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SEWAGE PLAN REVIEW CHECKLIST
�I.ocation: A.M. P� 7 Lot_�_ Zone of Contribution: In� dut Acreage �7 � � '
� �L��� Commercial: Residential: �d
Street:__�, T
Village:_� L Floor Plan:"__�_.__ #Bedrooms: �-
Qwner: �iC,+y/l f'.� /ti.t?l�l� Installer: �
Address: ' Phone: �
Phone: �? , �'"� .C�'�TC��7
l
Builder: Engineer: � ��----��
Address: _.,,,,,_._� Phone: �G�';�" � �" �/ �/
Phone: ,�....
N!A YES NO
1.Re uired# of copies received
2.Date of soils eacam and colarion test not older than 2 years
3. 4-5 ft of naturall occurrin erviaus material, above water table
4.Poundation 2 ft above hi oint af road H.P.: Fnd: Vaz.:
5.Water line 14 ft from s tic com onants Vaz.:
6.Benchmark indicated and shown-NGVD if near wetlands �./"-
7. S tic tank minimurn 10 ft from faundation,de�k Var.:
8.Leachin minirnuw 20 8 full, 15 ft crawl, 10 ft slab Vaz.: �^r
9. Leachin minimum 100 ft from wetlands Var.:
10.Leaching minimum I50 ft from drinking watU25 ft irrigation well Vaz.:
11.Tank/leachin minimum 10 ft from rope line Var.:
12. S stem meets all other setback r nirements Vaz.: �'
t 3.Uses adjustment for maximum hi groundwater Var.:
14. L,eachin set 4-5 ft above ad'.water or bottam af test hole Var.:
I 5.S stem not in to or subsoiI A,B horizons)or 5'removal
16.Fro sed eontours are snitable
17. S stern meets slo e re irements-min. 1/8", '/o" referred
18. S stem meets breakaut r uirements PVC liner: Wati:
, 19. S ec�ed tee sizes aze roper, s baffJe on outlet tee .../"�'
Z0. Sewa e is under 10,000 d for arcel �~
21.No ba dis osal
' 22. S stem ad uatel sized£or its intended use
23.Minimum 6"stane or compaoted below tank and dbox ✓
24.Manhoie cov�s within 6"of ade, um chamber caver to ade i..��
25. Ins ection port on lasric chambers/leach field
26.Electrical ermit for um chamber/S azate meter for du lexes =_-�"'
27.Pum system-2" lina,weep hole,check valve,tee ia dbox,pum size _.�'
28. S tio tank/pum chamber to be facto wat roofed
29.Vent rovided if leachin below 3 feet,under drivewa /parkin
30.Buo ancy calculatians for tankf ump chamber
31. En ' eer ta ins ect and certi soils: wall: cammercial:
32.E ' eertR 'stere@ Sanitarian and Land Surve ar stam slsi ature
33.H-20 loadin is sub'ect to vehicular tzaffic, oundwater
34.Title V A lication and ermit fee, installer signature
35.Foundation foating min. 2 feet abave adjust�i ound water for naw house
36.I7eed Restriction r uired max. #bedrooms: �r max. flow: � d
37.Check azea lots for oundwater/[,abet oundwater in Assessor's Map
Plan reviewed by: T`�� wo3io3
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