IM Inspection Worksheet_16-11-2023_15-19-09INSPECTION WORKSHEET (SEP-028959-2023)
RC-0296-2023Case Number:Case Module:Permit Management
11/16/2023 PassedInspection Status:Inspection Date:
SepticInspection Type:Inspector:Charles Dyer
Job Address:Parcel Number:98 West Mountain Rd
Queensbury, NY 12804
315.6-1-18
Company Name NameContact Type
Applicant Cerrone Builders Inc
Contractor Cerrone Builders Inc
Engineer Vision Engineering
Granted Permission Cerrone Builders Inc
Primary Owner Cerrone Builders Inc
Checklist Item CommentsPassed
Building Inspector Notes True See inspection report dated 11/15/23 for details. This report is to
signify that home has a 1250 gallon septic tank, not a 1000 gallon
septic tank. 11/16/23
Soil Type: Sand False
Size of Stone False
Roof gutters don't discharge over leach field False
Waterline separation distance False
Building to Tank False
Public Sewer Sign-Off False
[Provide extension collar if Yes]False
Tank to Distribution Box False
Size False
Opening Sealed:False
Soil Type: Clay False
End Cap False
Absorbtion Fields: Total Length False
Septic system field above flood plain False
Foundation to Tank False
Engineer Report and As-Built False N/A
Sump pump not connected to septic system False
Well Casing Length: 50ft +/-False
Location of system on property False
Inlet & Outlet manholes 12"+ below grade False
Septic tanks & pump station anchored in flood zone False
Water softener not connected to septic system False
Type of Water: Municipal / Well Water False
Locations / Separations False
Well separation distance False
Depth of Trenches False
Separation of Pits False
November 16, 2023 Page 1 of 2
INSPECTION WORKSHEET (SEP-028959-2023)
Checklist Item CommentsPassed
Stone Size:False
Seepage Pits: Number False
Length of Each Trench False
System Use Status False
Conforms as per Plot Plan False
Size of tank True
Distribution box to Field / Pit False
Foundation to Absorption False
InletOutlet Pipes & Baffles False
Soil Type: Loam False
November 16, 2023 Page 2 of 2