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Location: AM LOT�_ Date of Subdivision Ap�roval c7 � ��
Street � ��Nl� Zone of Contribution: In � ut
Village Commercial Residential
Owner �� Wr(_Gt� Installer
Builder Engineer � j�,^
� N/A � Yes No
1. Recruired number of copies received. — —
2. Date of soils exam and ercolation test not older than 2 ears.
3. 4 feet of naturall occurring ervious material, above water table.
; 4. Foundation 2 feet above high int in fronting road.
5_ Water availability letter from 6Tater Deoartment.
6. Benchmark indicated and shown.
7. Buildin sewer does not exit center of house.
8. Septic tank a minimum of 10 feet from house and deck.
9. Leachin a minimum of 20 feet from house and 10 feet from deck.
10. Leaching a minimum of 100 feet from wetlands.
11. Leaching a minimum of 150 feet from wells.
12. Svstem meets all other setback reauirements. "
13. USGS ad 'ustment used for maximum high groundwater.
14. Leaching 4 feet above ad 'usted water table or bottom of test oit.
� . Svstem not in top or subsoil or 10 foot removal.
16. Proposed contours are suitable.
y7. Svstem meets slope reauirements. —
18. Svstem meets breakout recruirement - calculations shown.
19. Sc�ecified tee sizes are roper. -
20. Sewage flow under 20,000 for parcel.
21. No arbaqe disposal.
22_ Svstem adeauatelv sized for its intended use.
23. Enctineer to certifv:
: a. Clav removal.
b. 25 foot removal.
c. Tight installation.
d. Commercial s stem.
24. Enaineer and Land Survevor Stamo and Signature.
� 25. H20 Loadina when svstem is sub'ect to vehicular traffic.
26. Title 5 aoolication and fee signed b licensed installer.
27. Foundation footing 2 feet above ad 'usted water table.
28. Lot subdivided rior to Julv 31, 1986 - Nitrate Loadin4.
29.Lot subdivided rior to Aoril 7, 19 9 - Phosohorus Zone 300'
Plan reviewed by: � , Y V1 1� ' � �,c(
7/6/89 .
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