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1985-351 BUILDING PERMIT TOWN OF Q' UEENSBURY 85- 351 No. -~7 WARREN COUNTY, NEW Y©RK 4 l t C " �c . PERMISSION is hereby granted to Walter J . Barthel rt M m OWNER of property located at Pilot Knob Road/Lake George Street, Road or Ave. in the Town of Queensbury, To Construct or place a Sewage System 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'SAddressis Star Route Glens Falls , New York 2. CONTRACTOR or BUILDERS Name h� r- Q rt 3. CONTRACTOR or BUILDER'S Address .� Q i� 4. ARCHITECT'S Name Q W IZ Sa 04 5_ ARCHITECT'S Address Q ::s f�1 6. TYPE of Construction — (Please indicate by X) " Q I ) Wood Frame I ) Masonry i ) steel l l f[� D ►i i. PLANS and Specifications uQ 1000 gallon septic tank. , dirt . box and 240 LF tile field (D No. per plot plan , application submitted and Sewage Variance 8. Proipussd use C!] Sewage system for cabins W m $ 106 00 PERMIT FEE PAID — THIS PERMIT EXPIRES July 11 (lf a longer period is required an application for an extension must be made to the Building and Zoning inspector of the l!-' town of Queensbury before the expiration date.) Sv Dated at the Town of Queensbury this , l I th Day of ,'Tiny , Q SIGNED BY far the Town of Queensbury !� � Building and Zoning Inspector TOWN OF OUFFNSBURY BUILDING & ZONING DEPARTMENT TOWN OF QUEENSBURY SEWAGF DISPOSAL PERMIT APPLICATION UJ IF II MAY 1 `7 1965 1 . owner ' s Name VI/A LTE1Q,73AFwJ 11 tea'. .M; 4C < v Address S'T4R RTE �CaL.,EMS P44L90 N.y 7 9 l 2 3 4 5 G Telephone No . 2 . Property location WEQT SI?aE OF ►^'ITT !d►1r38 . , K.a2Scrtl.e�.4S� 3 . Name of person or firm responsible for installing system Telephone No . 6 Address 5 ' 4 . Number of bedrooms ( residential buildings only ) A S . Daily flow tg!f 0 AMEL__ gallons/day 6 . Septic tank capacity J, tin gallons 7 . Topography : flat , rolling , steep $ of slope �Lr 8 . Nature of soil and depth a�) �jt�,�¢ ts�'� _ 9 . , If ground water , bedrock or impervious material is apparent at what depth does it begin? �/ ft . 10 . Percolation test : A is required B is not required C� If required what is the rate !o minutes/.inch 11 . Water supply : municipal , well , other jV4907 Q# E0A4E 12 . Type of system proposed : drywell , the field , other Tr,LE X:jELb 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 . L7 ate ! � �S signature appl i cant 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 / c y 1 30' oaf Z�tS TIDE i EACk dC �Ao CO rTA 66 E I000 S�?AatC 00 ! r -- L o cATt v1v ©F Srs 74 M To r COM PLY w IrTM T` wiv BoA RQ Col,t a { TION PXOPeRTY Ll tV6 f` ,45 Poi MAX !/aflz SEP� ` t' ,+71Q/1! li[E/ e+��3c3tz3 4tJ1:4*L PLAN FOP SEPTIC LCACH FIELD SCALE it WOLTER BtgRTHEt STAR RTI=, C4.91NIS FALLS , N y 6,56 - 9 515