Signed Inspection Worksheer 05_22_2017 IIII IIIIIIIIIIIIIIIIII IIII IIII IIIIIIIIII III IIII III I IIII IIIIIIIIIIIII IIIIIIIIII IIIIII IIIIII IIIIIII ����IIIIIIIIIIIII����� IIIII IIII II ������I
Town of Queensbury-Building and Codes-Fire Marshal
742 Bay Road-(518)761-8256 Building(518)761-8206 Fire Marshal
Case Number: RC-000513-2016 Case Module: Permit
Inspection Date: 05/22/2017 Inspection Status: Partial Pass
Inspector: Charles Dyer Inspection Type: Septic
Job Address: 15 ANTIGUA RD Parcel Number: 239.17-1-5
Lake George, NY 12845
Contact Type Company Name Name
Primary Owner Pickett, III, Daniel
Contractor [Bonacio Construction, Inc.]
Granted Permission [Bonacio Construction, Inc.]
Applicant [Bonacio Construction, Inc.]
Checklist Item Passed Comments
Building Inspection notes YES Partial inspection for Eljen field-3 runs at 24 ft for start of backfill
5/22/17
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Soil Type: Sand NO
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Soil Type: Loam NO
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Soil Type: Clay NO
Type of Water:Municipal/Well Water NO
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Waterline separation distance NO
Well separation distance NO
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Well Casing Lengt:50ft+/- NO
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Absorbtion Fields:Total Length NO
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Septic system field above flood plain NO
:::::::::: st tanks&pump ::::at::ion anchored in fl:: ::ood zo:::ne::::e...::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::: ::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::...........................
S eptic NO
Length of Each Trench NO
Depth of Trenches NO
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Size of Stone NO
Seepage Pits: Number NO
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Size: NO
Stone Size: NO
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Building to Tank NO
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Tank to Distribution Box NO
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Distribution box to Field/Pit NO
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Opening Sealed: NO
E
::::: ::nd C::::::a p p...::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::: ::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::...........................
NO
n:l:etOut::l:et Pipes&Bale:::s::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::NO
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Manholes 12 or less below grade NO
[Provide extension collar if Yes] NO
Locations/Separations NO
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Foundation to Tank NO
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Foundation to Absorption NO
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Separation of Pits NO
May 22,2017 Page(1)
IIII IIIIIIIIIIIIIIIIII IIII IIII IIIIIIIIII III IIII III I IIII IIIIIIIIIIIII IIIIIIIIII IIIIII IIIIII IIIIIII ����IIIIIIIIIIIII����� IIIII IIII II ������I
Checklist Item Passed Comments
Conforms as per Plot Plan NO
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Engineer Report and As-Built NO
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ETU Maintenance Contract provided NO
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Location of system on property NO
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System Use Status NO
Dyer, Charles(Inspector)
May 22,2017 Page(2)