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�'' �� ��' TOWN O�YARMOUTH '
SEWAGE PLAN REVIEW CHECKLIST
Location: A.M.� Lot1� Zone of Contribution: In Out� Acreager--�- �
Commercial: Residential:�/
Street: � , /
Village: _ Floor Plan: v #Bedrooms: '
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Owner: Insta.11er: �
Address: Phone: � 7 -- 7�
Phone:
� ✓l'��-�/� ����?��-�d�-��i' � �
Builder: Engineer: �C.� L/ �
Address: Phone: � Z -- D
Phone: `� ���"/l� //-.., L �/ �,.u``
, l'i°��1�.
N/A S NO
1.R uired#of co ies received
2.Date of soils e�.m and ercolation test not older than 2 years
3_4-5 ft of natura occurrin ervious material,above water table �----�
4.Foundation 2 ft above hi oint of road H.P.: Fnd: Var.:
5.Water line 10 ft from s tic com onents Var.: '
6.Benchmark indica.ted and shown-NGVD if near wetlands
7. S tic tank minimum 10 ft from foundaxion, deck Var.: c.�� '
8.Leachin minimum 20 ft full, 15 ft erawl, 10 ft slab Var.: C._.�-
9.Lea.ching minimum 100 ft from wetlands Var.: �� . '
10.Lea.chin minimum 150 ft from drinkin welU25 ft irri tion well Var.:
11.Tank/leaching minimum 10 ft from roperty line Var.:
12. S stem meets all other setback r ' ements Var.: �..�
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13.Uses ad'ustment for maximum hi oundwater Var.: �.�-� �
14.Leacliin set 4-5 ft above adj.water or bottom o st Var.: � ;
15.System not in to or subsoil(A,B horizons)or 'removal �
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16.Pro sed contours are suitable �i'
17. S stem meets slo e r uirements-min. 1/8", '/a" eferred :
18. System meets breakout r uirements PVC liner: Wall: ;
19. S ecified tee sizes are ro er, ba.ffle on outlet tee , �
20. Sewa e is under 10,000 d for azcel �� i
21.No ba e dis osal j
22. S stem ad uatel sized for its intended use :_---
23.Minimum 6"stone or com acted below tank and dbox ��^ •
24.Manhole covers within 6"of ade, um chamber cover to grade ��
25.Ins ion rt on lastic chambers/leach field �--
26.Electrical ermit for um cha.mber/S arate meter for du lexes
27.Pum system-2" li.ne,wee hole,check valve,tee in dbo� um size /
28.S tic tank/pum chamberto be factory waterproofed �/' ;
29.Vent rovided if leaching below 3 feet,under drivewa / arking .,/� �
30.Buoyancy ca.lculations for tank/pump chamber
31.En ' eer to ins ect and cert' soils: wall: commerciaL•
32.En ' eer/Re ' tered Sanitarian and Land Surveyor stam s/si ature +
33.H-20 loading is subject to vehicular traffic, groundwater / �
34.Title V A lication and ermit fee, installer signature ,_,�i �
35.Founda.tion footin min. 2 feet above ad'usted ound water for new house ✓"
36.Deed Restriction r uired max. #bedrooms: max. flow: d
37.Check area.lots for oundwater/Label oundwater in Assessor's Ma �
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Plan reviewed by: �o3io� �
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