IM Inspection Worksheet_31-08-2023_13-40-30INSPECTION WORKSHEET (SEP-027533-2023)
RC-0413-2022Case Number:Case Module:Permit Management
08/31/2023 Partial PassInspection Status:Inspection Date:
SepticInspection Type:Inspector:Charles Dyer
Job Address:Parcel Number:32 Forest Rd
Lake George, NY 12845
226.19-1-41
Company Name NameContact Type
Applicant RONALD SEGULJIC
Contractor Dufford Construction
Designer Williams & Williams Designers Inc.
Granted Permission RONALD SEGULJIC
Primary Owner RONALD SEGULJIC
Checklist Item CommentsPassed
Building Inspector Notes True for septic alteration
ETU Maintenance Contract provided False N/A
Size of Stone False N/A
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
Soil Type: Clay False soils are of loamy sand / Eljen matts sit atop 6+" washed sand
End Cap True
Absorbtion Fields: Total Length True 80 ft / 4 laterals with 5 Eljen modules each
Septic system field above flood plain True
Foundation to Tank True 10+ ft / no basement
Engineer Report and As-Built False please provide engineer asbuilt
Location of system on property True
Inlet & Outlet manholes 12"+ below grade False
Type of Water: Municipal / Well Water True well
Locations / Separations True
Well separation distance True See variance / septic tank 50ft from well / field 85+ ft
Depth of Trenches True 6+"
Length of Each Trench True 20 ft
System Use Status True
Conforms as per Plot Plan True
Size of tank True 1000 precast
Distribution box to Field / Pit True 4" SCHD 20 perforated
Foundation to Absorption True 20+ft
InletOutlet Pipes & Baffles True
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