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�» TOWN OF YAI�MOUTH
' SE�VAGE PLAN REVIEW CHECKLIST �
�ocation: A.M. 11- 3 Lot� Zone of Contribution: In Out� Acreage �
Commercial: Residential: �
Street: � S � .
Village: Floor Pla . Bedrooms:
Owner: � `L G /-�-�`� Insta.11er:
Address: Phone: �� I
Phone: �'
Builder: Engineer: '
Address: Phone: ' -1 ? ';
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Phone: `/�✓� �' -���-�-{ �i �� I
' � �f� - G����` �
N/A YES NO
1.Re uired#of co ies received C
2.Date of soils exam and colation test not older than 2 years L� �
3. 4-5 ft of natural occurrin ervious material,above wa.ter table �-� '
4.Founda.tion 2 ft above h� oint of road H.P.: Fnd: Var.: '
5.Water line 10 ft from s tic com onents Var.: C.-�'�
5.Benchmark indicated and shown-NGVD if near wetlands �.-�'
7. S tic tank minimum 10 ft from founda.tion, deck Var.: �
8.Leachin minimum 20 ft full, 15 ft crawl, 10 ft slab Var.:
9. Leachin minimum 100 ft from wetlands Var.: f
10. Leachin minimum 150 ft from drinkin welU25 ft irri ation well Var.: �=�
1 l. Tank/leachin minimum 10 ft from r line Var.:
12. S stem meets 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 bott ar.: `
15. S stem not in to or subsoil(A,B horizon or 5'removal �
r _ _..,._
16.Pro sed contours are suitable
17. S stem meets slo e r irements-min. 1/8", '/a" eferred i
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•18. S stem meets breakout r uirements PVC liner: Wall: �
�
19. S ecified tee sizes are ro , as baffle on outlet tee
20. Sewa e is under 10,000 d for arcel �-� ;
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21.No ba e dis osal �
22. S stem ade ua.tel sized for its intended use �/ '
23.Minimum 6"stone or com acted below tank and dbox L/
24.Manhole covers within 6"of ade, um chamber cover to ade �� ;
25. Ins ection ort on lastic chambers/leach field '
26.Electrical ermit for um cha.mberlS arate meter for du lexes'
27.Pum system-2"line,wee hole,check valve,tee in dbo� um size .f
28. S tic tank/pump chamber to be factory waterproofed �-� ,
29. Vent rovided if leachin below 3 feet,under drivewa / arking
30. Buoyancy calculations for tank/ ump chamber ✓
31. En ' eer to ins ect and cert' soils: wall: commerciaL• ,�
32.En ' eer/Re 'stered Sanitarian and Land Surve or stam s/si ature
33. H-201oading is sub'ect to vehicular traffic, oundwater ---�
34. Title V A lication and ermit fee, installer signature
35.Foundation footin min. 2 feet above adjusted ound water for new house �
36. Deed Restriction r uired max. #bedrooms: max. flow: d
37. Check area lots for groundwater/Label groundwater in Assessor's Map
Plan reviewed by: � wo3�os
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