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Location: AM LOT Date -Approval"'
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of Subdivision
Street{Zone of Contribution: In
Out
Commercial Residential
Vil7�lagl�
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Owner�E.� j
� � = Installer f�l..�''� I
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Builder
Engineers(
N/A Yes No
1.
Recuired number of copies received.
2.
Date of soils exam and percolation test not older than 2 vears.
3.
4 feet of naturally occurring gervious material, above water table.)
4.
Foundation 2 feet above high point in fronting road.
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5.
Water availability letter from Water Department.
6.
a
Benchmrk indicated and shown.
7.
Buildina sewer does not exit center of house.
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8.
Septic tank a minimum of 10 feet from house and deck.
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9.
Leacnina a minimum of 20 feet from house and 10 feet from deck.
10.
Leaching a minimum of 100 feet from weti_ands.
11.
Leacning a minimum of 150 feet from wells.
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12.
System meet.= ail other setback cecuirements.
13.
USGS ad;ust:nent used for maximum hi h groundwater.
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14.
Leacnina 4 feet_ -above adjusted water table or bottom of test pit.
15. System not in top cc supsoillor 10 foot removal.
16. Propcsec ccnlE;_:�n,�re-suitable.
1i. System meets sieoe cecuirements. ,
18. Svste:n ;nets oreaxcut cecuirement - caicuiations shown.
ouec:-Lieu tee sizes are proper.
20. Sewace t'_cw under 20,000 apd for paccei.
11. No Qac=age ciscosai.
22. Svstem acec::ateiv sized for its intended use. i
zi. Engi.neec to certIfv:
a. Clav cemcvai.
b. 25 fcot removal.
c. Tient installat:en.
a. ccmmecc_ai system.
24. Engineer and land Survevcr Stamp and Sicnature. j
25. H2O 7,cadinc •.:nen system is subject to veniculac traffic. I
4e0. ace :zat:cz and fee signed by licensed instai:er.
27. Fcunc_=- cn feet above a&usted water table.
28. Lot suc('ivicec�pricr to July 31, 1986 - Nitrate Lcacing.
29. Subdivided pr.cr to Aoril 7, 1989 - Phcscnorous lone, 300'
Plan reviewed by
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a x
7/6/89