IM Inspection Worksheet_13-12-2023_10-26-12INSPECTION WORKSHEET (SEP-029339-2023)
SEP-0691-2023Case Number:Case Module:Permit Management
12/13/2023 Partial PassInspection Status:Inspection Date:
SepticInspection Type:Inspector:Charles Dyer
Job Address:Parcel Number:119 Gurney Ln
Queensbury, NY 12804
288.-1-85
Company Name NameContact Type
Applicant Tanya Bruno
Contractor Nick Perrone
Engineer Richard E. Jones Associates
Granted Permission Tanya Bruno
Primary Owner David Bruno
Tanya Bruno
Checklist Item CommentsPassed
Building Inspector Notes False
Soil Type: Sand True
Size of Stone True #2
Waterline separation distance True
Building to Tank True 4" SCHD 40
Public Sewer Sign-Off False
[Provide extension collar if Yes]False
Tank to Distribution Box True 4" SDR 35
Opening Sealed:True
Soil Type: Clay False
End Cap True
Absorbtion Fields: Total Length True 138 ft
Septic system field above flood plain True
Foundation to Tank True 10 ft
Engineer Report and As-Built False please provide asbuilt from Architect
Sump pump not connected to septic system False
Well Casing Length: 50ft +/-True
Location of system on property True see specs
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 True well
Locations / Separations True
Well separation distance True 101 ft to field
Depth of Trenches True 16+"
Length of Each Trench True 46 ft
System Use Status True
Conforms as per Plot Plan True
December 13, 2023 Page 1 of 2
INSPECTION WORKSHEET (SEP-029339-2023)
Checklist Item CommentsPassed
Size of tank True 1000 gallon
Distribution box to Field / Pit True 4" SDR 35 perforated
Foundation to Absorption True 30+ ft
InletOutlet Pipes & Baffles True with effulent filter at outlet
Soil Type: Loam True
December 13, 2023 Page 2 of 2