IM Inspection Worksheet_13-11-2023_12-59-40INSPECTION WORKSHEET (SEP-028841-2023)
RC-0389-2022Case Number:Case Module:Permit Management
11/13/2023 Partial PassInspection Status:Inspection Date:
SepticInspection Type:Inspector:Charles Dyer
Job Address:Parcel Number:104 Knox Rd
Lake George, NY 12845
239.7-1-20
Company Name NameContact Type
Applicant Antonio Civitella
Architect Adirondack Designers & Builders
Contractor Adirondack Designers & Builders
Granted Permission Antonio Civitella
Primary Owner Maria Civitella
Antonio Civitella
Checklist Item CommentsPassed
Building Inspector Notes True for placement of 1250 septic and 500 gallon pump chamber
(precast) only 11/9/23
11/13/23 verified 4" SCHD 40 foundation to septic tank and pump
chamber in order for backfill / ok'd.
Soil Type: Sand False
ETU Maintenance Contract provided False
Size of Stone False
Final Electrical False
Roof gutters don't discharge over leach field False
Waterline separation distance False
Building to Tank True 4" SCHD 40
Public Sewer Sign-Off False
[Provide extension collar if Yes]True
Tank to Distribution Box False
Size False
Opening Sealed:False
Soil Type: Clay False
90% alarm level activates False
End Cap False
Absorbtion Fields: Total Length False
Septic system field above flood plain False
Foundation to Tank False
Engineer Report and As-Built False
Sump pump not connected to septic system False
Water shut off activates at 90% full False
Location of system on property False
Inlet & Outlet manholes 12"+ below grade True
Septic tanks & pump station anchored in flood zone False
Water softener not connected to septic system False
Type of Water: Municipal / Well Water False lake
November 13, 2023 Page 1 of 2
INSPECTION WORKSHEET (SEP-028841-2023)
Checklist Item CommentsPassed
Locations / Separations False
Depth of Trenches False
Separation of Pits False
Stone Size:False
Seepage Pits: Number False
Length of Each Trench False
System Use Status False
Conforms as per Plot Plan False
Size of tank False
Distribution box to Field / Pit False
Foundation to Absorption False
InletOutlet Pipes & Baffles True
50% alarm level activates False
Soil Type: Loam False
November 13, 2023 Page 2 of 2