IM Inspection Worksheet_13-10-2023_15-06-09INSPECTION WORKSHEET (SEP-028311-2023)
RC-0610-2022Case Number:Case Module:Permit Management
10/13/2023 PassedInspection Status:Inspection Date:
SepticInspection Type:Inspector:Charles Dyer
Job Address:Parcel Number:308 Cleverdale Rd
Queensbury, NY 12804
226.12-1-82
Company Name NameContact Type
Applicant David Brownell
Architect Curtis Dybas
Contractor DB Carpentry
Granted Permission Jean Tarrant
Primary Owner Jean Tarrant
Robert Tarrant
Checklist Item CommentsPassed
Building Inspector Notes True This system has been inspected after installation from Chris
Crandal, asbuilt has been received, inspection was done under
the variance. Pump chamber verified / floats / alarm and final
electrical all verified. CMD 10/5/23
Soil Type: Sand True
ETU Maintenance Contract provided True Please provide maintenance contract / received 10/13/23
Final Electrical True
Waterline separation distance True
Building to Tank True 4" SCHD 40
[Provide extension collar if Yes]True
Tank to Distribution Box True 2" SDR 26 force main to 4" SDR 35
Opening Sealed:True
90% alarm level activates True
End Cap True
Absorbtion Fields: Total Length True see asbuilt
Foundation to Tank True
Engineer Report and As-Built True received engineer asbuilt / inspection report was performed under
variance permit # 9/7/23 sent to T Hutchins.
Location of system on property True See asbuilt
Inlet & Outlet manholes 12"+ below grade True
Type of Water: Municipal / Well Water True lake
Locations / Separations True See asbuilt
Depth of Trenches True Eljen Matts
Length of Each Trench True see asbuilt
System Use Status True
Conforms as per Plot Plan True
Size of tank True FUJI-Clean CE-5 ETU
Distribution box to Field / Pit True 4" SDR 35
Foundation to Absorption True
InletOutlet Pipes & Baffles True
October 13, 2023 Page 1 of 2
INSPECTION WORKSHEET (SEP-028311-2023)
Checklist Item CommentsPassed
50% alarm level activates True
October 13, 2023 Page 2 of 2