IM Inspection Worksheet_14-07-2023_15-20-51INSPECTION WORKSHEET (PTI-026583-2023)
PT-0380-2023Case Number:Case Module:Permit Management
07/14/2023 PassedInspection Status:Inspection Date:
Property Transfer InspectionsInspection Type:Inspector:Charles Dyer
Job Address:Parcel Number:133 Tee Hill Rd
Queensbury, NY 12804
289.7-1-50
Company Name NameContact Type
Applicant Victoria LaMarque
Proposed Owner MATTHEW EBERLEIN
Checklist Item CommentsPassed
Building Inspector Notes True See failed notes / 7/14/23 returned to site to verify inside of pitts,
all dry.Then returned to verify extension collars at inlet and outlet,
replacement of effluent filter / D box with speed levelers, 2 new
lines of SDR 35 to each pitt.
Weather/lack of information/inaccessibility True No
Capacity in gallons True 1000 gallon
System/components indicate unacceptable True Yes / Outlet baffle / distribution box / verified new components
7/14/23
Roof gutters don't discharge over leach field True No
Concrete tank True Yes
Temperature (Fahrenheit)True 85
D-box material: concrete or plastic True Concrete / completely filled with dirt and roots - 7/14/23 verified
replacement of new D-box
It was observed effluent flowing into D box
Baffle & D-box or 45° angle True Concrete / completely filled with dirt and roots - 7/14/23 verified
replacement of new D-box
Apparent structural damage False
Septic inlet cover ext - Req 12"+ below grade True Will need to provide extension collars / both inlet and outlet
7/14/23 verified
Visible scum layer True Yes
Septic tank (include # of tanks)True One / 1,000 gallon precast concrete
Plumbing fixtures tested & confirmed True Yes
Evidence of a pipe bypassing tank True No
System appears undersized/undersized components True No
Speed levers in D-box True Difficult to verify
Tank cover True Yes / concrete
System appears to have functioned adequately True
System passes all function testing True Flow of fixtures into septic tank only
Septic outlet cover ext - Req 12"+ below grade True Will need to provide extension collars / both inlet and outlet
7/14/23 verified
System needs repairs True Yes
Overflow pipe (automatic failure)True No
Depth below grade to top of tank True 20+"
Access riser? (if yes, depth to cover)True No / new
Cesspool (automatic failure, if yes)True No
July 14, 2023 Page 1 of 2
INSPECTION WORKSHEET (PTI-026583-2023)
Checklist Item CommentsPassed
Inlet baffle True Yes / concrete
Recommend upgrade/expand/replace 1+ components True
No treatment tank/other critical component(s)True No
As-built provided is accurate True
Test each fixture flow to septic tank True Yes
Water softener not connected to septic system True No
Is tank pumped more than 4x/year?True No
On-site as-built req'd before insp is complete True
Solids in D-box True Concrete / completely filled with dirt and roots 7/14/23 new D-box
Outlet baffle True No / will need to provide sanitary T to extend into septic tank
16"-18" / 714/23 verified effluent filter at outlet
Weather True Partly cloudy
Main tank cleanout size and location True 16x16" at inlet
Seepage Pits: Number True As per septic alteration permit / dated 4/18/1995 (2)
8x8 seepage pitts
Leaking water fixtures True No
Cracked, corroded or deformed?True Yes / needs to be replaced / yes- replaced
Water tight tank True Yes
Other False C
Sump pump(s)True No
July 14, 2023 Page 2 of 2