IM Inspection Worksheet_20-09-2023_11-36-53INSPECTION WORKSHEET (SEP-027820-2023)
SEP-0074-2022Case Number:Case Module:Permit Management
09/20/2023 Partial PassInspection Status:Inspection Date:
SepticInspection Type:Inspector:Charles Dyer
Job Address:Parcel Number:308 Cleverdale Rd
Queensbury, NY 12804
226.12-1-82
Company Name NameContact Type
Agent Hutchins Engineering
Primary Owner Jean Tarrant
Robert Tarrant
Checklist Item CommentsPassed
Building Inspector Notes True for verification of bed system / placement of tanks / will need to
verify floats / alarm / final electric. Call when ready. Floats / alarm
and final electric verified. Please provide maintenance agreement
for Fuji system. 9/20/23
Soil Type: Sand True
ETU Maintenance Contract provided True please provide ETU maintenance agreement
Size of Stone True #2
Final Electrical True verified
Roof gutters don't discharge over leach field False
Waterline separation distance True
Building to Tank True 4" SCHD 40 to Fuji clean ETU
Public Sewer Sign-Off False
[Provide extension collar if Yes]True
Tank to Distribution Box True from 500 gallon pump chamber / 2" SCHD 40 forcemain to 4"into
D-box
Opening Sealed:True
90% alarm level activates True
End Cap True lines are looped
Absorbtion Fields: Total Length True 20x22 absorption bed / 4 lines at 18ft looped at 5 ft = 87 ft
Septic system field above flood plain True
Foundation to Tank True see variance
Engineer Report and As-Built True please provide asbuilt report
Location of system on property True see specs
Inlet & Outlet manholes 12"+ below grade True
Type of Water: Municipal / Well Water True lake
Locations / Separations True
Depth of Trenches True raised bed in stabilized fill
System Use Status False
Conforms as per Plot Plan True
Size of tank True CE-5 Fuji clean ETU
Distribution box to Field / Pit True 4" sewer and drain perforated
Foundation to Absorption True see specs
InletOutlet Pipes & Baffles True at pump chamber / inlet
September 20, 2023 Page 1 of 2
INSPECTION WORKSHEET (SEP-027820-2023)
Checklist Item CommentsPassed
50% alarm level activates True
Soil Type: Loam True
September 20, 2023 Page 2 of 2