2010-435 •
TOWN OF QUEENSBURY
_ 742 Bay Road,Queensbury,NY 12804-5904 (518)761-8201
Community Development- Building&Codes (518)761-8256
CERTIFICATE OF OCCUPANCY
Permit Number: P20100435-37143 Date Issued: Tuesday, September 7, 2010
This is to certify that work requested to be done as shown by Permit Number P20100435-37143
has been completed.
Tax Map Number: 301.17-2-47
Location: 861 SHERMAN AVE
Owner: Michael Duggan
Applicant: Michael Duggan
This structure may be occupied as a:
By Order of Town Board
TOWN OF QUEENSBURY
Issuance of this Certificate of Occupancy DOES NOT relieve the
property owner of the responsibility for compliance with Site Plan,
Variance,or other issues and conditions as a result of approvals by the Director of Building&Code Enforcement
Planning Board or Zoning Board of Appeals.
.v.01.14 TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development- Building&Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20100435 Application Number. A20100435
Tax Map No: 523400-301-017-0002-047-000-0000
Permission is hereby granted to: MICHAEL DUGGAN
For property located at: 861 SHERMAN Ave
in the Town of Queensbury,to construct or place
at the above location in accordance with application together with plot plans and other information hereto filed
and approved and in compliance with the NYS Uniform Building Codes and the Queensbury Zoning
Ordinance. Type of Construction Value
Owner Address: MICHAEL DUGGAN
861 SHERMAN Ave Septic Alteration Residential
QUEENSBURY, NY 12804-0000 Total Value
Contractor or Builder's Name/Address Electrical Inspection Agency
Plans &Specifications
2010-435
septic alteration residential
$25.00 PERMIT FEE PAID- THIS PERMIT EXPIRES: Wednesday,August 31, 2011
(If a longer period is required,an application for an extension must be made to the code Enforcement Officer
of the Town of Queensbury before the expiration date.)
Dated at the To o eensb , r s• y,August 31, 2010
SIGNED BY .,L42. for the Town of Queensbury.
Director of Building&Code \ orcement
7,C,/ —4/7OFFICE USE ONLY
•
•
•
TAX AP NO. PERMIT NO.I0L4 PERMIT FEE; Su/
APPROVALS: ZONING TOWN CLERK
J
APPLICATION FOR SEPTIC DISPOSAL SYSTEM PERMIT:
A PERMIT MUST BE OBTAINED BEFORE WORK BEGINS.APPLICATION IS SUBJECT TO REVIEW BEFORE ISSUANCE OF A VALID
PERMIT.
OWNER: Al6%Ct 'el-
V
��C'�� INSTALLER: /C/o`CiLA(21 Al %%II
ADDRESS: u '.( c—dfIQCO1, 0.va A�� ADDRESS: U 'd 6LQr ,,C((,
PHONE NOS. 7% -86)-S^ PHONE NOS.
LOCATION OF INSTALLATION: R ( 5(--v,--4-14.:,--1. �-/-L-(
YEAR BUILT NO.OF X COMPUTATION= RESIDENCE INFORMATION:
BEDROOMS = TOTAL DAILY FLOW
1980 or older X 150 gallon per bedroom = GARBAGE GRINDER
INSTALLED?
=
1981 -1991 X 130 gallon per bedroom ( 67)
1992-present X 110 gallon per bedroom = SPA OEDT
INSTALLED? TUBS
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PARCEL INFORMATION:
✓ TOPOGRAPHY: Flat rolling " Steep slope %Slo e
p
✓ SOIL NATURE: Sand X Loam
Clay Other
✓ GROUNDWATER: At what depth?
✓ BEDROCK/IMPERVIOUS MATERIAL: At what depth?
✓ DOMESTIC WATER SUPLY: Municipal /( Well (If well: Water supply from any septic
system absorption is ft.)
✓ PERCOLATION TEST: Rate is per minute per inch.
(Test to be completed by a licensed professional engineer or architect.)
PROPOSED SYSTEM FOR NEW CONSTRUCTION: All individual sewage disposal systems must be designed by
a licensed professional engineer or architect (unless installed in a Planning Board approved subdivision).
TANK SIZE: /66D GALLON (MIN. SIZE IS 1,000 GAL.) Add 250 gallons to the size of the septic tank for
each garbage grinder, spa or whirlpool tub. p
SYSTEM TYPE:
❑ ABSORPTION FIELD (WITH NO. 2 STONE) Total length ft. Each trench X
,8 SEEPAGE PIT(S) (WITH NO. 3 STONE) How many? I Size? '%'
❑ ALTERNATIVE SYSTEM Bed or other type?
0 HOLDING TANK SYSTEM Total required capacity?
Tank size? Number of tanks?
NOTE: ARM SYSTEM AND ASSOCIATED::..::....................................:................................................... .. ......
.................................._............ ....... .. ... ...
I. ELECTRICAL WORK MUST BE INSPECTED BY A TOWN
APPROVED ELECTRICAL INSPECTION AGENCY. PLEASE REVIEW LIST PROVIDED.
For your protection, please note that pursuant to Section 136-29 of the Code of the Town of Queensbury, any
permit or approval granted which is based upon or is granted in reliance upon any material misrepresentation or
failure to make a material fact or circumstance known by or on behalf of an applicant, shall be void.
//.- )
Septic Inspection Report
Office No. (518) 761-8256 Date Ins•-.1. request received:
Queensbury Building&Code Enforcement Arrive: I, am�. Depart: am/pm
742 Bay Rd., Queensbury, NYNY12804 Inspector's Initials: .
NAME: Lite �IJ;�a &,n PERMIT NO.: k.
LOCATION: S7 ,-1, .� �c/4,_ INSPECT ON: TRY iv
RECHECK:
Comments and/or diagram
Soil Ty, Sand Loam/Clay
Type of Water: un' •• /Well Water
Waterline separation distance ft.
Well separation distance ft.
Other wells: ft.
Well Casing Length 50'+/- Y N NIA
[150'to well required If NO]
Absorption Field: Total length ft.
Length of each trench ft.
Depth of trenches ft.
Size of Stone
Seepage Pits: Number /
Size: x g
Stone Size: r
Piping Size Type
Building to tank
Tank to Distribution Box
- Distribution Box to Field/ Pit
Opening Sealed: Y N
End Cap _Y N
Inlet/Outlet Pipes&Baffles Y_N
Manholes 12"or less below grade Y_..,_N
[provide extension collar if Yes] Y N
5–Qa- c144c) 0- Pick
Location/ Separations
Foundation to tank ft.
Foundation to absorption ft.
Separation of Pits ft.
Conforms as per Plot Plan _ Y N (oV
Engineer Report and As-Built _Y—N
ETU Maintenance Contract Y_N ISA. /6
provided
Location of System on Property:
Front Rear Le- •- :'•u Side Middle •• Middle Rear
e - t .: f
Approved (Nker r*41- e 0444 r
Partial Approved and"needs to/ - re-inspected, please call the Buildi &Codes Office
P •i .' �•
L:\Pam Whiting\2010\Buliding Codes Fonns\Inspect on Fams\Septic Inspection Report_03 29 10.doc
INVOICE
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PLANT TIME DUE _ DATE ACCOUNT*l TRUCK NO. DRIVER TICKET NO.
tl i-: a
CUSTOMER NAME DELIVERY ADDRESS
i•i I : if i. I,
'
eg.=
PURCHASE ORDER SALES ORDER TAX. �' CREDIT PROJECT SLUMP ISE'. , i _.
A,
LOAD UNIT
QTY. PRODUCT DESCRIPTION _ ORDERED DELIVERED PRICE AMOUNT
at
Leave Plant Arrive Job Start Discharge Finish Discharge Arrive Plant SUB TOL c , \`
TAX / r� \ ''3 :i:, _i
Time Difference Time Allowed Excess Time Unit Prue Amount TOTAL 1, `1(;. \,..„, „\,.:0,!..:1,)
...
All bills payable upon receipt.All bills unpaid within 30 days of the close of Total water added o job at ustcri4s eque gals.
statement will incur an INTEREST CHARGE of 1-1/2% per month. SLUMP POURED inches E
WARNING: IRRITATING TO THE SKIN&EYES.Contains C A
Portland Cement.Avoid Contact with eyes and prolonged contact NY MILES ��. H D
with skin.Wear rubber boots and gloves. In case of contact with skin W T
or eyes,flush thoroughly with water. If irritation persists,get medical A i
attention. Keep children away. CT MILES T 0
E H
Purchaser assumes all responsibility for injuries caused due to failure to follow this warning. R
OUR TRUCKS ARE NOT PERMITTED TO GO BEYOND CURB LINE,EXCEPT BY OWNER'S OR CUSTOMERS AUTHORIZATION,AND I HEREBY
ACCEPT ALL RESPONSIBILITY FOR THE RESULTING DAMAGE.ANY WATER ADDED TO THE MIX ON THE JOB SHALL BE AT THE
PURCHASERS OWN RISK.
Received&Subject to the conditions above: -
By: - - Print NameA/'
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