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�7- /-�f� Tawiv oF YAxmou�
" SEWAGE PI.AN REVIEW CHECKLIST
Location: A.M. / / Lot ��--� Zone of Co�ribution: In� Out� Acreage
� Cornmercial: Residential:__�_
Street: � ,.��lit'���� �
Village: �-J%�li��� Floor PLua: #Bedrooms:
� Owner:�,yl.P,2���_�•�'�'J Installer: (�.� � ,� ������,,yy�_
Address: �- Phane: -�iD�' 'i�'�X_ .�//-�'
Phone:
Buslde,r: _ .. Engin�:,_�� 1����
Address: � Phone: '
Phone: - .- /'s'��7'. �G J� � i
N/A YES NO
L R uved#of copies received
2.Date of soils exam and colation test not older than 2 ears �"
3.4-5 ft of naturall occurrin erviaus material, above watzr table �^^--�""'
4.Foundation 2 ft above hi int of raad H.P.: Fnd: Vaz.:
5.Water line 10 ft from septic com anents Vaz.:
6. Benchmark indicated and shown-NGVD if nea r wetlands
7.S tic tank minimum 14 ft from faundafio de�k Var.: ✓
8. Leachin minimum 20 ft full, 15 ft crawl, 10 ft slab Var.:
9.Leaching minimum 106 ft from wetlands Var.:
10.L�eachu� minimum 150 ft from driniting welU25 ft irri 'on well Var.:
]1. Tank/leachin minunum 10 ft from r line Vaz.:
22.S stem mcets all othea s�tback r uirements Var.: *.a..�
13.IJses ad'ustment for maxila�um hi oundwater Vaz.: 4--�
14.Leachin set 4-S ft above adj. water or bottom oftest hole Vaz.:
]5.S stem not in t or subsail A,B laorizons}or 5'r�oval
16.Pro osed contours are sixitable
17.S stem meets slo e uirements-min. 1/8", '/n" eferred
28.S stem m�ts breakaut r uirements PVC liner: WaIl:
19. S eo�ed tee sizes aze pro er, gas baffle on outlet tee
20.Sewa e is ande,r i0,00d far arcel �--/��
' 2 L No ba e dis osal
22. S stem ad uafel sized for its intended use
23.Minintum d"stone or com ted below fank and dbox
. 24.Manhole covers within 6"of ade, um chamb�cover to grade
25.Inspection on lastic chambers/leaoh field
_ 26.Electr"zcat__�_it�ar um_cliamliei7Sy^arafe mefer for dd`Texes __ ___ _ __ __ ,
27.Pum s stem-2" line,wee hole,check valve,tee in dbaY, um size
28.S tic tank/ um chamber to be facto wat roofed
29.V'ent ravided if leachiu below 3 feet,under drivewa 1 kin
30.Buoysnc calculaticros for tanklpum chamber
31.En ' eer to ins ect aad cert' soils: wall: wmmercial:
32.En 'neerfRegistered Sanikarian and Land Surv or s slsi alure
33.H-201oadin is sub'ect to vehicular traffic, oundwater
34.TiRIe V A Iication and ermit fee, instatler si at�ne '
35.Poundation footin min. 2 feet above ad'usted aund water far new house
36.Deed Restriction r ired max. #bedrooms: matc. 11ow: d
37.Ch�k ama bts for oundwatexlLalrel aundwat�in.�ssessar's Ma
PIan reviewed by: sro3ro�