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Location: AM 82 LOT Date of Subdivision Approval f0/-9--
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Street ( . ;.! . -; ,,, If.7.Zone of Contribution: In Out
Villageav Commercial
a. LN Residential
Owner fz, ,S, d41 srry7 Installer. ,E///.S 13P .
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Builder A/41716' cw, c00 Engineer ePhig 1V/k0 - --
N/A Yes No '
1. Required number of copies received. I
2. Date of soils exam and cercotation test not older than 2 years. I n
3. 4 feet of naturally occurring pervious material, above water table.I X
4. Foundation 2 feet above high point in fronting road. I X
5. Water availability letter from Water Department. ,8/4{, I - 3¢ I
6. Benchmark indicated and shown. �
7. Building sewer does no: exit center of house. I X
8. Septic tank a minimum of 10 feet from house and deck.
9. Leaching a minimum of 20 feet from house and 10 feet from dec`:. X
10. Leaching a minimum of 100 feet from wetlands.
11. Leacninc a minimum of 150 feet from wells. X
Y
12. System meets ail other setback requirements. �
13. USGS adjustment used for maximum high groundwater. I �' X
14. Leacninc 4 feet._abcve ac;usted water table or bottom of test oil. I X
X
15. System not in coo or su:_ci_lor 10 foot removal.
16. Pce:osed cont ur 'are-su:`able. k
17. System meets sicoe recu_rements. �
18. System meets breakout ce uirement - calculations shown. Jr
� Jr
19. Specified tee sizes are Prober. X -
20. Sewace flow under 20,C00 cad for cartel.
21. No carcace disccsai. 'f
22. System adequately sized for its intended use.
23. Engineer to certify:
a. Clay removal.
b. 25 foot removal.
c. Tient installation. l
d. Commercial system.
24. Engineer and land Surveyor Stamp and Signature. I '
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25. H2O Loading ::nen systems subject to vehicular traffic.
26. Title 5 acpi cat_cn and fee signed by licensed installer.
27. Foundation foo-inc 2 fee: above adjusted water table. I
2Lot subdivided crier tc July 31, 1986 - Nitrate Loading. I c 'k
8.
29. Subdivided prior to April 7, 1989 - Phosphorous Zone 300' i
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Plan reviewed by: ,4 (o4f 1('
r L b'a -_ll`�y- cry
7/6/89 ,e. L
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77"14
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