IM Inspection Worksheet_15-11-2023_12-51-49INSPECTION WORKSHEET (PTI-028811-2023)
PT-0102-2023Case Number:Case Module:Permit Management
11/15/2023 PassedInspection Status:Inspection Date:
Property Transfer InspectionsInspection Type:Inspector:Charles Dyer
Job Address:Parcel Number:180 Lake Pkwy
Lake George, NY 12845
226.19-1-92
Company Name NameContact Type
Applicant Kevin Cioffi
Property Owner 180 LAKE PARKWAY, LLC
Checklist Item CommentsPassed
Watertight True
Building Inspector Notes True System is newly installed / see specs from permit #402-2023 for
details
Weather/lack of information/inaccessibility False
Capacity in gallons True 1500
Is there a high water alarm?True
Roof gutters don't discharge over leach field False
Temperature (Fahrenheit)True 40+
D-box material: concrete or plastic False N/A manifold
Baffle & D-box or 45° angle False
Effluent filter True
Septic inlet cover ext - Req 12"+ below grade True
Visible scum layer False
Septic tank (include # of tanks)True 1 1500 gallon plastic fiber septic tank / 1000 gallon pump tank
Number of tank compartments True dual compartment at 1500 gallon tank
Capacity of pump tank (gallons)True 1000 gallon
Plumbing fixtures tested & confirmed True
Evidence of a pipe bypassing tank False
Foundation drain(s)False Home sits atop piers
Verify 50% & 90% floats True
Is there evidence of surface water infiltrating False
Tank cover True
System appears to have functioned adequately True
System passes all function testing True
Outlet pipe (automatic failure, if yes)False
Does the pump(s) appear to be operating properly?True
Septic outlet cover ext - Req 12"+ below grade True
System needs repairs False
Sand filter False
Absorption bed False
Overflow pipe (automatic failure)False
Depth below grade to top of tank True 12+"
Evidence of prolonged high liquid level False
November 15, 2023 Page 1 of 2
INSPECTION WORKSHEET (PTI-028811-2023)
Checklist Item CommentsPassed
Access riser? (if yes, depth to cover)True
Cesspool (automatic failure, if yes)False
Inlet baffle True
As-built provided is accurate True
Mound system True see specs
Test each fixture flow to septic tank True
Is tank pumped more than 4x/year?False
On-site as-built req'd before insp is complete True
Are both switch and alarm operable?True
Outlet baffle False
Weather True cloudy
Main tank cleanout size and location True 20"
Plastic tank True
Dosing or pump tank sealed True
Absorption field False
Pump station extention - Reg 12"+ below grade True
Leaking water fixtures False
Water tight tank True
Other False
Sump pump(s)False
Are there any obvious electrical shortcomings?False
Raised system False
November 15, 2023 Page 2 of 2