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TOWN OF I'ARMOUTH
�„�`� "����� SE�VAGE PLAN REVIEW CHECKLIST �
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w Le�eation: A.M. b / Lot �� Zone of Contribution: In Out� Acxeage
� � . Residential:
, Comme �
' Street: �R ��
� ViIlage: 1�. Floor Plan: #Bedrooms:
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{ Owner: ��L Lr�Q���e�� Installer:
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_ Address: U Phone:
, Phone: '' �� ,�3 �t�! ���� �-- j��
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Builder: Engineer:
Address: Phone: ? - � Q✓%��
Phone: � -- ��L� 7�" �ldoJiJ
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N/A YES N
1.Re uired#of co ies received
2. Date of soils exam and ercolation test not older than 2 ears ✓
3. 4-5 ft of naturall occurrin ervious material,above water table
4.Foundation 2 ft above hi� int of road H.P.: Fnd: Var.:
5. Water line 10 ft from s tic com onents Var.: ✓
6.Benchmark indicated and shown-NGVD if ne�r wetlands
� 7. S tic tank minimum 10 ft from foundation,deck Var.: (
�
8.Leachin minimum 20 ft full, 15 ft crawl, 10 ft slab Var.:
9.Leachin minimum 100 ft from wetlands Var.: �i
10. Leachin minimum 150 ft from drinkin welU25 ft irri tion well Var.: �/
11. Tank/leachin minimum 10 ft from ro line Var.:
i 12. S stem mcets all other setback r irements Var.:
13.Uses ad'ustment for maximum hi oundwater Var.:
14.Leachin set 4-5 ft above ad'.water or bottom of test hole Var.:
15. S stem not in to or subsoil(A,B horizons or 5'removal
16.Pro sed contours are suitable
17. S stem meets slo e r uirements-min. 1/8", '/a" ef'erred
18. S stem meets breakuut r irements PVC liner: Wall:
19. S ified tee sizes are ro , baffle on outlet tee
20. Sewa e is und� 10,000 d for arcel
�21.No ba e dis osal
22. S stem ade uatel sized for its intended use
23.Minimum 6"stone or com acted below tank and dbox
24.Manhole covers within 6"of de, um chamber cover to ade
25.Ins tion ort on lastic chambers/leach field
26.Electrical ermit for um chamber/S arate meter for du lexes
27.P stem-2"line,wee hole,check valve,tee in dbo� um size
28. S tic tank/ um chamber to be facto wat roofed
�_ 29.Vent rovided if leachin below 3 feet,under drivewa / arkin
30.Buo anc ca.lculations for tank/ um chambec
: 31.En ' eer to ins ect and cert" soils: wall: commerciaL•
32.En ' eer/Re 'stered Sanitarian and Land Surv or s s/si ture
33.H-201oadin is subject to vehicular traffic, oundwater
34. Title V A lication and ermit fee,installer si ture
35.Foundation footin min. 2 feet above ad'usted ground water for new house
36.Deed Restriction r ired m�. #bedrooms: max. flow: d
37.Check area lots for oundwater/Label oundwater in Assessor's Ma
Plan reviewed by: �o�io�