Review Checklist 7�-/�-/� Towrr oF Ya�ouTa '�`� "�
SEWAGE PLAN REVIEW CHECKLIST /(;%,�: =� ��'`°'`'�'�
Location: A.M. /L� Lot / J Zone of Comnburion: In�Out Acreage /���7��ye�
Commeacial: Residential:
' Street: 7 �
Village: Floor Plan: �� #Bedrooms:�_
Owner: f����1�2GU ,�.(1.!%Y/C!" Installer: -7
Address: Phone: � /
Phone: ,!�/l/ /`% `R 1� ' '' Lca'���<%'�A
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Build�: Engincer:
Address: Phone: , - � y '
� Phone: � ��r S_
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N/A YES NO
1. uired#of ies received
2.Date of soils exam and ercolation test not older than 2 ears ��
3.45 ft of occurrin ervious materia.l,above water table �/
4.Foundation 2 ft above lu im of road H.P.: Fnd: Var.:
5.Water line 10 ft from s tic com one�s Vaz.:
6.Bencl�mazk indicated and shown-NGVD if near w�lands
7. S 'c tank minimum 10 ft from foundation, deck Var.:
8.Leachin minimum 20 ft full, 15 ft crawl, 10 ft slab Var.: c._�'
9.Leaching minim„m 100 ft from wetlands Vaz.:
10.Leachin m;n;m� 150 ft fi-om drinldn we1U25 ft irri tion well Var.:
11.Tank/leachin minim� 10 ft from r erty line Vat.:
12.S stem meets all other setback r ' ements Vaz.:
13.Uses ad'ustment for maximum hi oundwater Vaz.:
14.I,eaching sex 4-5 ft above ad'.wates or bott of test helc-� az.: `
15. S stem not in to or subsoil(A,B horizo )or 5'removal '
16.Pr sed co�ours are suitable
17. S stem meets slo e u�ements-min. 1/8", '/a" eferred
18. S stem mcets breakout r irements PVC lin�: Wall:
19. S ecified tee sizes aze roper, baffie on outlex tee
20. S e is under 10,000 d for azcel
21.No e dis osal
22. S stem ad uatel sized for its intended use
23.Minimum 6"stone or com acted below tank and dbox C1
• 24.Manhole cov�s within 6"of ade, chamb�cover to e
25. ection ort on lasric chambers/leach field
26.Electrical ermit for um chamber/S arate mexes for du leses
27.Pum system-2"line,w hole,check valve,tee in dbox, size
28.S tic tank/ chamber to be facto wa oofed
29.Vent rovided if leactvn below 3 feet,under drivewa / azking
30.Buoyanc calculations for tank/ u chamba
31.E ' eer to ins and soils: wall: comm�cial:
32.En ' eerBe ' ed Sanitarian and Land Surveyor s/si ture
33.H-201oadin is sub'ect to vehicular traffic, undwat�
34.Title V lication and ermit fee, installer s' e �
35.Foundation footin min.2 fe,�above ad'usted ound water for new house �
36.Dced Restriction r ired max #bedrooms: m�.flow: �
37.Check azea lots for oundwater/Iabel oundwates in Assessor's Ma
Plan reviewed by: / � woua�