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� T4Wi�I O�YARMOUTH
SEWAGE PLAN REVIEW CHECKLIST _
� f,acation: A.M. /z� � i� Zone of Cantribution: In Qut�" Acreage
�//�? � Commercial: Residetrtiai:�__
; Street: /�� 2-
Village: - _..._ Flarr Plan: # Br.dranms:
C)wner_ /�iL �L`' Instnller: �S
Address: P6one: "a� -77 2- - p�'�
j Phone:
�� ___._ I�evr` ��d7 D�2
Buitder: Engineea�:
' Address: , __ Phone: �-!�F`` _�c��i/�.
Phone: - �o�/ {a ! �'/`?"
/
' NlA S NO
i 1. R nired#of co ies received _
j 2. Date o£soiLs exam and tation test nar older fihan 2 ears r,�"�
3.45 ft of natural occurrin ervioas material,a6ove water table <✓""
4. Faundation 2 ft above hi int af road H.P.: Fud: Var.:
5.Wata� line 14 ft from tic cam ents Var.: t/
6. Etenchmark indicated and shown-NGVD if near wetlands
7. S tic taak minimum 10$from foundatio deck Vaz.: ✓
S. Leaohin minimum 20 ft full, I S ft crawl, 10 ft slab Var.: r/
9. Leachin minimum 100 tt from wetlands Var.: `-'
I0.Leachin minimum 150 ft from rtrinkin welU25 ft irri tion well Vaz.: �`
11.Tank/leachin minimum 10 ft from r line Var.: t.-/
12. S stem meets all other s�back airemenis Vaz.: `-`
23.Uses ad' ent far:naxilnum hi ndwater Vaz.: �✓"�
14. Leachin set 4-5 ft above ad'.water or hrotta est Var•: �
I 5. S stem not in ta or subsoii A,B horizans)o 'remov �'"
16.Pr contours are suitable
17. S stem me�ets slo irements-min. 1/8", '/+" efared
1 S.S stem meets breakcwt irements PVC liner: t�, Wa1L• '� '"
19. S �ed tee sizes are , baftle on outtd tee t_.--
. . 20. Sewa e is undea' 10,000 for 1 "-� �
21.IVo e dis ! �
22.S siem uatel sized for its iirtended use
' 23. Minimum 6"stane ar com cted below tank and dbox �-f"' �
24.Manhole cav�s widun 6"of , um chamber cav�to e ��
2S.Ins ion on lastic chambers/]each field �i
26. Electricai ' for um chambexlS ate m��far du lexes �./
27.Pu stem-2"tine,w hote,ct�k valve,tee in dbox, um size
28. S ic tank/ um chamber to be fact wa fed
24. Ve�rt rovided if teaehin belaw 3 fec4, under drivewa 1 �.�''
30.Buo attc calculatians fa tank! chamber t...�
31. En ' eer to ins and cert' soils: wall: commercial: �-.�''
32.E 'nea'1R 'stered Sanitar+an and Iand Surv �stam slsi re �--�""
33. H-20 l�xidin is sub'ect ta vehicular traffic, nundwater
34. Title V A lication and ennit fee, installer si hue
35. Fouudatioo footin min.2 feet above ad�usted ound watcs f�new house �--�
36. Deed Restricrion uired max. #balrooms: m:uc. flow:
37. Check area lots for oundwatcx/Labe( oundwater in Assessa''s Ma
-���Plan reviewed by: �0�01