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SEWAGE PLAN REVIEW CHECKLIST '
r Location: A,M.�_ Lot / / Zone of Cornribution: In Out_�Acreage
• CommerciaL• esidential: j
Street: � � � -:..,� ��.,�,� /�/
Village: - Floor Plan: #Bedrooms: (�� �
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Owner: /�/ � Insta.11er: �� i' I
Address: � / - ��F(,�hone: 7 -' - i,
Phone: �
Builder: � Engineer: -�
Address: Phone: �
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Phone: '
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N/A S NO
1.Re uired#of co ies received
2.Date of soils exam and ercolation test not older than 2 ears
3.4-5 ft of na.tural occurrin ervious material,above water table '
4.Foundation 2 ft above hi oint of road H.P.: Fnd: Var.:
5.Water line 10 ft from s tic com onents Vaz.:
6.Benchmark indicated and shown-NGVD if near wetlands �� �`✓ , '
7. S tic tank minimum 10 ft from foundation, deck Var.: ',
8.Leaching minimum 20 ft full, 15 ft cra.wl, 10 ft slab Var.: '
9.Leachin minimum 100 ft from wetlands Var.: •-�
10.Leachin minimum 150 ft from drinkin welU25 ft irri tion well Var.: '
11.Tank/leachin minimum 10 ft from r erty line Var.: j
12. S stem meets all other setback r uirements Var.: L/ i
13.Uses ad'ustment for maximum hi oundwater Var.:
14.Leachin set 4-5 ft above ad'.water or bottom of test hole Var.:
15. System not in to or subsoil(A,B horizons)or 5'removal �
16.Pro sed coirtours are suitable �
17. S stem meets slo e r irements-min. 1/8", '/4" eferred �
18. S stem meets breakout r uiremerns PVC liner: Wall:
19. S ified tee sizes aze ro er, baffle on outlet tee
20. Sew e is under 10,000 for arcel �/
21.No e dis osal
:22.S stem ad uatel sized far its intended use �
23.Minimum 6"stone or com acted below tank and dbox '
24.Manhole covers within 6"of ade, chamber cover to ade
25.Ins ection ort on lastic chambers/leach field
26.Electrica.l ermit for um cha.mber/S ate meter for du lexes
27.Pum stem-2"line,w hole,check valve,tee in dboaz, um size
28. S tic tank/ um chamber to be facto wa roofed �
29.Vent rovided if leachin below 3 feet,under drivewa / arkin
3 0. Buoyanc ca.lcu lations for t a n k/ um chamber ;
3I.En ' eer to ins ect and c ' soils: wall: commercia.l:
32.En ' eer/Re ' ered Sanitarian and Land Surv ar s/si ture
33.H-201oadin is subject to vehicula.r traffc, oundwater
34. Title V A lication and ermit fee, insta.11er si ture
35.Foundation footin min.2 feet above ad'usted ound water for new house
36.Deed Restriction r uired max. #bedrooms: max. flow: d
37. Check azea lots for oundwater/Label oundwater in Assessor's Ma
Plan reviewed by: �,���
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