1985-498 BUILDING PERMIT
TOWN OF QUEENSBURY No
S� } } WARREN COUNTY, NEW YORK
Z� LD , i 1 L-
PERMISSIQN is hereby granted to Robert A . Lupe
OWNER of property located at 35- r Cleyerdale Road/Lake George Street, Road or Ave.
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Sewage Alteration
in the Town of Queensbury, To Construct or place a e3 rd
at the above location in accordance to application together with plot plans and other information hereto filed and (D
approved and in compliance with the Town of Queensbury Building and Zoning Ordinance.
1 . OWNER'S Address is
100 Cordell. Road
Schenectady, New 'York 12304
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2. CONTRACTOR or BUI LDER'S Name
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John A . Mason �
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3. CONTRACTOR or BUILDER'S Address (p
P . 0 . Box 86 7d
Cleverdale , New Fork 0
4_ ARCHITECT'S Name ~`
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5. ARCHITECT'S Address M
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& TYPE of Construction — (Please indicate by X)
1 1 Wood Frame 1 1 Masonry 1 ) Steel i Y
7. PLANS and Specifications
new septic system per plot plan and application
No_ submitted .
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B. Proposed Use �
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Sewage system for dwelling (D
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$ PERMIT FEE PAID — THIS PERMIT EXPIRES 4 n_�_...6
(If a longer period is required an application far an extension must be made to the Building and Zoning inspector of the
town of Oueensbury before the expiration date.)
Dated at the Town of Queensbury this fr,t,• h Day of,�j etm]a -
SIGNED BY /��c/g ' a for the Town of Queensbury
Building and Zoning Inspector QM)
TOWN of QUFENSBURY
BUILDING & ZONING DEPARTMENT
H' O"!r i�f]EENSBURY
SE4t?AGF DISPOSAL PERMIT APPLICATION R E E 9 V n
1 . Owner ' s Name Robert A . Lu a 1UJ
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Address 100 Cordell Road Schenectady , N . Y . 230Q4}
Telephone NO .'
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2 . Property location Cleverdale.
3 . Name of person or firm responsible for installing system
John A . Mason Telephone No . 656 - 9956
Address
4 . Number of bedrooms ( residential buildings only ) four
5 . Daily flow 600 crallons/day
6 . Septic tank capacity 100 gallons
7 . Topography : flat , rolling , steep
% of slope flat
8 . Nature of soil and depth clay/ loam to 5 ' 0 "
9 . If ground water , bedrock or impervious material is apparent at what
depth does it begin? over I ft .
10 . Percolation test : A is reaulred
B is not required
C If required what is the rate minutes/ inch
110 water supply : municipal , well , other Lake Lake George
12 . Type of system proposed : drywell , tile field , other pressurized field
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 August 30 , 1985 -- ' --- - ---_____
signature of applicant
on separate sheet of paper submit a Udiagram 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
_Down n� �ueen ,s6urt�t
BUILDING and ZONING DEPARTMENT
Bay and Haviland Road, R.D. 1 Box 88
Queensbury, New York 12801
SEPTIC DISPOSAL SYSTEM INSPECTION
NAME / [JJ'
LOCATION (f / 1/ 'p o::' :w
DATE � . ,+ A PERMIT NO ,
SOIL 'TYPE - Sand - oam Cla -_�� � SYDX�
Percolation Test Requsred YES -C
Percolation rate - Min/Inch -
TYPE of SX/E;MAbsorpti . total length
Length french
Depth f ts
Size f gr _
SEE GE PITS#Number of)
Size- ft . X ft.
Gravel siZ
PIPINsize �T-yppe.-,,.-
Bldg Co Tan to dD ' t4 boxpit
enings YES NO Partial
I.00ATIONfS :
Foundation to tank f t.
Foundation to absorption � f t.
Absorption to lot line G7 ft .
Separation of pits Wft.
LOCATION - YSTEM ON PROP le one )
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Front ealr - Left side - Righter sx -
COMMENTS : �,y }r ,
aAl
*3 gs
SYSTEM USE APPROVED YES NO
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