septic as built Septic Inspection Report
Office No. (518)761-8256 Date Inspection requ t e ive .
Queensbury Building&Code Enforcement Arrive: a art: am/pm
742 Bay Rd.,Queensbury,NY 12804 Inspector's Initials.
NAME: ► RMIT NO.: 23Dm4 — (p71 Cs)
LOCATION: SPECT ON: 1 Z. —3 —O Li-
RECHECK:
Comments and/or diagram
Soil Type: Sand/Loam/Clay
Type of Water: Municipal/Well Water
Waterline separation distance ft.
Well separation distance ft.
Other wells: ft.
Absorption Field: Total length ft.
Length of each trench ft.
Depth of trenches ft.
Size of Stone
Seepage Pits: Number
Size: x
Stone Size:
Piping Size Type
Building to tank
Tank to Distribution Box
Distribution Box to Field/Pit
Opening Sealed: Y/N/Partial
Location/Separations
Foundation to tank ft.
Foundation to absorption ft.
Separation of Pits ft.
Conforms as per Plot Plan Y_N RECEI S ED M 031
•
Location of System on Property:
Front Rear Left Side Right Side
Middle Front Middle Rear
S stem Use St us:
Approved
Partial Approved and needs to be re-inspected, please call the Building&Codes Office
Disapproved
L:\.SueHemingway\Building.Codes.Inspection.FORMS\Septic Inspection Report.doc January 28,2003
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"I have seen or observed, or believe I saw evidence of, 0 . ��'U
all obiects such as houses, wells, trees, fences, etc., BUILDING U D CODE Y
shown on this document. I also represent that I have
personally measured the distances set forth on the diagram."
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