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j TOWN OF YA7tMO�1TH . ; -
1 . SEWAGE PLA�1 REVIEW CHECKLIST
- Location: A.M. � � � Lot a Zone of Contribution: In Out � Acreage
Commer Residential:�`
� . Street: � Gl9 - -�'�
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j Village: � Floor Plan: #Bedrooms: 0��.��
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Owner: � Installer: �� �''�I
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Address: Phone: �' l
Phone:
Builder: Engineer: �
Address: Phone: S
Phone:
' � N/A YES NO �
1.Re uired#of co ies received
2.Date of soils e�m and colation test not older than 2 ea.rs
3.4-5 ft of naturall occurrin ervious material,above wate,r ta.ble `./
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 near wetlands ✓
7.Se tic tank minimum 10 ft from foundation,deck Var.: i
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8.Leaching minimum 20 ft full, 15 ft crawl, 10 ft slab Var.`.
' 9.Leachin minimum i 00 ft from wetlands Var.. �--�'
10.I.eachin minimum 150 ft from drinkin welU25 ft irri ation well Var.:
11.Tank/leachin minimum 10 ft from ro erty line Var.:
12. S stem meets all other setback r uirements 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.: i��'
15.S stem not in to or subsoil(A,B horizons)or 5'removal
16.Pro osed.contours are suitable
17. S stem meets slo e r uirements-min. 1/8", '/a" referrEd ✓
18. System meets breakout r uirements PVC liner: Wall: �-�
19. S ecified tee sizes are ro , ba.ffle on outlet tee �'
2U. Sewa e is under 10,000 for arcel
21.No arba e dis osal ✓
' 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 fo grade `/
25.Ins tion on iastic chambers/leach field
26.Electrical ermit for um cha.mber/S arate meter for du lexes -�'
27.P stem-2"line,w hole,check valve,tee in dbo� um size �"'
28. S tic tank/ um chamber to be facto wa roofed ,�-�'
29.Vent rovided if leachin below 3 feet,under tlrivewa / arkin
30.Buoyanc ca.lculations for tank/ um chamber
31.En ' eer to ins ect and cert' soils: wall: commercial: �
32.En 'neer/Registered Sanita.rian and Land Surveyor s m s/si ature
33.H-201oadin is subject to vehicular traffc, oundwater
34.Title V A lication and ermit fee, installer si ature
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 Ma
Plan reviewed by: �� �03�0�