IM Inspection Worksheet_06-10-2023_12-53-03INSPECTION WORKSHEET (PTI-028177-2023)
PT-0635-2023Case Number:Case Module:Permit Management
ScheduledInspection Status:Inspection Date:
Property Transfer InspectionsInspection Type:Inspector:Mark Smith
Job Address:Parcel Number:175 Assembly Point Rd
Lake George, NY 12845
239.7-1-34
Company Name NameContact Type
Primary Owner PETER STECIUK
Checklist Item CommentsPassed
Watertight False
Building Inspector Notes False
Weather/lack of information/inaccessibility False
Maintenance Agrmnt/Srvc contract (required)False
Holding tank (if yes, include capacity)False
Capacity in gallons False
System/components indicate unacceptable False
Is there a high water alarm?False
Roof gutters don't discharge over leach field False
Concrete tank False
Temperature (Fahrenheit)False
D-box material: concrete or plastic False
Baffle & D-box or 45° angle False
Apparent structural damage False
Effluent filter False
Septic inlet cover ext - Req 12"+ below grade False
Visible scum layer False
Septic tank (include # of tanks)False
Number of tank compartments False
Capacity of pump tank (gallons)False
Plumbing fixtures tested & confirmed False
Evidence of a pipe bypassing tank False
Holding Tank:verify level rises; cap. w/in 250 gal False
Whirlpool tub add 250 gal False
System appears undersized/undersized components False
Foundation drain(s)False
Verify 50% & 90% floats False
Speed levers in D-box False
Is there evidence of surface water infiltrating False
Stormwater False
Septic tank for bdrms/whrlpl/grndr w/in 250 gal False
Garbage grinder add 250 gal False
Tank cover False
System appears to have functioned adequately False
October 06, 2023 Page 1 of 3
INSPECTION WORKSHEET (PTI-028177-2023)
Checklist Item CommentsPassed
Engineer's report on ETU False
System passes all function testing False
Outlet pipe (automatic failure, if yes)False
Metal tank (automatic failure)False
Does the pump(s) appear to be operating properly?False
Surface discharge? (if yes, to where?)False
Roof runoff False
Septic outlet cover ext - Req 12"+ below grade False
System needs repairs False
Sump pump not connected to septic system False
Sand filter False
Absorption bed False
Outflow line invert above leach line invert(s)?False
Overflow pipe (automatic failure)False
Depth below grade to top of tank False
Evidence of prolonged high liquid level False
Access riser? (if yes, depth to cover)False
No treatment tank/other critical component(s)False
Pump station extention - Reg 12"+ below grade False
Absorption field False
Leaking water fixtures False
Liquid level AT/ABOVE/BELOW (one) discharge invert False
Recommend upgrade/expand/replace 1+ components False
Number of drop box(es)False
Cesspool (automatic failure, if yes)False
Sump pump(s)False
Are there any obvious electrical shortcomings?False
Type False
Outlet baffle False
As-built provided is accurate False
Mound system False
Plastic tank False
Evidence of liquid above outlet inverts?False
Other False
Manufacturer False
On-site as-built req'd before insp is complete False
Cracked, corroded or deformed?False
Solids in D-box False
Is tank pumped more than 4x/year?False
Cracked, corroded or deformed?False
Water softener not connected to septic system False
Model False
October 06, 2023 Page 2 of 3
INSPECTION WORKSHEET (PTI-028177-2023)
Checklist Item CommentsPassed
Excavate 18" around,no leach field connected False
Main tank cleanout size and location False
Ejector or grinder pump sealed False
Dosing or pump tank sealed False
Raised system False
Water tight tank False
Weather False
Aerobic system False
Other False
Inlet baffle False
Seepage Pits: Number False
Other False
Are both switch and alarm operable?False
Test each fixture flow to septic tank False
October 06, 2023 Page 3 of 3