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SEWAG PLANOREVIEWC HECKLIST =���� � ��'-%�����y
; Location: A.M. ��� Lot�_ Zone af Contribution: In i��0ut Acreage I� ��
Commercial: Residential:__����
Street� ' f
Village: �/ Floor Plan: v #Bedrooms:�_
o��-: ����� �f��� �S�.11�: P
Address: Phone:
Phone: �"d�2 •"�1�� -6�� 7
Builder: Engineer: !
Address: Phone: -
Phone: ff- �.� �--� _j
. > ,�
� N/A YES NO
1.Re uired#of co ies received
' 2.Date of soils exam and percolation test not older than 2 ears `�'
3. 4-5 ft of natura.11 occurrin ervious material, above water table
4.Founda.tion 2 ft above high oint of road H.P.: Fnd: Var.:
5.Water line 10 ft from septic com onents Var.: [�
6.Benchmark indica.ted and shown-NGVD if near wetlands
7. S tic tank mini.mum 10 ft from foundation, deck Var.:
8.Leaching minimum 20 ft full, 15 ft crawl, 10 ft slab Var.: L�
9.Leachin minimum 100 ft from wetlands Vaz.:
10.Leachin minimum 150 ft from drinking welU25 ft irrigation well Vax.:
11.Tank/leaching minimum 10 ft from ro erty line Var.: ��
12. S stem meets all other setback r uirements Var.: r� .z'` '� � 2 ���
13.Uses adjustment for ma�cimum high groundwater Var.:
14.Leaching set 4-5 ft above adj.water or bottom of test hole Var.:
15. System not in to or subsoil(A,B horizons)or 5'removal C^��L' �cl�' �/
16.Pro osed contours are suita.ble � �.��'�°' � �
17. S stem meets slo e r uirements-min. 1/S", '/<" referred
18. System meets breakout requirements PVC liner: Wall: t�''
19. Specified tee sizes are proper, as ba.ffle on outlet tee �/
20. Sewa e is under 10,000 d for arcel �
. 21.No garbage dis osal ��
22. S stem ad ua.tel sized for its intended use
23.Minimum 6"stone or com acted below tanlc and dbox L,%
• 24.Manhole covers within 6"of grade,pump cha.mber cover to grade
25.Inspection ort on plastic chambers/leach field
26.Electrical ermit for um chamber/S arate meter for du lexes
27.Pum system-2" line,weep hole,check valve,tee in dbo� um size
28. Septic tank/ chamber to be factory wat roofed `�-
29.Vent provided if leaching below 3 feet, under driveway/ azking �.-----
30.Buoyancy calculations for tank/pum chamber `�
31.En ' eer to ins ect and c ' soils: wall: commercial: �"
32.Engineer/Registered Sanitarian and Land Surveyor stam s/si ture
33.H-201oadin is sub'ect to vehicular traffic, groundwater �---
34.Title V A lication and ermit fee, insta.11er signature - -
35.Foundation footing min. 2 feet above adjusted ound water for new house
36.Deed Restriction r ired max. #bedrooms: max.flow: d .
37.Check area lots for oundwater/Label oundwater in Assessor's Map /�'
Plan reviewed by: �(� ' 6/03/03