IM Inspection Worksheet_21-11-2023_14-02-18INSPECTION WORKSHEET (SEP-029080-2023)
RC-0553-2022Case Number:Case Module:Permit Management
11/21/2023 Partial PassInspection Status:Inspection Date:
SepticInspection Type:Inspector:Charles Dyer
Job Address:Parcel Number:21 Duncan Cv
Queensbury, NY 12804
226.16-1-7
Company Name NameContact Type
Applicant AJA Architecture & Planning
Architect AJA Architecture & Planning
Contractor Hilltop Construction
Granted Permission Stephen Orban
MEGHAN ORBAN
Primary Owner Stephen Orban
MEGHAN ORBAN
Checklist Item CommentsPassed
Building Inspector Notes False
Soil Type: Sand True
ETU Maintenance Contract provided False
Size of Stone False N/A
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 False N/A 2" force main to manifold from pump chamber
Opening Sealed:True
90% alarm level activates True
End Cap True
Absorbtion Fields: Total Length True 144
Foundation to Tank True 10ft
Engineer Report and As-Built False Please provide
Sump pump not connected to septic system False
Location of system on property False see specs / asbuilt
Inlet & Outlet manholes 12"+ below grade True
Type of Water: Municipal / Well Water True lake
Locations / Separations True
Depth of Trenches True 10"-12"
Length of Each Trench True 36 ft Eljen matts
System Use Status False
Conforms as per Plot Plan False
Size of tank True 1250 to 1000 gallon pump chamber
November 21, 2023 Page 1 of 2
INSPECTION WORKSHEET (SEP-029080-2023)
Checklist Item CommentsPassed
Distribution box to Field / Pit False 1/2" SCHD 40 with drilled holes 4oc through 4" sewer and drain
perforated
Foundation to Absorption False see specs
InletOutlet Pipes & Baffles False provide baffles
50% alarm level activates True
November 21, 2023 Page 2 of 2