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i TOWN OF YARMOUTH
j ' SEWAGE PLAN REVIEW CHECKLIST
Location: A.M. l I.ot
( : �_ � Zone of Contribution: In_ Out�Acreage
� Commercial: Residential:�_
� Street: �
Village: �' Floor Plan: (� #Bedrooms: �
� Owner: �'�/Q$Gl �Q Installer: �
Address: ' Phone:_ ��'- � �1/
Phone: '
Builder: Engineer: i.,�-e�j(/ �/,lQQ�
Address:_ Phone: ���Q,���
Phone:_ _ ��. � y, _ t;�
L�rT'\
N/A YES NO
I.R ' ed#of ies received
2. Date of soils eacam and olation test not older than 2 ears �f
3.4-5 ft of natura occurrin ious material,above wat�table
4.Foundation 2 ft above hi im of road H.P.: Fnd: Vaz.: -
5.Wat�line 10 ft from s 'c com onents Vaz.:
6. Benchwark indicated and shown-NGVD if near wetlands M
7. S 'c tank minimum 10 ft from foundation, deck Var.: L
8.I.eachin minimum 20 ft full, 15 ft c�awl, 10 ft slab Var.:
9.Leachin minimum 100 ft from wetlands Vaz.:
10.I.eachin minimum 150 ft from dtinkin welll25 ft' ' tion well Var.:
1 L Tank/leachin minimum 10 ft from r line Var.:
12. S stem meets all�her setback ' ements Var,;
13. Uses ad'ustmevt for ms�ximum hi oundwater Vaz.:
14.Leachin set 45 ft above ad'.water or bottom of test hole Vaz.:
15. S tem not in to or subsoil(A,B horizons)or 5'removal
16.Pr sed contours are suitable
17. S stem meets sl r irements-min. 1/8", '/d' etted ,�/
18. S stem meets breakout r uirements PVC lin�: Wall: ��
19. S �ed tee sizes aze ro baffle on outid tez
20. Sewa e is unda 10,000 for arcel
• 21.No lxi di osal
22. S stem ad uatel sized for its intended use
23.Minimum 6"stone or com ed below tank and dbox
" 24.Manhole covers within 6"of e, chambea�cover to e
25. ion on ]astic chambers/leach field `/
26.Electrical ermit for um chambet/S arate meter for du lexes
27.Pum stem-2" line,w hole,check valve,tee in dbox, um size ��
28. S 'c tank/ um chamber to be wa roofed `f
29.Vern rovided if leachin below 3 feet,und�drivewa / azkin ✓
30.Buo anc calculations for tank/ um chamber `�
31.E ' eer to ins ect and c ' soils: wall: commercial:
32.E ' eedRe ' �ed Sanitarian and Land Surveyor s/si ture ��
33.H-201oadin is sub'ect to vehicular traffiq undwater ���,
34.Title V lication and ermit fee, installer si ture
35.Foundation foot min.2 fe�above ad'usted ound water for new house .�� `'
36.Dead Restriction ired ma�c. #bedrooms: ma�c. flow: �
37.Check azea lots for oundwatea/Label dwater in Assessor's Ma
Plan reviewed by: �y�,
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