IM Inspection Worksheet_20-07-2023_11-23-17INSPECTION WORKSHEET (SEP-026696-2023)
SEP-0435-2023Case Number:Case Module:Permit Management
07/20/2023 Partial PassInspection Status:Inspection Date:
SepticInspection Type:Inspector:Charles Dyer
Job Address:Parcel Number:12 Queens Ln
Queensbury, NY 12804
301.5-1-34
Company Name NameContact Type
Applicant IBS Septic
Contractor IBS Septic
Granted Permission Rick Davidson
Primary Owner Rick Davidson
Checklist Item CommentsPassed
Building Inspector Notes True partial inspection only / placement of 1250 gallon fiber / plastic
tank
Soil Type: Sand True
ETU Maintenance Contract provided False
Size of Stone False
Waterline separation distance True
Building to Tank True 4" SCHD 40
[Provide extension collar if Yes]True
Tank to Distribution Box False
Size False
Opening Sealed:True
End Cap False
Absorbtion Fields: Total Length False not installed at time of inspection 7/20/23
Septic system field above flood plain True
Foundation to Tank True
Engineer Report and As-Built False
Sump pump not connected to septic system True
Location of system on property False
Inlet & Outlet manholes 12"+ below grade True
Type of Water: Municipal / Well Water True municipal
Locations / Separations True new tank off of patio behind garage
Depth of Trenches False
Separation of Pits False
Stone Size:False
Seepage Pits: Number False
Length of Each Trench False
System Use Status False
Conforms as per Plot Plan False
Size of tank True 1250 gallon
Distribution box to Field / Pit False
Foundation to Absorption False
July 20, 2023 Page 1 of 2
INSPECTION WORKSHEET (SEP-026696-2023)
Checklist Item CommentsPassed
InletOutlet Pipes & Baffles False only inlet at time of inspection
July 20, 2023 Page 2 of 2