INSPECTION WORKSHEET 04102024
INSPECTION WORKSHEET
Town of Queensbury - Building and Codes - Fire Marshal
742 Bay Road - (518) 761-8256 Building (518) 761-8206 Fire Marshal
Case Number: RC-0389-2022 Case Module: Permit
Inspection Date: April 10, 2024 Inspection Status: Reinspect
Inspector: Charles Dyer Inspection Type: Septic
Job Address: 104 Knox Rd
, Parcel Number:
Contact Type Company Name Name
Granted Permission N/A Antonio Civitella
Primary Owner N/A Antonio Civitella
N/A Antonio Civitella
Contractor Adirondack Designers & Builders
Architect Adirondack Designers & Builders
Primary Owner N/A Maria Civitella
Checklist Item
Status
Building Inspector notes
for partial inspection / septic tank and pump chamber verified at previous
date. 4/10/24 inspection for field.
PASS
Roof gutters don't discharge over leach
field
N/O
Soil type: sand
PASS
Soil type: loam
PASS
Soil type: clay
N/O
Type of water: municipal or well water
lake
PASS
Waterline separation distance
PASS
Well casing length 50 ft. more or less
N/O
Total length of absorption fields
total of 280 ft consisting of Advanced environment pipe lines 4@ 40 ft 4@
30 ft with vents in place
PASS
Septic system field above field plain
PASS
Sump pump not connected to septic
system
N/O
Length of each trench
see specs drawing no. C-4.10 from 4/29/22
PASS
Depth of trenches
absorption bed
PASS
System use status
FAIL
Distance from building to tank
20 ft
PASS
Distance from tank to d-box
30 - ft
N/O
Distance from d-box to field or pit
PASS
Opening sealed
PASS
End cap
lines connected
PASS
Inlet outlet pipes and baffles, provide
extension collar if yes
FAIL
Locations and separations
see specs
N/O
Distance from foundation to tank
10 ft
PASSN/O
Distance from foundation to absorption
field
40 ft
PASSN/O
Size of tank
1250 gallon
PASS
50 percent alarm level activates
not yet installed
FAILN/O
90 percent alarm level activates
FAIL
Final electrical
FAIL
Conforms as per plot plan
PASS
Engineer report and as-built
to be provided
N/O
ETU Maintenance Contract provided
N/O
Location of system on property
see specs
PASS
Well separation distance
N/O
Charles Dyer
Code Enforcement Officer