7838 BUILDING PERMIT
TOWN OF QUEENSBURY
No. 7838
WARREN COUNTY, NEW YORK
PERMISSION is hereby granted to Charles Russell, Jr.
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OWNER of property located at 255 Burch Road Street, Road or Ave.
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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.
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1. OWNER'S Address is 255 Burch Road
Glens Falls, N. Y.
• 2. CONTRACTOR or BUILDER'S Name ri
Same
3. CONTRACTOR or BUILDER'S Address
same
4. ARCHITECT'S Name
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5. ARCHITECT'S Address %b
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6. TYPE of Construction—(Please indicate by X)
( )Wood Frame ( ) Masonry ( )Steel ( 1
7. PLANS and Specifications 1000 gallon septic tank, dist. box and
No. 2 drywells 6 'x8 '. each with stone per
plot plan and application submitted.
8. Proposed Use �W
Sewage system for dwelling.
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$ 10. 00 PERMIT FEE PAID —THIS PERMIT EXPIRES May 6 19 85 P
(If a longer period is required an application for an extension must be made to the Building and Zoning inspector of the O'
town of Queensbury before the expiration date.) 0
Dated at the Town of Queensbury this 6th Day of May 19 83
SIGNED BY• �S G +� . for the Town of Queensbury
Bui ding and Zoning Inspector
TOWN OF QUEENSBURY
BUILDING & ZONING DEPARTMENT 'N F(�
� R N O QUEENSBLt�Y
SEWAGF DISPOSAL PERMIT APPLICATION E is Q VIE le.
1. Owner ' s Name / J- L e SZIR7 t S ,/ al, 61 3
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I- !! II / p.m.
Address ,�j 6-R c'r Ic 1 R 6.. 's 2 y � ��gilOjlp1 )I��1394I516'
`es Y 1 " /..c ,/?' r f� `Telephone No. Ø/ OI . ,. f7
2. Property location , C-( hC,h R 0 c � 9/1 „- 's:S$ /V \/J2. J.. �O
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3 . Name of person or firm responsible for installing systemc'p p" f,-... ' ,
c%i m y Se kr • Telephone No. MO i>")
Address
4. Number of bedrooms (residential buildings only) -.
5. Daily flow <, 5(.5(O gallons/day -
6. Septic tank capacity /ii (906 gallons
7 . Topography: flat, rolling, steep
% of slope I t P .
8 . , Nature of soil and depth, (Sc/h C
9. If ground water, bedrock or' impervious material is apparent at what
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depth does it beginOect,he. i' 6 jQft.
10. Percolation test: A is required
B ,,-� is not required
C If Fecitired what is the rate minutes/inch
11. Water supply: municipal other .
12. Type of system proposed i tile field, 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_- 5 A-ce/-7/1.0 /2.e.
signature of applicant
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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