1988-829 BUILDING PERMIT
TOWN OF QUEENSBURY
No. 88-829 zo
„� � WARREN COUNTY, NEW YORK •
nr I �
PERMISSION is hereby granted to Adirondack An' Hospital
OWNER of property located at Rid oad L.kon W 6 Ortiti , Road or Ave. •
in the Town of Queensbury,To Construct or place a Sewage Alteration
at the above location in accordance to application together with plot plans and other information hereto filed and
approved and in compliance with the Town of Queensbury Building and Zoning Ordinance.
1. OWNER'S Address is
SAME
H
2. CONTRACTOR or BUILDER'S Name
t7
Dale Granger Construction n
3. CONTRACTOR or BUILDER'S Address H
O
4. ARCHITECT'S Name
ro
H
Hyy
t-'
5. ARCHITECT'S Address
6. TYPE of Construction— (Please indicate by X)
I I Wood Frame ( ) Masonry ( I Steel (
LTJ
7. PLANS and Specifications
99O
No. 7000 gal tank,360' tile field, as per plot plan and application.
8. Proposed Use
Sewage Alteration
Cl]
tlj
$ 35.00 PERMIT FEE PAID —THIS PERMIT EXPIRES 10/21 1990
(If a longer period is required an application for an extension must be made to the Building and Zoning inspector of the
town of Queensbury before the expiration date.)
;CrJ
Dated at the Town of Queensbur is 21st Day of October 19 88
0
SIGNED BY ( /(?/./ i! for the Town of Queensbury
Building and Zoning Inspector
VN OF QUEENSBURY
TOWN °�
if APPLICATION FOR D + NJ:
/ /--/-9 2-SEPTIC DISPOSAL:.: .PERMIT
G 41_ ING & CODE DEPT
.
DATE (1) Z0 346-9A—QAID
LOCATION OF PROPERTY FOR INSTALLATION 'ez d' , 11J ► �•
Owner's Name: fa1.rtycx 044-4N KdS1 Telephone:
Address: 2 dL/aO ,� C96i,,,/J( , 1 .9 • )Z sib/
Installer's Name: r- � �� Telephone: 039
Number of bedrooms (residential only)
Total daily flow (compute @ 150 gal per bedroom)
Topography: circle one: Rolling Steep sloge % of slope
Soil Nature: circle one: and Loam Clay Other / Depth: feet
Ground Water: At what depth? feet
r
Bedrock or Impervious Material: At what depth? / o feet
Percolation test: circle one: not required required/rate min.inch.
Domestic water supply: circle on- : Municipal Well Other
If domestic water supply is a Well:
Separation: Watersupply from Septic absorption feet
PROPOSED SYSTEM: Septic Tank 766E al. (mninimum size: 1,000 gal.)
' /� Pri /
TILE FIELD: . Each Trench 1p 0 feet / Total system length 36.0 feet
SEEPAGE PIT(S)•: Number of / Size each feet by feet
Size of stone to be used # /Depth or Thickness / feet
******************************************************
I have read the regulation on the reverse side of this sheet and agree
to abide by these and all requirements o the Town of eensbury Sanitary
Sewage Disposal Ordinance.
Signature of responsible person: T`
Date: /6/2 4 /g g
(OVER)
Septic System Inspections:
A. All applications for septic system installation, alteration or repair,
as required by the Town of Queensbury Sanitary Sewage Ordinance, shall
be submitted to the Building Department at least 24 hours before start
of construction and shall include a plot plan showing:
1.) the proposed location of the system
2.) location and distance to lot lines
3.) location and distance to structures
4.) location and distance to any water supply
5.) size and dimensions of all tanks, distribution boxes,
tile fields and/or drywells
B. No system shall be covered before inspection and approval by the
Building Inspector. Failure to comply with this requirement may
result in the uncovering of the system by the installer and a fine
of up to $250.00.
C. An approved copy of the plot plan shall be available on the construction
site. Failure to produce said plot plan at time of inspection may
result in an immediate work stoppage.
D. Should unforeseen problems during construction prevent proper installa-
tion, alteration or repair of an approved system, a new proposal must
be submitted to the Queensbury Building Department before further
construction.
Town of Queensbury
BUILDING and CODES DEPARTMENT
Bay and Haviland Roads
Queensbury, New York 12804
Remarks:
..own o/ Queen3bury
: BUILDING and ZONING DEPARTMENT
Bay and Haviland Road, R.D. 1 Box 9
Queensbury, New York 12801
SEPTIC DISPOSAL SYSTEM INSPECTION
NAME 1:61 GY'Q sit L e ll' /) 14Q
LOCATION 7.4 A.A.
DATE.//"/D / PERMIT NO. '`(6',2/7
SOIL TYPE - Sand - E� " - • //
Percolation Test Required? YES - NO
Percolation rate - Min/Inch _
TYPE of SYSTEM:, ,
sorption fie total length 7 tto
L t '•rench
• Depth of trenches .
Size of gravel_
SEEPAGE PITS-EN .er of)
Size- ft. X ft. •
Gravel size
PIPING: Siz- Type
Bldg. to tank •
Tank to dist. box
Dist. box to field/pi
Openings sealed? YE: NO Partial
LOCATION/SEPARATION :
Foundation to tank/ • Goft.'{-
Foundation to absArption ft.
Absorption to lot line ' ft.
Separation of p is ft.
' LOCATION OF SY TEM ON PROPE TY(circle one)
. Front - Rear Left side - R.ght side - .
COMMENTS: .
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. SYSTEM USE APPROVED ES 0
•
Buil ing Inspect r
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TOWN OF - QUEENSBURY
BULL DH Gk gig°
REVIEWED BY �_
DATE
Is��.rn1 orrr ®wruw
TOWN
07 01 ll=_ •
OCT 201988
BUILDING & CODE DEPT.