Location of existing structures, sanitary systems, and
water supplies depicted and labeled (indicate if none)
For Residential subdivision – typical dwelling with
sanitary and water supply depicted on each lot
Label sanitary systems, water supplies, or structures
that are to be removed
Typical lot layout depicted
Metes and Bounds of proposed lot lines
Drainage shown in flag lot driveway or common
driveways
Water easement area labeled
Lots labeled (i.e. Lot 1, Lot 2, etc.)
Water lines shown for flag lots
For high groundwater – typical sanitary profile with
invert and grade elevations depicted
Test Hole location/ data/ elevation/date/company
depicted
Scale (Engineering scale)
Soil classification based on unified soil Classification
system
SCDHS approval stamp language
Groundwater and highest expected groundwater
elevation stated
Neighboring water supplies stated (public water,
private well, vacant) for all lots within 150ft of the
Corner elevations stated or 2ft contours
Location of neighboring wells depicted for all lots
within 150ft of the subdivision
Elevations based upon NAVD (1988), USC & GS Datum
Location of existing and/or proposed water mains
For private wells, test well location depicted and
labeled
Location of existing and/or proposed sewer mains
For private wells, well detail depicted
Location of surface waters/wetlands within 300ft of
the property depicted
Land Surveyor original signature and seal
(Either the seal or signature must be original)
For commercial subdivisions, allowable flow calculation
stated for each lot
Design professional statement on the plan and signed
For commercial subdivisions with existing buildings,
existing sanitary flow calculations provided
Design professional original signature and seal
(Either the seal or signature must be original)
Additional Comments/Explanations:
APPLICATION IS HEREBY MADE FOR A PERMIT IN ACCORDANCE WITH THIS APPLICATION, SURVEY(S) AND PLAN(S) SUBMITTED. WE CERTIFY THAT THE
INFORMATION ON ALL THE PAGES OF THIS CHECKLIST AND ALL THE ATTACHMENTS HAVE BEEN REVIEWED BY US AND THAT, BASED ON OUR INQUIRIES, SITE
INVESTIGATION(S) AND/OR OTHER STUDY(IES), WE BELIEVE THAT THE INFORMATION IS TRUE, ACCURATE AND COMPLETE. WE UNDERSTAND THAT FALSE
STATEMENTS MADE HEREIN ARE PUNISHABLE AS A CLASS A MISDEMEANOR PURSUANT TO SECTION 210.45 OF THE PENAL LAW.
APPLICANT’S SIGNATURE(S), (AGENT, ETC. NOT ACCEPTABLE) ________________________________________________ DATE __________
PRINT APPLICANT’S NAME (S) _________________________________________________________________________________
DESIGN PROFESSIONAL’S SIGNATURE _________________________________________________ DATE ____________________
PRINT NAME ___________________________________________________________________ LICENSE # _________________
WWM –203 (4/15) Page 2 of 2
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