1985-061 BUILDING PERMIT
TOWN OF QUEENSBURY
No. s, 5- 61
WARREN COUNTY, NEW YORK
PERMISSION is hereby granted to ro7lll ±am W . Maille
OWNER of property located at
} Cottage Hill Road Street, Road or Ave_
Sewage Alteration
in the Town of Queensbury, To Construct or place a
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 . OWNEWS Address is 18 Manor Drive
Glens Falls , New York
2. CONTRACTOR or BUILDER'S Name C
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3. CONTRACTOR or BUILDER'S Address (D
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4. ARCHITECT'S. Narne i
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5. ARCHITECT"S Address
6. TYPE of Construction — (Please indicate by X)
{ ) wood Frame ( ) Masonry { ) Steel { Y
7. PLANS and Specifications rn
1000 gallon septic tank , dint . 'box and l 6 ' xS ' drywe 1
No. with # 3 stone per plot Plan and application submitte iv
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S. Proposed Use �
Sewage system for dwelling I-
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$ 10 . 00 PERMIT FEE PAID — THIS PERMIT EXPIRES March 27 19 $ 7 0'
(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 Oueensbury this 27�rth Day ofMarch 19 85
SIGNED BY .c p for the Town of Queensbury
Building and Zoning In ctor
TOWN OF OVFFNSDUR'Y
PUILDING & ZONING DEPARTMENT
SEF?AGF DISPOSAL PERMIT APPLICATION TOWN QF QLdEENsauRy
1 . Owner ' s Name William W . Maille t u
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Address 18 Manor Drivel, Glens Fall , '"' Y 12801 MAR �R
A.M. /& - v-\u :nA
Telephone. 1"#� 7ICQB, '
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2 . Property location 1 Cottage Hill Road Glens Falls V(Y . 12801
3 . Name of person or firm responsible for installina system
W . W . Faille Telephone No . 792 0089
.Address 18 Y nor Drives Glens Falls $ T? v 3 28C71
4 . Number of bedrooms ( residential buildings only ) 2
5 . Daily flow 150 gallons,/day
6 . Septic tank capacity 1 41 OCQ �^ gallons
? . Topography : flat , rolling , steep
% of slope flat
80 nature of soil and depth grave ] at leapt 10 ft
9 . If ground water , bedrock or impervious material is apparent at what
depth does it begin? ? ft .
lO . Percolation test : A is required
B xx is not required
C If required what is the rate minutes/ inch
ll . Water supply : municipal , well , other. municipal
12 . Type of system proposed : drywell , tile field , other dry well 29COOga� 1
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 arch 209 1985 '
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 .
Form 3 - 82
TOWN OF QUEENSBURY
Bai1di112S D►ePILYtment
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Permit No.
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Final. Survey
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