SEP-003217-2019 06032019INSPECTION WORKSHEET (SEP-003217-2019)
Town of Queensbury - Building and Codes - Fire Marshal
742 Bay Road - (518) 761-8256 Building (518) 761-8206 Fire Marshal
Case Number:RC-0530-2018Case Module:Permit
Inspection Date:Mon Jun 3, 2019Inspection Status:Partial Pass
Inspector:Charles DyerInspection Type:Septic
Job Address:15 GENISTA LNParcel Number:289.10-1-36
Lake George, NY 12845
Contact TypeCompany NameName
ApplicantWilliams, Danny
ContractorBarber, Daniel
Granted PermissionBarber, Daniel
ArchitectWilliams, Danny
Primary OwnerJudkins, David
Primary OwnerJudkins, Dawn
Checklist ItemPassedComments
Building Inspector NotesNO6/3/19 inspection was to verify placement of 1250 gallon
septic tank along with 405 sq.ft of stone absorption bed, with
60+ linear ft of 4"SDR 35 perforated, looped
Public Sewer Sign-OffNO
Soil Type: SandNO
Soil Type: LoamNO
Soil Type: ClayNO
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INSPECTION WORKSHEET (SEP-003217-2019)
Checklist ItemPassedComments
Type of Water: Municipal / Well WaterYESWell
Waterline separation distanceNO
Well separation distanceNO
Well Casing Lengt: 50ft +/-NOSee specs
Absorbtion Fields: Total LengthNO
Septic system field above flood plainNO
Septic tanks & pump station anchored in floodNO
zone
Length of Each TrenchNO
Depth of TrenchesNO
Size of StoneNO# 2
Seepage Pits: NumberNO
Size:NO
Stone Size:NO
Building to TankNO
Tank to Distribution BoxNOSee specs
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INSPECTION WORKSHEET (SEP-003217-2019)
Checklist ItemPassedComments
Distribution box to Field / PitNOSee asbuiltr
Opening Sealed:NO
End CapYESLooped
Manholes 12 or less below gradeNO
[Provide extension collar if Yes]NO
Locations / SeparationsNO
Foundation to TankNOSee asbuilt
Foundation to AbsorptionNO
Separation of PitsNO
Conforms as per Plot PlanNO
ETU Maintenance Contract providedNO
Location of system on propertyNOSee asbuilt
System Use StatusNO
Dyer, Charles (Inspector)
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