8396 - BUILDING PERMIT
TOWN OF QUEENSBURY
No. 8396
WARREN COUNTY, NEW YORK
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PERMISSION is hereby-granted to Thomas Rabine
OWNER of property located at 10 Northup Drive Street, Road or Ave. m.
in the Town of Queensbury,To Construct or place a Sewage Alteration 0u..,
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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 10 Northup Drive
Glens Falls, New York
2. CONTRACTOR or BUILDER'S Name
Daniel Drellos
Sanitary Sewer Service
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3. CONTRACTOR or BUILDER'S Address Ii
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53 Fourth St.
Glens Falls, New York
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4. ARCHITECT'S Name 1-1
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5. ARCHITECT'S Address
6. TYPE of Construction—(Please indicate by X)
( )Wood Frame ( ) Masonry ( ) Steel ( )
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7. PLANS and Specifications
dist. box and 240 ft. tile field per
No. plot plan and application submitted.
8. Proposed Use
Sewage system for dwelling -
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$ 10. 00 PERMIT FEE PAID —THIS PERMIT EXPIRES April 19 19 86
(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.)
Dated at the Town of Queensbury thisl9th Day of April 19 84
SIGNED BY L117de i Q- ,Y for the Town of Queensbury
Building and Zoning Inspector
TOWN OF QUEENSBURY
BUILDING & ZONING DEPARTMENT
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SEWAGF DISPOSAL PERMIT APPLICATION TOWN ®F QiJEENSBURY
1. Owner ' s Name --r (!� '-i PAhr,* E G E g it
Address l.v 1U 0 2Y6 0 .-7)7) ,'iANR. 1 41'84
Telephone I9�10111,12)11'JJ4J5'6 �
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2. Property location
3 . , N e of person or firm res onsible for installing system
< n PI iTrkPl S76.)--Lr -eAt-etom.( Telephone No. 7,(30)- - id-S4
Address - •
4. Number of bedrooms (residential buildings only)' ,.S
5. Daily flow gallons/day
6. Septic tank capacity / 6 d 3 gallons
7. Topography: flat, rolling, steep
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8 . Nature of soil and. depth j •
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9. If ground water, bedrock or impervious material is apparent at what
depth does it begin? ' .ft:
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10. Percolation test: A oe is requjired
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B re is not quired f
C If required what i's' the rate 0 ' S.- minutes/inch
•11. Water supply: unicipa , well, other
12. Type of system proposed: drywell, 14123 other
Any contractor,, corporation, individual, etc. engaged in" the construction
of a sanitary sewage disposal system who covers the same before inspection,
does not have an approved permit, or varies from the approved application
will be subject to a penalty of $250 as provided for in Section 6 . 010 of the
Queensbury Sanitary Sewage Ordinance.
Date . y., / 0 , Y. et l' gnatur' eof�app scan -L..
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On separate sheet of paper submit a diagram of the proposed septic system
with all dimensions, including distance from any structure, distance from
property line and domestic water supply, etc. Include all dimensions of
the system itself.
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Form 3-82
SANITARY SEWER SERVICE
Division of G. P. Drellos, Inc.
53 FOURTH STREET GLENS FALLS, N.Y. 12801
TELEPHONE 792-7257
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