IM Inspection Worksheet_07-09-2023_15-36-51INSPECTION WORKSHEET (SEP-027628-2023)
SEP-0484-2023Case Number:Case Module:Permit Management
09/07/2023 PassedInspection Status:Inspection Date:
SepticInspection Type:Inspector:Charles Dyer
Job Address:Parcel Number:103 Coolidge Ave
Queensbury, NY 12804
302.18-3-35
Company Name NameContact Type
Applicant Sanitary Sewer Service
Contractor Sanitary Sewer Service
Engineer Center Project Services
Granted Permission Sanitary Sewer Service
Primary Owner Bruce Frost
Checklist Item CommentsPassed
Soil Type: Sand True
Size of Stone True #2
Waterline separation distance True
Building to Tank True 4" SCHD 40
[Provide extension collar if Yes]False
Tank to Distribution Box True 4" SDR 35
Opening Sealed:True
End Cap True lines are looped
Absorbtion Fields: Total Length True 20x30 bed system / 4 lines at 25 ft, looped at 5 ft=115 ft
Septic system field above flood plain True
Foundation to Tank True 11 ft
Engineer Report and As-Built True please provide engineer asbuilt / received 9/7/23
Location of system on property True rear of home
Inlet & Outlet manholes 12"+ below grade False
Type of Water: Municipal / Well Water True municipal
Locations / Separations True
Depth of Trenches True bed is roughly 18+"
Length of Each Trench True 20x30 bed system / 4 lines at 25 ft, looped at 5 ft=115 ft
System Use Status True
Conforms as per Plot Plan True
Size of tank False 1250
Distribution box to Field / Pit True 4" sewer and drain perforated
Foundation to Absorption True 29 ft
InletOutlet Pipes & Baffles True
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