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SEWAGE PLAN REVIEW CHECKLIST wi; �4 -s c4e, -s
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Location: A.M. 59 Lot 30 Zone of Contribution: In Out 2 Acreage r AtIcaeo?
Commercial: Residential:
Street: 1 4,,, c- /< '0( e
Village: 6140 Kdr,0 C Floor Plan: d #Bedrooms:
Owner: Elle" /7, n7e6ialG/"17 Installer: S caTT ✓v7 .c.,,,14
Address: Phone: Sob A95=o 9
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Phone:
Builder: Engineer: h).9, €, C-sc, hc: 7 ow,-
Address: ! Phone: ,See y....08��f .
Phone:
N/A YES , NO
1.Required#of copies received ✓
2.Date of soils exam and percolation test not older than 2 years
3.4-5 ft of naturally occurring pervious material,above water table ✓
4.Foundation 2 ft above high point of road . H.P.: Fnd: Var.: V
5.Water line 10 ft from septic components Var.:
6.Benchmark indicated and shown-NGVD if near wetlands
7. Septic tank minimum 10 ft from foundation, deck Var.: 4c e)h.
8.Leaching minimum 20 ft full, 15 ft crawl, 10 ft slab Var.: C 5')' Q
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.: $/
12. System meets all other setback requirements Var.:
13.Uses adjustment for maximum high groundwater Var.: t/
14.Leaching set 4-5 ft above adj.water or bottom of test hole Var.: ✓
15. System not in top or subsoil(A,B horizons)or 5'removal ,✓
16.Proposed contours are suitable L//
17. System meets slope requirements-min. 1/8", I/<"preferred ✓
18. System meets breakout requirements PVC liner: Wall: ✓
/
19. Specified tee sizes are proper, gas baffle on outlet tee V
20. Sewage is under 10,000 gpd for parcel ✓
21.No garbage disposal f
22. System adequately sized for its intended use V
23.Minimum 6"stone or compacted below tank and dbox 14.
24.Manhole covers within 6"of grade,pump chamber cover to grade
25.Inspection port on plastic chambers/leach fieldA//
26.Electrical permit for pump chamber/Separate meter for duplexes ✓
27.Pump system-2"line,weep hole,check valve,tee in dbox,pump size V
28.Septic tank/pump chamber to be factory waterproofed ✓
29.Vent provided if leaching below 3 feet,under driveway/parking V.
30.Buoyancy calculations for tank/pump chamber
31.Engineer to inspect and certify soils: wall: commercial: ✓
32.Engineer/Registered Sanitarian and Land Surveyor stamps/sigoature �i 1, GS
33.H-20 loading is subject to vehicular traffic, groundwater i/-10 D#SGX evo V
34.Title V Application and permit fee,installer signature 1/35.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: +`016A 6/03/03