2001-659 TOWN OF QUEENSBURY
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742 Ba Road ueensbu NY 12804-5902 518 761-8201
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Community Development - Building & Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: P20010659 Date Issued: Monday, September 10, 2001
This is to certify that work requested to be done as shown by Permit Number P20010659
has been completed.
Tax Map Number: 523400-240-006-0001-016-000-0000
Location: 27 HANNEFORD Rd
Owner: KENNETH & DIANA KAMBAR
Applicant: KENNETH & DIANA KAMBAR
This structure may be occupied as a:
By Order of Town Board
Septic Alteration Residential TOWN OF QUEENSBURY
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Director of Building& Code Enforcement
��� TOWN OF QUEENSBURY
too 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development- Building& Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20010659 Application Number: A20010659
Tax Map No: 523400-240-006-0001-016-000-0000
Permission is hereby granted to: KENNETH &DIANA KAMBAR
For property located at: 27 HANNEFORD Rd
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: KENNETH& DIANA KAMBAR Septic Alteration Residential
33 THOMAS Ave Total Value
HUDSON FALLS,NY 12839
Contractor or Builder's Name/ Address Electrical Inspection Agency
ARMONDO, DAVE
747-7765
NY 12804
Plans & Specifications
2001-659
SEPTIC ALTERATION AS PER PLOT PLAN SPECIFICATIONS
$25.00 PERMIT FEE PAID - THIS PERMIT EXPIRES: Friday,August 30,2002
(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 f Qu Miry; h1 rsda ,August 30,2001
SIGNED BY 4 for the Town of Queensbury.
Director of Building&Code Enforcement
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Application for Permit - Septic Disposal System
Town c f Queens/my 742 Bay Road Queer►sbury, NY 12804 (318) 761
1, OWNER INFORMATION: µ .
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Location of installation: jl f U/'�% l n%'� ). �� t,0
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Tax Map No. / / / �� ----V/40j , (d
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Owner's Name: yt: " /mow/ /44/ 143
Address: i '"i 5 /IT)E
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2, •.INSTALLER'S NAME : 1)Av r /`�--yi , sJ r PHONE NO. 7y7 7.6 S
3. RESIDENCE INFORMATION: (circle year of dwelling, indicate II bedroom(%) and multiply II of
bedrooms with applicable gallons her bedroom to equal total daily flow)
Year album No, of Bedrooms x Coinpt 1 on = Total Daily Flow
1980 or older x 150 gnt/bdrin
1980- 1991 x 130 ga1/bdrin =
1991 -present x 110 gal/bdrm =
Garbage Grinder Installed yes— / no
Spa or Whirlpool Installed yes / no
4. PARCEL INFORMATION: (circle applicable information & indicate measurements) •
Tvv9xta1tthY .SoiLNatll.tc__.. C7tvutrd.Wntvr.. _Uosirock.vr_iiiiper_vj_v.u.s_M.eloti;►I_ _t)omoslic_Wataf.5tr1►1!IY
Hot sand in whirr depth rrl what depth municipal
Rulllrrg loam _ feet ______ feet well
Steep slope clay (/'well; water supply
%slope other from any septic-system
depth: absorption is fl.
other
•
• Percolation Test: (To be completed by licensed professional engineer or architect)
Rate: minute per Inch
_.� _
5. PROPOSED SYSTEM: For New Constructlen: All individual sewage disposal systems must be designed by n licensed
professional engineer or architect (unless installed in a Planning Hoard approved sulxlivision). Add 251) gallons to the size
of the septic tank and leach field for each Garbage Grinder, Spa or Whirlpool Tub. , ta1/t!�H7 - y'es t t/tl:-
7"4--Ag Septic Tank: 1,lion (min. .size 1,000 gal.) , �� •�. ?
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Tile Field: each trench ft. Total System Length: _ _fl.
Seepage Pit(s): number of size ()fetich: ft by fl•
Size of Stone to be used: II _____ _____ / de/,llr or thickness .__.__._.__...___fret
Bed System Size: x
' Alternative System: length and/or size
ti 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 tint pursuant to Section I36-29 of tho Code of(Ito Town
of Quoonsbury, any permit or approval granted which is based upon or is granted in
reliance upon any tnntetiat misrepresentation or failure to make a material fact or
circumstanco known by or on behalf of an applicant, shall bo void.
I have road the regulations with respect to this application and agree to abide by those and all
requirements of the Town of Queensbury Sanitary Sewage Disposal Ordinance.
2-...4 .- e/
S `nature of responsible person Date
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TOWN OF QUEENSBURY
BUILDING DE DEPT, a /e'e�s L�� '®.� �`
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REVIEWED BY ,Po
DATE
TOWN OF QUEENSBURY
BUILDING & CODE ENFORCEMENT
742 Bay Road
Queensbury NY 12804
(518) 761-8256
SEPTIC DISPOSAL SYSTEM INSPECTION
Name
Location
Date g1t'6/ f91)/ Permit # o /-
SOIL TYPE: Sand-Loam-Clay-
Results of Percol .ti o. Test-
(if applicable) R.te-M ute/Inch
TYPE OF SYSTEM:
ABSORPTION FIELD: otal ►ength
Length of each tren h
Depth of trenches 4"
Size of stone
SEEPAGE PITS: Numbe -
Size - ft. x ft.
Stone size
PIPING: Size Type
Bldg. to Tank /4/" <,G-(-1-10
Tank to Dist. Box di" PO
Dist. Box to Field
Openings Sealed Y- 1111r N.o.-Partial
LOCATION/SEPARATIONS:
Foundation to Tank `C54- feet
Foundation to Absorption feet
Separation of Pits et
Conforms as per Plot 1 an �o
LOCATION OF SYSTEM PROPERTY:
(circle one)
ca Rear - Left ide Ri ht Sid
Middle Front - Middle Rear
COMMENTS:
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SYSTEM USE APPROVED: ES 0
Arrived: ' =2.0
Dep. ed: - dig'
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/1Pr wilding Ins, - tor