IM Inspection Worksheet_24-08-2023_15-30-15INSPECTION WORKSHEET (SEP-027356-2023)
SEP-0409-2023Case Number:Case Module:Permit Management
08/24/2023 Partial PassInspection Status:Inspection Date:
SepticInspection Type:Inspector:Charles Dyer
Job Address:Parcel Number:11 Lynn Ave
Queensbury, NY 12804
303.20-1-59
Company Name NameContact Type
Applicant ALISON BATCHELOR
Contractor Sanitary Sewer Service
Engineer Hutchins Engineering
Granted Permission ALISON BATCHELOR
Primary Owner ALISON BATCHELOR
Checklist Item CommentsPassed
Building Inspector Notes False
Soil Type: Sand True
ETU Maintenance Contract provided False
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 20x35 bed lines are 30ft x 4 / looped at 5 ft = 115ft
Foundation to Tank True 12 ft
Engineer Report and As-Built False please provide engineer asbuilt report
Location of system on property False
Inlet & Outlet manholes 12"+ below grade False
Type of Water: Municipal / Well Water True municipal
Locations / Separations True
Depth of Trenches True shallow bed 12-18" in depth
Length of Each Trench True 20x35 bed lines are 30ft x 4 / looped at 5 ft = 115ft
System Use Status True
Conforms as per Plot Plan True
Size of tank True 1000 gallon
Distribution box to Field / Pit True 4" SDR 35 perforated
Foundation to Absorption True 20+ ft
InletOutlet Pipes & Baffles True
Soil Type: Loam True
August 24, 2023 Page 1 of 1