IM Inspection Worksheet_06-12-2023_08-58-35INSPECTION WORKSHEET (SEP-029184-2023)
SEP-0130-2023Case Number:Case Module:Permit Management
12/06/2023 Partial PassInspection Status:Inspection Date:
SepticInspection Type:Inspector:Charles Dyer
Job Address:Parcel Number:66 Rockhurst Rd
Queensbury, NY 12804
227.13-2-49
Company Name NameContact Type
Applicant Kimberly Glomb
Contractor Ellsworth & Son Excavation
Engineer Hutchins Engineering
Granted Permission Gary Glomb
Primary Owner Gary Glomb
Checklist Item CommentsPassed
Building Inspector Notes True for placement of 1500 gallon holding tank of precast concrete with
floats/alarms and water shut off.
Final Electrical False to be provided
Waterline separation distance True
Building to Tank True 4" SCHD 40
[Provide extension collar if Yes]True traffic rated
Tank to Distribution Box False N/A
Opening Sealed:True
90% alarm level activates True
Foundation to Tank True
Engineer Report and As-Built False please provide engineer as built
Water shut off activates at 90% full True
Location of system on property True
Inlet & Outlet manholes 12"+ below grade True
Type of Water: Municipal / Well Water False lake
Locations / Separations False
Conforms as per Plot Plan True
Size of tank True 1500 gallon precast holding tank
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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