IM Inspection Worksheet_25-10-2023_15-22-04INSPECTION WORKSHEET (SEP-028528-2023)
SEP-0074-2023Case Number:Case Module:Permit Management
10/25/2023 Partial PassInspection Status:Inspection Date:
SepticInspection Type:Inspector:Charles Dyer
Job Address:Parcel Number:11 Duncan Cv
Queensbury, NY 12804
226.16-1-5
Company Name NameContact Type
Applicant Deborah Purcell
Contractor Crandall Excavating
Engineer Environmental Design Partnership (EDP)
Granted Permission Barbara D'Agostino
Primary Owner Barbara D'Agostino
Checklist Item CommentsPassed
Building Inspector Notes True partial inspection / 4 rows ELJEN bio matts
Soil Type: Sand True
ETU Maintenance Contract provided False
Size of Stone False N/A
Final Electrical False
Waterline separation distance True
Building to Tank True 4" SCHD 40
[Provide extension collar if Yes]False
Tank to Distribution Box True 2" force main to 4" SDR 35
Opening Sealed:True
90% alarm level activates False
End Cap True
Absorbtion Fields: Total Length True 132ft
Septic system field above flood plain True
Foundation to Tank False
Engineer Report and As-Built False
Sump pump not connected to septic system True
Water shut off activates at 90% full False
Location of system on property False
Inlet & Outlet manholes 12"+ below grade False
Type of Water: Municipal / Well Water False Lake
Locations / Separations False
Depth of Trenches True matts sit atop washed sand / see specs
Separation of Pits False
Length of Each Trench True ELJEN matts 4 rows @ 32 ft
System Use Status False
Conforms as per Plot Plan False
Size of tank False
Distribution box to Field / Pit True 4" sewer and drain perforated
October 25, 2023 Page 1 of 2
INSPECTION WORKSHEET (SEP-028528-2023)
Checklist Item CommentsPassed
Foundation to Absorption False
InletOutlet Pipes & Baffles True
50% alarm level activates False
October 25, 2023 Page 2 of 2