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SEWAGE PLAN REVIEW CHECKLIST
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Location: A.M. 41 S Lot LibZone of Contribution: In Out Acreage T
Commercial: Residential: ✓ 3)tCrl'
Street: t S 13 e Anti 12c/ a -f
Village: cue S+ yai•,�a tit, Floor Plan: ✓ #Bedrooms: 3 e�
Owner: (MI 1,cam, Rex/LA- Installer: t c 'at- 3. Oc.Ce. co .
Address: yp c��-, Sr lh t//e.c 4, rye Phone: 5 og '7'3 R-casso
Phone: 76/ -.Elsa -1,599
Builder: Engineer: 8ccsS (1t,ve; erk,q r tVein9
Address: Phone: .5 364/- ?0.e.,/gr"
Phone:
N/A YES NO
1.Required#of copies received k
2.Date of soils exam and percolation test not older than 2 years "biei J/9
3.4-5 ft of naturally occurring pervious material, above water table V
4.Foundation 2 ft above high point of road . H.P.: Fnd: Var.: ,/
5.Water line 10 ft from septic components Var.: ✓
6.Benchmark indicated and shown-NGVD if near wetlands i/
7. Septic tank minimum 10 ft from foundation, deck Var.: ✓ _
8.Leaching minimum 20 ft full, 15 ft crawl, 10 ft slab Var.:
9.Leaching minimum 100 ft from wetlands Var.: ,
10.Leaching minimum 150 ft from drinking well/25 ft irrigation well Var.: __--
11.Tank/leaching minimum 10 ft from property line Var.: S"` e r C2
12.System meets all other setback requirements Var.: f+�� 1,
13.Uses adjustment for maximum high groundwater Var.: fo or V
14.Leaching set 4-5 ft above adj.water or bottom of test hole Var.: / ,a, Q _
ir 15.System not in top or subsoil(A,B horizons)or 5'removal ?fit-, V olJe.
9 \
16.Proposed contours are suitable
17.System meets slope requirements-min. 1/8", 1/4"preferred 1/
18. System meets breakout requirements PVC liner: / Wall: ✓ _J
19. Specified tee sizes are proper, gas baffle on outlet tee 2c6t.1 .Me,,., (ni-) I/
20. Sewage is under 10,000 gpd for parcel 3 tiS c 9D ✓
21.No garbage disposal V
22. System adequately sized for its intended use V
23.Minimum 6"stone or compacted below tank and dbox V
24.Manhole covers within 6"of grade,pump chamber cover to grade - V
25.Inspection port on plastic chambers/leach field ✓
26.Electrical permlit for pump c ber/Sep ate meter for duplexes V
27.Pump system 2" line,weep ho checl6ave,tee int ox,pump size /PP 6.1 9"p,/y C,
28. Septic tank/pump chamber to be factory waterproofed ?
29.Vent provided if leaching below 3 feet,under driveway/parking /
30.Buoyancy calculations for tank/pump chamber
31.Engineer to inspect and certify soils: wall: commercial: 1
32.Engineer/Registered Sanitarian and Land Surveyor stamps/signature ✓
33.H-20 loading is subject to vehicular traffic, groundwater
34.Title V Application and permit fee,installer signature / t/35.Foundation footing min.2 feet above adjusted ground water for new house ✓/
36.Deed Restriction required max. #bedrooms: max.flow. gpd_ ✓
37. Check area lots for groundwater/Label groundwater in Assessor's Map .,./
Plan reviewed by: h ft- (brig , .20/i ' 6/03/03