IM Inspection Worksheet_27-09-2023_15-23-46INSPECTION WORKSHEET (SEP-027962-2023)
SEP-0384-2023Case Number:Case Module:Permit Management
09/27/2023 Partial PassInspection Status:Inspection Date:
SepticInspection Type:Inspector:Charles Dyer
Job Address:Parcel Number:360 Cleverdale Rd
Queensbury, NY 12804
226.12-1-65
Company Name NameContact Type
Applicant LAKESIDE CHAPEL INC
Contractor Crandall Excavating
Engineer Hutchins Engineering
Granted Permission LAKESIDE CHAPEL INC
Primary Owner LAKESIDE CHAPEL INC
Checklist Item CommentsPassed
Building Inspector Notes True For verification of the placement of (2) 1,000 gallon precast
holding tanks, floats, alarm and water shut off. Approved 9/27/23
Soil Type: Sand True
Final Electrical True
Waterline separation distance True
Building to Tank True 4" SCHD 40
[Provide extension collar if Yes]False
Tank to Distribution Box False N/A
90% alarm level activates True
Absorbtion Fields: Total Length False N/A
Foundation to Tank True 10 ft+
Engineer Report and As-Built False please provide engineer asbuilt report
Water shut off activates at 90% full True verified 9/27/23
Location of system on property True
Inlet & Outlet manholes 12"+ below grade False
Type of Water: Municipal / Well Water False Lake George
Locations / Separations False
Length of Each Trench False N/A
Conforms as per Plot Plan True
Size of tank True (2) 1,000 gallon holding tanks
Distribution box to Field / Pit False N/A
Foundation to Absorption False N/A
InletOutlet Pipes & Baffles True inlet only
50% alarm level activates True
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