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2001-618 TOWN OF QUEENSBURY 742 Bay Road, Queensbury,NY 12804-5902 (518) 761-8201 Community Development - Building & Codes (518) 761-8256 CERTIFICATE OF COMPLIANCE Permit Number: P20010618 Date Issued: Tuesday, August..14, 2001 This is to certify that work requested to be done as shown by Permit Number P20010618 has been completed. Tax Map Number: 523400-308-014-0001-061-000-0000 Location: 4 LANTERN HILL Rd Owner: JAMES LIZOR Applicant: JAMES LIZOR This structure may be occupied as a: By Order of Town Board Septic Alteration Residential TOWN OF QUEENSBURY (D,„,,,P _ Director of Building& Code Enforcement '., TOWN OF QUEENSBURY 1 ; - 742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201 0;0 Community Development-Building& Codes (518) 761-8256 BUILDING PERMIT Permit Number: P20010618 Application Number: A20010618 Tax Map No: 523400-308-014-0001-061-000-0000 Permission is hereby granted to: JAMES LIZOR For property located at: 4 LANTERN HILL Rd 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: JAMES LIZOR Septic Alteration Residential ANNE THOMPSON Total Value 4 LANTERN HILL Rd QUEENSBURY,N.Y. 12804 Contractor or Builder's Name/ Address Electrical Inspection Agency I.B.S. SEPTIC 2 LOWER WARREN STREET OUEENSBURY,NY Plans &Specifications 2001-618 SEPTIC ALTERATION AS PER PLOT PLAN SPECIFICATIONS $25.00 PERMIT FEE PAID - THIS PERMIT EXPIRES: Wednesday,August 14,2002 (If a longer period is requited,an application for an extension must be made to the code Enforcement Officer of the Town of Queensbury before the expiration date.) Dated at the own Que sb , e•s ay,August 14,2001 SIGNED BY t for the Town of Queensbury. Director of Building&Code Enforcement Application for Permit—Septic Disposal System ,_ • • Town of Queensbtuy 742 Bay Road Queensbury,NY 12804 (518) 761-82' v— . '' * rt . 13s 1. OWNER INFORMATION: II • Office Use • Location of installation: q 6,v AJ o f JV Tax Map No. / / Filo Porntit No:C ©0I— 18' p Fee F Paid c,�'�� 4 Owner's Name: iet. ,,e> 6; -2, ._/- 4r ilAY •ti Address: 4i' 1 �dr—r Al-� tL` - =��•t-�' / 1eCer 4001 2. INSTALLER'S NAME : TTr1 ? �, -f I PHON `� Sty e ,., �007 'S 3. RESIDENCE INFORMATION: (circle year of dwelling, indicate II bedroom(~) and nui 04)$hls,6 bedrooms with applicable gallons per bedroom to equal total daily f o Cp P, Year of House: No. of Bedrooms x Computation = - Total Daily Flow 1980 or older 1 x 150 gal/bdrm = 65)0 '. 1980— 1991 x 130 gal/bdrm — — 1991 —present x 110 gal/bdrin = • Garbage Grinder Installed yes / no /, Spa or Whirlpool Installed yes / no 4. PARCEL INFORMATION: (circle applicable information &indicate measurements) op ►raphy •r attire Ground Water 13edrock or Impervious Material _ _ r S mply F ui r epth Fla sand ' at w at w> t th dep municl • _.. ._ a _ 'fling r et /f fee.t c Steep slope clay if well; water supply %slope other from any septic-system • depth: absorption is ft. other Percolation Test o be completed by licensed professional engineer or architect) Rate:• minute per inch 5. 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 13oard approved subdivision). Add 250 gallons to the size of the septic tank and leach lie tor rcacll(; age Grinder, Spa or Whirlpool Tub.�k 55/// Septic Tank: lboe gallon (min. size 1,000 gal) Tile Field: each trench ,,,,5(' ft. Total System Length: sD ft. .. ✓'. C / f\ci-/d-f Seepage Pit(s): number of size of each: ft. by f1. Size of Stone to be used: it / depth or thickness __ _feet Bed System Size: • x Alternative System: length and/or size 6. HOLDING TANK SYSTEM: (if required) • Number of tanks: / Size of each: gallons /TOTAL Capacity: gallons Note: Alarm System and associated electrical work must be inspected by a Town approved electrical inspection agency. 7. SIGNATURE &INFORMATION FOR RESPONSIBLE PERSON (please read) 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. I have read the regulations with respect to this application and agree to abide by these and all requirements of the To i of Queensbury Sanitary Sewage Disposal Ordinance. 4,// 1( - /I-)470 7 nature of re ponslble p4rson Date i • Office Use GENERAL INSPECTION REPORT Inspector: Town of Queensbury Ready at timer' -419q-s" Dept. of Community Development Request received:' U'I 7.7/62 Meet: ! Building& Code Enforcement . . At time: 742 Bay Road Queensbury, NY 12804 ARRIVE am/pm: DEPART V " .')am/pm Notes: (518) 761-8256 Inspector's Initials �`' C./ ,� P NAME: ei 6'VnhL/ PERMIT# /�l�nn,,6Z LO_ 0`/L l LOCATION: T ?D }-1A_ �' INSPECT ON(date): (1 /Z /4 TYPE OF STRUCTURE: + 0 RECHECK N/A YES NO COMMENTS Footings(Piers Monolithic Pour Form Reinforcement in Place - The contactor is responsible for providingprotection from freezing for 48 hours following the placement of the concrete. Materials for as purpose on site Foundation/W allpour� Reinforcement inPlace Foundation/Dampproofing Backfill Approval Plumbing Under Slab _ umbin Vent/Vents in Place h lumbigg Heating Rough--Ills" Insulation Foundation Walls Interior R- Foundation Walls Exterior R- S Floors R- Walls It- Ceiling R- , Duct work or piping in • unheated spaces R- \ Proper Vent,Attic Vent J ); 11111M_ JikkildL • Jack tuaff eaders • Bracing/Bridging / Joist Hangers +/ jJack-P©s#s sin Beam I irltration Barrier Fire Separation 1,2,3,hour P 'netration Sealed ire Wall 2,3,4 hour_ 11 1i estopprng = L:\SueHemingway\B ilding.Codes.Inspection.FORMS\GENERAL INSPECTION REPORT.doc _. AI TOWN OF QUEENSBURY 'r BUILDING & CODE ENFORCEMENT \\: 742 Bay Road Queensbury NY 12804 (518) 761-8256 SEPTIC DISPOSAL SYSTEM INSPECTION Name 4f - 7,0S Location k L \ gl\ T' \\ Dates —/ u'2rb) Permit # 1`(-(2 1 SOIL TYP . an Clay- Results of Percolation Test- (if applicable) Rate-Mi . . :/Inch TYPE OF SYSTEM: ABSORPTION FIELD: To'al Le gth 2.617)_ Length of each tren . A _ ' e i Depth of trenches Size of stonestone iiNaltkriMieW SEEPAGE PITS: Num•er- Size - ft. x ft. Stone siz- PIPING: Size Type Bldg. to Tank -� !7"---���� Tank to Dist. Box 4 t r ,s7D4Z '3 Dist. Box to Fi el o/Pit I-i ' ` .,L- Q.1\Z Openings Sealed? es No . .Partial LOCATION/SEPARAT1O . Foundation to Ta k c. jTfeet Foundation to 'Ab.orption . ___ feet . Separation of Pits • __ t Conforms as per Plot Plan es LOCATION OF SY EM ON PROP . (circle one) Fron - :-.r - Left Side - Right Side middle F� ront - Middle Rear • SYSTEM.USE APPROVED: YES Arrive.- j�// Depar °i�7 /° /1ding In p• 'ov tv�I� if"I have Sen or observed or b lieve I s l , cy � " all ob;e�cts sucki_ 'J a-�v°vide cti ot(e { as �o�rses, �I xrQ nee ot, se�!�� �;n t1� s alocu ' Qt. des, der,;es � ally r� G;urQd N e,sen:th I J' fi . t�'� Cll�ia. :ten �� r � ._ I — ice: �t r`or�, �n the d�a6r O.' 1 AUG 1.3_2001 ___I_ I I F�q j�E SBUR — S `U E F I Lç2iT®WN®I ��ATE AND CO®� BUILDING - 1 � � 1- - (:„,.:Nliti , ..:t.„ . )4Dusc 5,L.!.1 (cfl' - '.'1 )( ; v c : (I ' 1 � � '�"•1) LL V U✓ J Q-0 .. 1 ■ 4v jij W iii i ita . t,1 I ` J csca � c.r 0 ---jr° gc1' , rt z) ° .. I. . - . ..:,..r. L= L=-i3 c.11 --'�_ =CJiVI T1 #4. ' f .. ��"�i-FiI .�� u - 11-1111 • _it i (I t4rL44cLL)(.)_. A.,.-ii., Li i '...t_ r 71 i r r.) ,i(C (-)I • 7 , I I I I I � I —I i_ k i /_t__J. I i