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2004-247 TOWN OF QUEENSBURY 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201 Community Development - Building & Codes (518) 761-8256 CERTIFICATE OF COMPLIANCE Permit Number: P20040247 Date Issued: Friday, April 30, 2004 This is to certify that work requested to be done as shown by Permit Number P20040247 has been completed. Tax Map Number: 523400-302-018-0002-037-000-0000 Location: 135 GRANT AVE. Owner: BURTON & CLAIRE KANTROWITZ Applicant: BURTON & CLAIRE KANTROWITZ This structure may be occupied as a: By Order of Town Board Septic Alteration Residential TOWN OF QUEENSBURY Director of Building&Code Enforcement TOWN OF QUEENSBURY 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201 Community Development-Building&Codes (518) 761-8256 BUILDING PERMIT Permit Number: P20040247 Application Number: A20040247 Tax Map No: 523400-302-018=0002-037-000-0000 Permission is hereby granted to: BTTRTON& C;T,ATRF,KANTROWTTZ For property located at: 135 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. Type of Construction Value Owner Address: BURTON& CLAIRE KANTROWIT 13 5 GRANT AVE. Ext Septic Alteration Residential Total Value QUEENSBURY,NY 12804 Contractor or Builder's Name /Address Electrical Inspection Agency Plans&Specifications 2004-247 SEPTIC ALTERATION $25.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Friday,April 29, 2005 (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 own Quee s u , rsd y,April 29, 2004 SIGNED BY �Q/ for the Town of Queensbury. Director of Building&Code Enforcement Application for Permit=Septic Disposal System Town of Queensbury 742 Bay Road Queensbury,NY 12804 (518) 761-8256 1. OWNER INFORMATION: :.........................................................I Office Use Location of installation: File Permit No. � Tax Map No. 1 E Fee Paid—� Owner's Name: /� ,��(/✓/ Y"� ....................................................................................................................................... Address: 2. INSTALLER'S NAME �,� ��,� ��Pb✓C fOHONE NO. 3. RESIDENCE INFORMATION: (circle year of dwelling,indicate#bedroom(s) and multiply#1 of / bedrooms with applicable gallons per bedroom to equal total daily flow) Year of House: No. of Bedrooms x Computation = Total Daily Flow 1980 or older 62 x 150 gal/bdrm = L7 0 1980—1991 x 130 gal/bdrm = BVED 1991—present x 110 gal/bdrm = Garbage Grinder Installed yes_ / no APR 2 8 2004 Spa or Hot Tub Installed yes_ ./ no TOWN OF QUEENSSURY BUILDING AND rCIDE 4: PARCEL INFORMATION: (circle applicable information&indicate measurements) TogogrVhy Soil Nature Ground Water Bedrock or Im ervious Material Domestic Water Su 1 a san at what depth at what depth < municapa Rolling loam feet feet well Steep slope clay if well; water supply _%slope other from any septic-system depth: absorption is ft. other Percolation Test: (To be completed by licensed professional engineer or architect) Rate: minute per inch 5. PROPOSED SYSTEM: For New Construction: All individual sewage disposal systems must be designed by a licensed professional engineer or architect(unless installed in a Planning Board approved subdivision). Add 250 gallons to the size of the septic tank and.leach field for each Garbage Grinder,Spa or Whirlpool Tub. � r Septic Tank: gallon (min. size 1,000 gal.)53I ) Tile Field: each trench_ f ft. Total System Length: ` ft. Seepage Pit(s): number of size of each: ft. by ft. Size of Stone to be used: # / depth or thickness feet i Bed System Size: x Alternative System: length and/or size 6. HOLDING TANK SYSTEM: (if required) Number of tanks: / Size of each: gallons /TOTAL Capacity: gallons Note: Alarm System and associated electrical work must be inspected by a Town approved electrical inspection agency. 7. SIGNATURE &INFORMATION FOR RESPONSIBLE PERSON(please read) For your protection,please note that pursuant to Section 136-29 of the Code of the Town of Queensbury,any permit or approval granted which is based upon or is granted in reliance upon any material misrepresentation 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 with respect to this application and agree to abide by these and all requirements of the Town of Queensb Sanitary ewage Disposal Ordinance. le� Signature of responsible person Date 1 Ti . � :'li�wtt •t>! �Zut�c+>IT,+al�ui•y St:�vt:T•:t :T,ul sewilge I)i ignsal t'.1121plt•:• Appemtiix C, t • A 1ISt)M'l' ON, It'11'I.1.) SI�:I'/11tA'1'1W1N Itl;tZt.111tI�I�]Il�N'1Ii c �17 � pQwp V•1ET.c. ut t�1►rr<•ct,• •. ,� rt tt•�vl . ' •tu�ur cJ�ft�t('; ram... .•- . t T Ole ,,.••��, t -Sc vx 1c, ' � 1.1.J •� '� T1t.1 ty.. \ -......« 1 \ /��'•� ��, 1 Ui'�TSttla111t•t t � i�TR.Lb , r ' R,c�AL� 7. SIQUNA,•T'URE &INFORMATION FOR il'UN OLZ rrcr-.0w , . r Septic Inspection Report n re Date Inspection u t ecei ed: '( Office No. (518)761-8256 a p q Queensbury Building&Code Enforcement Arrive: p e alr�i In 742 Bay Rd., Queensbury,NY 12804 Inspector's Initialsl r NAME: � P RMIT NO.: �-�� 'L-v17 LOCATION:, INSPECT ON: RECHECK: Comments and/or diagram Soil Tyw S Clay Type of Water: unici e Water Waterline sepa distance ft• Well separation distance ft• Other wells: ft• Absorption Field: Total length ft• Length of each trench Depth of trenches �s ft• Size of Stone Seepage Pits: Number Size: x Stone Size: Piping Size T e Building to tank +� Tank to Distribution Box Distribution Box tb ield/Pit Opening Seale N/Y Partial �� Location/Separations Foundation to tank ft• Foundation to absorptionA ft. Separation of Pits ft• Conforms as per Plot Plan Location of System on Property: �o Front Rear Left Side !!� ide r� Middle Fron iddle Re System Use Stat Approved Partial Approved and needs to be re-inspected,please call the Building&Codes Office Disapproved L:\SueHemingway\Building.Codes.Inspection.FORMS\Septic Inspection Report.doc January 28,2003 Septic Inspection Report Office No. (518)761-8256 Date Inspection req st ece, Queensbury Building&Code Enforcement Arrive: epart: ✓ n 742 Bay Rd., Queensbury,NY 1,2804 hispector's Initials: - NAME: \Ri eT Z P IT NO.: —O LOCATION: � C,RA� � RAF h�RECHECK: SPECT ON: �1. —��,��—c� Comments and/or diagram Soil Type: Sand/Loam/Clay Type of Water: Municipal/Well Water Waterline separation distance ft. Well separation distance ft. Other wells: ft. Absorption Field: Total length ft. �c Length of each trench ft. Depth of trenches ft. 1J �l Size of Stone -Seepage Pits: Number , J Size: x `/ A Stone Size: \ Piping Size Type Building to tank Tank to Distribution Box Distribution Box to Field/Pit Opening Sealed: Y/N/Partial Location/Separations Foundation to tank ft. Foundation to absorption ft. Separation of Pits ft, Conforms as.per Plot Plan Y N Location of System on Property: Front Rear Left Side Right Side Middle •ont iddle Rear System Use S atus: Approved Partial Approved and needs to be re-inspected,please call the Building&Codes Office Disapproved LASueHemingway\BuiI ding.Codes.Inspection.FORMS\Septic Inspection Report.doc January 28,2003 _ t — '41ell a �KS1 j�e�c1` YY i� f "{ have se n or observed, or believe I saw evidence of, all objects such as houses, wells, trees, fences, etc., _ shown on his document. I also represent that I have personally mpa red the ist nces s i forth on the diagram" 01 CC � SIGNATURE DATE = . BUILDING & : �2 �9 EVIEWED BY +y J L ATE �Mz W,W 2 4o' q