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TOWN OF YARMOUTH
' SER'AGE PLAN REVIEW CHECKLLST
Locarion: A.M.�_ I.ot� Zone of Comnbution: In_ Out / Acreage
Commercial: Reside�ial:�_
S�: 3 L�',r,.�� Jc�o / 3
Village: I'S,� Floor Plan: t/ #Bedrooms:
Owna�:� �/ /�l'G�/l'!!� Installer:��
Address: Phone:
Phone: _�I'� �/ /�'�n.�C/��j ' ���r'Zl�r/
Builder: Engineer: ` �
Address: Phone: - -
Phone: i�" ^tC � �.c�C�' � C� �
K
A YES NO
1.R ' ed#of ies received
2.Date of soiLs exam and ercolation test nat older than 2 ears �
3.4-5 ft of occurrin ious material,above water table ✓
4.Foundation 2 ft above]ri oint of road H.P.: Fnd: Var.:
5. Water line 10 ft from s tic com onents Vaz.:
6.Benchmark indicated and shown-NGVD if near wetlands
7. S 'c tank minimum 10 ft from foundation,deck Vaz.: �" "
8.Leachin minimum 20 ft full, 15 8 crawl, 10 ft slab Var.: ,
9,I,eachin minimutn 100 ft&om weNands Var.: � °
�
10. Leachin min;mum 150 ft from drinkin welU25 ft irri 'on well Var.:
11. Tank/le2chin minimum 10 ft from r eriy line Vaz.:
12. S stem meets all other setback ' ements Vaz.:
13.Uses adjustment for maximum hi oundwater Var.:
14.Leachin set 45 ft above ad'.water ar bottom of test hole Var.:
15. S stem not in t or subsoil(A,B horizons)or 5're�oval C/
16.Pr ed co�ours aze suitable
17. S stem meets sl e r irements-min. 1/8", '/<" ferred �/
18. S stem meets breakout ' ements PVC liner: all:
19. S ified tee sizes are , baffle on outled tee
20. Sewa e is under 10,000 for azcel
21.No lm e dis osal
- 22. S stem ad uatel sized for its intended use
23.Minimum 6"stone or com acted below tank and dbo�c
24.Manhole covers within 6"of chamb�cova to ade ✓
25. e�tion on lastic cLambers/leach field
26. Electrical ermit for um chamber/S arate mder for du lexes
27.P stem 2" line,w hole,check valve,tee in dbox, size
28. S 'c tank/ um chamber to be factory wa roofed •�
29.Vent vided if leachin below 3 feet,under drivewa / azking
30.Buoyancy calculaYions for tank/ u chamba
31.E ' eer to ' ect and soils: wall: commareial:
32.E ' eer/R ' ered Sanitarian and Land Surv or s/si
33. H-201oadin is sub'ect to vehicular traffiq oundwater
34.Title V A lication and ermit fee, installea s' e '
35.Foundation footin min. 2 feet above ad'usted ound water for new house �
36.Dced Restriction ired max. #bedrooms: max.flow:
37.Check azea lots for oundwat�/Label oundwater in Assessor's
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Plan reviewed by: dmm;