137 GRANT AVE
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
Tvceof Construction
Owner Name: Jason Kantrowitz Septic Disposal-Residential $0.00
Owner Address: 137 Grant AVE Total Value $0.00
Queensbury,NY 12804
Contractor or Builders Name/Address Electrical Inspection Agency
Morning Star Excavation&Septic
59 Blanchard RD
Gansevoort,NY 12831
Plans&Specifications
Residential Septic Alteration
$40.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Saturday,May 19,2018
(If a longer period is required,an application for an extension must be made to the code Enforcement Officer
of the Town of ueensb before the ex ' tion date.
Dated at the Town of uecash /.Fri ) 19,2017
SIGNED BY: VV for the Town of Queensbury.
Director of Building&Code Enforcement
SEPTIC DISPOSAL PERMIT A e On]
742 Bay Road,Queensbury, NY 1280 D IE C
LJ rA —a-V EJ
P:518-761-8820056 www. u//eensbur .
Tax Map ID#: `�71/p �Z-3p d?, j ;;Permi `1r''W ' Invoice#: 1 UZ
Project Location: 13:7 l31,0, AVE. UE arian e? Yes No
Primary Owner(s) —_Vc_sPvN Kc r\ VELOPMENT
Mailing Address 6—""- Ava
eF
Phone & Email Z(z_ 7Z — y82
Installer/Builder � � r EX'Z�iion
Mailing Address gp..f�r9rf3
Phone & Email ?q-?— ZZ-crio
Engineer g :Te^S'e
Mailing Address 1-7 L4A2S¢ R
Phone & Email 5/e) 7 O — 3$S
Contact Person for Building&Code Compliance: {'Otte 'A e r Phone: I8 6J 7-CPg3
RESIDENCE INFORMATION:
Year Built #of bedrooms X gallons per bedroom =total daily flow Garbage Grinder Yes Nom
1980 or older3 3�D Installed? (circle one)
Spa or Hot Tub Yes No
1981-1991 Installed? (circle one)
1992-Present
PARCEL INFORMATION:
Topography _Flat Rolling _Steep Slope _%Slope
Soil Nature Sand _Loam _Clay _Other
Groundwater At what depth. t`
Bedrock/Impervious material At what depth?
Domestic Water Supply 6ZMunicipal _Well (if well,water supply from any septic system absorption is_ft.)
Percolation Test Rate: per minute per inch (test to be completed by licensed engineer/architect)
PROPOSED SYSTEM FOR NEW CONSTRUCTION:
Tank size 52 COgallons(min.size 1,000 gallons,add 250 gallons for each garbage cylinder or spa/hot tub
System Absorption field with#2 stone Total length ft.; Each Trench
Seepage Pit with#3 stone How many: ; Size:
Alternative System Bed or other type:
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 and approved.
The installed system must match the septic layout on file—no exceptions.
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: �`��2r DATE: S b
SIGNATURE: DATE: S 6
Town of Queensbury Building&Code Enforcement Revised February 2017
06-01-' 17 13:41 FROM- T-001 P0002/0002 F-188
t3. Deter Jensen
17 West Road
South Glens Palls
New York 12803
(518) 798 —3859
May 26, 2017
To Whom It May Concern:
I have designed(plan 17-0503)and observed the installation of the septic system
for for the residence at 137 Grant Avenue Extension,Queensbury,Warren County, New
York.It would appear that the installation is within the intent of the desipn documents.
;o the best of my knowledge and belief, no field conditions were encountered that would
require a re-design of the septic system.
To the best of my knowledge and belief all of the distance separation requirements
have been met.
Sincerely,
G.Pet Jensen 'PED AnC,
�•(SR JE4st ro
y a
A � �
& 029oso
grEOF "via.4