IM Inspection Worksheet_06-10-2023_13-05-50INSPECTION WORKSHEET (SEP-028134-2023)
RC-0532-2023Case Number:Case Module:Permit Management
10/06/2023 Partial PassInspection Status:Inspection Date:
SepticInspection Type:Inspector:Charles Dyer
Job Address:Parcel Number:19 Park Ave
Queensbury, NY 12804
303.16-1-64
Company Name NameContact Type
Applicant Ronald Dufour Sr
Contractor Windy Hollow Homes Inc
Granted Permission Ronald Dufour Sr
Primary Owner Ronald Dufour Sr
Checklist Item CommentsPassed
Building Inspector Notes True system is for a manufactured home to be placed on slab
Soil Type: Sand False
ETU Maintenance Contract provided False
Size of Stone True #2
Waterline separation distance True
Building to Tank True 4" SCHD
[Provide extension collar if Yes]False
Tank to Distribution Box False
Opening Sealed:False
End Cap True
Absorbtion Fields: Total Length True 100 ft
Septic system field above flood plain True
Foundation to Tank False slab next to system
Engineer Report and As-Built False please provide engineer asbuilt report
Location of system on property False right side of property
Inlet & Outlet manholes 12"+ below grade False
Type of Water: Municipal / Well Water True municipal
Locations / Separations False
Depth of Trenches True 16"
Separation of Pits False
Length of Each Trench True 50 ft
System Use Status False
Conforms as per Plot Plan False
Size of tank True 1000
Distribution box to Field / Pit True 4" sewer and drain
Foundation to Absorption False
InletOutlet Pipes & Baffles True
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