Signed Inspection Worksheet 05_26_2017 IIII IIIIIIIIIIIIIIIIII IIII IIII IIIIIIIIII III IIIIIII I IIII IIIIIIIIIIIII IIIIIIIIII IIIIII IIIIII IIIIIII����� IIIIIIIIIIIII IIIII IIII II ������I
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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: 05/26/2017 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.]
Applicant [Bonacio Construction, Inc.]
Granted Permission [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
Soil Type: Sand YES
Soil Type: Loam NO
Soil Type: Clay NO
Type of Water:Municipal/Well Water NO
Waterline separation distance NO
Well separation distance NO
Well Casing Lengt:50ft+/- NO
Absorbtion Fields:Total Length YES 180ft
Septic system field above flood plain NO
Septic tanks&p u m p station anchored in flood zone NO
Length of Each Trench YES Eljen system-each run is 60 ft partial inspection for 60 ft less 12 more
feet of run at each line
5/24/17
Depth of Trenches YES Eljen system placed on washed sand
Building to Tank YES 1000 gal tank placed next to existing 1250 tank see specs
an to Distribution Box YES 4"SDR 35
Distribution box to Field/Pit YES 4"SDR 35
Opening Sealed: YES
End Cap YES
InletOutlet Pipes&Baffles YES
Manholes 12 or less below grade NO
[Provide extension collar if Yes] NO
Locations/Separations NO
Foundation to Tank YES See specs
Foundation to Absorption NO
Separation of Pits NO
Conforms as per Plot Plan NO
Engineer Report and As-Built NO Provide engineer asbuilt report
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Checklist Item Passed Comments
ETU Maintenance Contract provided NO
Location of system on property NO See specs
System Use Status YES
Dyer, Charles(Inspector)
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