2014-024 TOWN OF QUEENSBURY
^ra 742 Bay RoadQueensbury,NY 12804-5902 (518)761-8201
Community Development - Building & Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number: P20140024 Date Issued: Thursday, June 02, 2016
This is to certify that work requested to be done as shown by Permit Number P20140024
has been completed.
Tax Map Number: 523400-227-014-0001-004-000-0000
Location: 31 HICKOK Ln
Owner: JAMES B AYERS
Applicant: JAMES B AYERS
This structure may be occupied as a:
Septic Alteration Residential
By Order of Town Board
TOWN OF QUEENSBURY
Issuance of this Certificate of Compliance DOES NOT relieve the (DJ 4
k'
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.
004
trpel. TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development-Building& Codes (518)761-8256
BUILDING PERMIT
Permit Number: P20140024 Application Number: A20140024
Tax Map No: 523400-227-014-0001-004-000-0000
Permission is hereby granted to: JAMES B AYERS
For property located at: 31 HICKOK Ln
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 B AYERS
413 LINCOLN Dr Septic Alteration Residential
GUILDERLAND,NY 12084 Total Value
Contractor or Builder's Name/Address Electrical Inspection Agency
MCNALLY EXCAVATION
518-251-5652
203 WEST Rd
OLMSTEDVILLE NY 12857-0000
Plans&Specifications
2014-024
Res. Septic Alteration
$40.00 PERMIT FEE PAID-THIS PERMIT EXPIRES: Friday,February 06,2015
(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 Town f Queetlsbury ` 'Th r.d,f; bruary 06, 2014
L2)a"/"/ -
SIGNED BY for the Town of Queensbury.
Director of Building& Code Enforcement
Office Use Only
Received: 1 /MIA
SI
Tax Map ID: '�+A i-q
Town of Queensbury Building & Codes PermitNo.: I y-0 c C/
SEPTIC DISPOSAL PERMIT Permit Fee: $ yD
A permit must be obtained before beginning construction Approvals:
Applicant: V ouGt.AS PAC C01-4— Installer/Builder (��C N ALL-V tkt,Auv'rtun.) J c_
Address: 14-Les- COV�--1-,,t etc 2f-, Address Z(33 '‘hl 25)
Coee►c ( lZi?C3 Ot-mSrEDtti 11 NY I185-7
Phone: Sly- LSI -36 r ct Phone 519- zs i -6-(05-7—
Owner: ,5 A ret Location of Installation ?,1 LAW
Address: -t i 3 Lr rvcoiryt7Q ?t'oT KNdt33 s,J
G JtL7 EQLAv D NV J21
Phone 5I8 - Oct - 7 7f3
Contact Person for Building&Code Compliance: `Ocuct_pS e CALL— Day Phone: `i' y ` `lir—
Residence Information:
Year Built #of Bedrooms x Gallons per bedroom =Total Daily Flow
1980 or older ' x 150 = 6,0c:3 Garbage Grinder installed?
1981-1991 x 130 = Spa or Hot Tub Installed?
1992-Present x 110
Parcel Information:
Topography _Flat Rolling _Steep Slope %Slope
Soil Nature Sand Loam Clay Other
Groundwater At what depth?
Bedrock/Impervious Material At what depth?
Domestic Water Supply Municipal Well(if well,water supply from any septic system absorption is ft.)
Percolation Test Rate- per minute per inch(Test to be completed by a licensed professional engineer or
architect) N 6 IN CE t LA►'\,I
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 gallon (minimum size 1,000 gallons),add 250 gallons to size of septic tank for each garbage grinder,spa or
whirlpool tub
System Type: Absorption Field(with#2 stone) Total length ft. Each trench X
Seepage Pit(S)(with#3 stone) How many? Size?
Alternative System Bed or other type?
Holding Tank System Total required capacity? Tank size? #of tanks?
NOTE: 1) Alarm system and associated electrical work must be inspected by a Town approved electrical inspection agency-see Certified
Electrical form on Town website;2)Effective as of March 23,2006 Septic System-As Built Plot Plan: The Building Department will no longer
allow systems to be covered until such time as an As-Built Plot Plan is received and approved by the Building Inspector. The installed
system must match the septic system layout on file. There will be no exceptions.
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.
✓1 have read the regulations with respect to this application and agree to abide by these and all requirements of the Town of Queensbury
Sanitary Sewage Disposal Ordinance. �p ,L
Print Name: '--0(7)0 caLAS 111 CCA I Date: Z7— )`T
Signature: Date: ) - 27 - /`I
Town of Queensbury Building odes Principal Structure Packet 518-761-8256
Town of Queensbury Building & Code Enforcement S�Zti�LJ
Office No. (518) 761-8256
} Septic Inspection Report
Inspection request received: ( l � '2-Q
Name: r�'1 Inspected on:
Location: 1 3 t 1iCk,C�_��� 1� Arrive: - a.m. ..m.
Permit No.: ' 1k Inspector's Initials: (al 1 1 le
Comments and/or diagram
Soil Type: Sand/Loam/Clay
Type of Water: Municipal/Well Water r�
Waterline separation distance ft. >JLC LA J, YDS CfO.Vie i
Well separation distance ft.
Other wells: ft.
Well Casing Length 50'+/- Y N_N/A
[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
Stone Size:
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
Location/Separations
Foundation to tank ft.
Foundation to absorption ft.
Separation of Pitst. - 0 \ ; 3 C.. oC o
Conforms as per Plot Plan /TN
Engineer Report and As-Built N
ETU Maintenance Contract provided Y N
Location of System on Property:
Front r Left Side Right Side Middle Front Middle Rear
S stem Use Sta s:
Approved
Partial Approved and needs to be re-inspected, please call the Building &Codes Office
Disapproved (� ,
Septic Inspection Report �/
WI N C H I P 6272 State Route 9 Phone: (518)494-2555
ENGINEER I N G F�: PO Box 116 Fax: (518)494-2566
Chestertown,NY 12817
May 11, 2016 Job No.: 13-121
Page 1 of 1
McCall Construction
Doug McCall
1485 County Route 29
North Creek, NY 12853
Re: Ayers Property
31 Hickok Lane
Queensbury, NY
Tax Map#227.14-1-4
Dear Mr. McCall,
On May 20, and 22, 2014 Zachary Monroe of my office, visited the above referenced
site. The purpose of these visits was to observe the construction of the replacement
wastewater system. Based on the visits the system appears to be constructed in general
conformance with the approved plans.
If you have any comments or questions, please do not hesitate to contact me.
Sincerely,
° j Jf 'fJfr
15
Bret W. Winchip
NYS PE#083076
Winchip Engineering, P.C.
[RA 01 2016i
TO1c`i4 GF QUEE. 61'1RY
BU LDlNG &CODES
Town of Queensbury Building & Code Enforcement In ect" + �3
Office No. (518) 761-8256
Septic Inspection Report
Inspection request received:
Name: (� er 3 Inspected on: 5 _ -j Al
Location: J- ' L Z)f< INV) Arrive: a.m.6 J.
Permit No.: 1.41-0 .C1 Inspector's Initials:
Comments an /or diagram
Soil Type: Sand/Loam/Clay
Type of Water: Municipal/Well Water
Waterline separation distance ft.
Well separation distance ft.
Other wells: ft.
Casing
�` _--
Well CasinggLength 50'+!- Y N N/A
[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
Stone Size:
Piping Size Type
Building to tank
Tank to Distribution Box
Distribution Box to Field/Pit /� -r I C1 CG FLI
Opening Sealed: Y N 1 JA
End Cap N
Inlet/Outlet Pipes&Baffles
Manholes 12"or less below grade Y N
[provide extension collar if Yes] Y N �j �� Dr, —�
Location I Separations
Foundation to tank ft. Y 1 —
Foundation to absorption ft.
Separation of Pits ft.
Conforms as per Plot Plan Y N
Engineer Report and As-Built Y N
ETU Maintenance Contract provided Y N
Location of System on Property:
Front Rear Left Side Right Side Middle Front Middle Rear
S stem Use Status.
Approved
Partial Approved and needs to be re-inspected, please call the Building &Codes Office
Disapproved
Septic Inspection Report
Town of Queensbury Building & Code Enforcement1 ( ` 30
Office No. (518) 761-8256
Septic Inspection Report
r
Inspection request received: 5 Z1 k _
)\5 '2_,c, '4--
Name: �`� Inspected on:
Location: ' 1 4-1 C K ' -"'t iArrive: 2_7 jib a.m.I p.m.
Permit No.: ? :1 It - (`3�,� Inspector's Initials:/ '.
Comments and/or diagram
Soil Type:`Sand'/Loam 1 Clay
Type of Water: Municipal/Weil-Wat
Waterline separation distance ft.
Kiez---Q-5 Well separation distance ft.
Other wells: ft.
Well Casing Length 50' +/- Y N N/A fa--- k> --C-
[150'to well required if NO]
Absorption Field: Total length ''Z-5 ft.
Length of each trench 'S 6 ft.
Depth of trenches _/_4(..
Size of Stone -g—L...
Seepage Pits: Number b
Size: / c12,c)\1` l
Stone Size: (-- d—i/
Piping Size Type
Building to tank I Z-
Tank to Distribution Box ti �. • . ip
Distribution Box to Field I Pit At.' 2
Opening Sealed: Y A Y
End Cap IX�.�. .�r�� �-v ������1
Inlet/Outlet Pipes&Baffles _Y W N "'"---7---
Manholes 12"or less below grade Y_N
[provide extension collar if Yes] Y N
Location/Separations
Foundation to tank ft. � �✓ 2- 2--.
�� 'j -n \ .
Foundation to absorption ft. �,v
Separation of Pits ft.
Conforms as per Plot Plan N • c.�
Engineer Report and As-Built Y �I � / � �?
ETU Maintenance Contract provided _Y—N nn - `ZC �f
Location of System on Property: yy //
Front Rear Left Side Right Side Middle Front Middle Rear
System Use Status:
aproved
rtial al
ParApproved Approved and needs to be re-inspected, please call the Building&Codes Office
Disapproved
Septic Inspection Report
Town of Queensbury GIS Viewer Page 1 of 2
'ice ���� J (1.10.'ie m CI
4. Zoom In
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Parcel Results_More Infos , Clear �– �� l 4
FID 3233 + - \ Kattsk,II J
C.: - I, Bay
PIN 227014000100400C ,
NEWNUMBER 227.14-1-4 It I,itif
GISACRES 0.539353 ti_
PRINT_KEY 227.14-1-4I LI Municipal Boundaries
AREA 23494.2029095192 j Town BND
PERIMETER 666.613546084063 M ,✓ Roads
PARCEL_ID 227.14-1-4
Mill • ,..1Queensbury Parcels
PARCADRNUM 31
I _ Election Districts
PARCADRNAM Hickok Ln "`
r- 1111 .1 , Subdivisions
OWNERI JAMES B AYERS Wir
irk C" \` h.
Zoning Districts
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