IM Inspection Worksheet_27-10-2023_15-39-22INSPECTION WORKSHEET (SEP-028590-2023)
SEP-0236-2023Case Number:Case Module:Permit Management
10/27/2023 PassedInspection Status:Inspection Date:
SepticInspection Type:Inspector:Charles Dyer
Job Address:Parcel Number:366 Cleverdale Rd
Queensbury, NY 12804
226.12-1-62
Company Name NameContact Type
Applicant Katheryn McMorrow
Contractor Crandall Excavating
Engineer Hutchins Engineering
Granted Permission Daniel McMorrow
Primary Owner Katheryn McMorrow
Checklist Item CommentsPassed
Building Inspector Notes True verified operation of unit / flow to D-box / floats & alarm with Pete
Carr
Soil Type: Sand False
ETU Maintenance Contract provided True please provide ETU maintenance agreement ? received
Size of Stone True # 2
Final Electrical True received
Roof gutters don't discharge over leach field False
Waterline separation distance True
Building to Tank True 4" SCHD 40
Public Sewer Sign-Off False
[Provide extension collar if Yes]True
Tank to Distribution Box True 2" force main from pump station
Opening Sealed:True
90% alarm level activates True
End Cap False lines are looped
Absorbtion Fields: Total Length True 11x29 bed system
Foundation to Tank True see asbuilt
Engineer Report and As-Built True received
Location of system on property True
Inlet & Outlet manholes 12"+ below grade True
Type of Water: Municipal / Well Water True Lake
Locations / Separations True see asbuilt
Depth of Trenches True bed
Length of Each Trench True 2 lines @ 25ft looped @ 6ft
System Use Status True
Conforms as per Plot Plan True
Size of tank True FUJI clean model CE-5 ETU
Distribution box to Field / Pit False 4" SDR 35
Foundation to Absorption True see asbuilt
InletOutlet Pipes & Baffles True outlet from FUJI clean CE-5 ETU to pump chamber
October 27, 2023 Page 1 of 2
INSPECTION WORKSHEET (SEP-028590-2023)
Checklist Item CommentsPassed
50% alarm level activates True
October 27, 2023 Page 2 of 2