2001-791 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: P20010791 Date Issued: Thursday, October 25, 2001
This is to certify that work requested to be done as shown by Permit Number P20010791
has been completed.
Tax Map Number: 523400-302-014-0003-056-000-0000
Location: 4 PARK VIEW Ave
Owner: RAYMOND KUHNERT
Applicant: RAYMOND KUHNERT
This structure may be occupied as a:
By Order of Town Board
Septic Alteration Residential TOWN OF QUEENSBURY
Director of Building&Co Enforcement
TOWN OF QUEENSBURY
F
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development- Building& Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20010791 Application Number: A20010791
Tax Map No: 523400-302-014-0003-056-000-0000
Permission is hereby granted to: RAYMOND KUHNERT
For property located at: 4 PARK VIEW 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: RAYMOND KUHNERT Septic Alteration Residential
JOHN MAJORANA Total Value
4 PARK VIEW Ave
QUEENSBURY,NY 12804
Contractor or Builder's Name/ Address Electrical Inspection Agency
OUEENSBURY SEWER
JAY SWEET
Plans &Specifications
2001-791
SEPTIC ALTERATION AS PER PLOT PLAN SPECIFCATIONS
$25.00 PERMIT FEE PAID - THIS PERMIT EXPIRES: Thursday, October 24,2002
(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 th n of Q ensbury; Wednesday, October 24,2001
SIGNED B for the Town of Queensbury.
Director of B g ode Enforcement
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Application'for Permit—Septic Disposal System •
Town of Queensbury. 742 Bay Road Queensbury,NY. 12804 (518) 761-8256
1. OWNER INFORMATION:
/ s Office Use
Location of installation: � 6g.
File Permit No 01— 71I
Tax Map No. / /• Fee Paid c` CIO
Owner's Name: � r (4 iq Pe it r
Address: 171 ' C t/ C o i t t •
2. INSTALLER'S NAME : CQQ. QC IJS C_ PHONE NO.N'67.X7-4
3. RESIDENCE INFORMATION: (circle year of dwelling, indicate#bedroom(s) and multiply# of
bedrooms with.applicable gallons per bedroom to equal total daily flow)
Year of House: No. of Bedrooms x Computation = Total Dail� El
�� VED
1980 or older x 150 gal/bdrm =
1980— 1991 .x 130 gal/bdrm = C T 2 j 20 01
1991 —present x 110 gal/bdrm =
TOWN OF QUEENSBURY •
Garbage Grinder Installed yes / BUILDING AND CODE
Spa or Whirlpool Installed yes •
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4. PARCEL INFORMATION: (circle applicable information&indicate measurements)
Topography Soil Nature Ground Water Bedrock or Impervious Material Domestic Water Supply
,T t A ,an at what depth at what depth municificib
Rolling own, 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.
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Septic Tank: /D gallon (min. size 1,000 gal)
Tile Field: each trench g ft. Total System Length: S7, ft. •
Seepage Pit(s): number of size of each: _ft. by ft.
Size of Stone to be used: # / depth or thickness feet
Bed System Size: x
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Alternative System: length and/or size /v —
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 Queensbury Sanitary Sewage Disposal Ordinance.
—c)
Sig atutje of l`esponsible person Date •
TOWN OF QUEENSBURY (21
BUILDING_ & CODE ENFORCEMENT
742 Bay Road
Queensbury NY 12804
(518) 761-8256
SEPTIC DISPOSAL SYSTEM INSPECTION
Name d 1-)1.4.16121— •
Location �.42kL v 1G
Date /0 emu! Permit # 0/ --73 i
SOIL TYPE Sand oam-Clay-
Results of Percolation Test-
(if applicable) Rate-Minute/Inch
TYPE OF SYSTEM:
ABSORPTION FIELD: otal Length J _
Length of each tre ch I 7 3
Depth of trenches
Size of stone C C C ;
SEEPAGE PITS: Nu .-r-
Size - ft. ft.
Stone size
PIPING: Size Type
Bldg. to Tank 1 ' 6og_
Tank to Dist. Box w o�
Dist. Box to Fieli/Pit '' ►+
Openings Sealed?-' Arai No _ .Partial
LOCATION/SEPARATIMIIII
Foundation to Tan 4/2) .feet
Foundation to 'Abs t'rpti on . L 5.feet , .
Separation of Pit et
Conforms as per Pl t Plan �.No
LOCATION OF SYSTEM ON PROPERT .
one) •
Front Rear - Left Side - Right Side
• e Front - Middle Rear
COMMENTS:
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SYSTEM.USE APPROVED: DYES NO
Arrived:
Departed:
. Building Inspector
ECEIVED
" have seen or observed, or believe I sawevidence fences,etc.,of, OCT 2 2001
I
all objects such as houses, alsos,trees,represent that I have :WU
N OF QUEENSBURYshown all this do ILDING AND CODE
II measured the distances set forth on the diagram:
personally C5-� —���
DATE �&
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