IM Inspection Worksheet_03-01-2024_14-07-33INSPECTION WORKSHEET (SEP-029677-2024)
SEP-0784-2023Case Number:Case Module:Permit Management
01/03/2024 PassedInspection Status:Inspection Date:
SepticInspection Type:Inspector:Mark Smith
Job Address:Parcel Number:4 Lady Slipper Dr
Queensbury, NY 12804
301.14-1-51
Company Name NameContact Type
Applicant IBS Septic
Contractor IBS Septic
Granted Permission IBS Septic
Primary Owner STEVEN SHATTUCK
Checklist Item CommentsPassed
Building Inspector Notes True 1/3/24 replacement septic system approved.
- Existing 1000 gallon septic tank with a replacement absorption
field of 200' of pipe and stone.
Soil Type: Sand True
Size of Stone True # 2
Roof gutters don't discharge over leach field True
Waterline separation distance True
Building to Tank True existing
[Provide extension collar if Yes]True
Tank to Distribution Box True 4" SDR 35
Opening Sealed:True
End Cap True
Absorbtion Fields: Total Length True 4 laterals at 50' each 200' total
Septic system field above flood plain True
Foundation to Tank True 10'
Engineer Report and As-Built True
Location of system on property True front yard
Inlet & Outlet manholes 12"+ below grade True
Type of Water: Municipal / Well Water True municipal water supply
Locations / Separations True
Depth of Trenches True
Length of Each Trench True 4 laterals at 50' each 200' total
System Use Status True system approved for use
Conforms as per Plot Plan True
Distribution box to Field / Pit True 4" SDR 35 perforated
Foundation to Absorption True 23'
InletOutlet Pipes & Baffles True
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