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TOWN OF YARMOUTH � /^
SEWAGE PLAN REVIEW CHECKI.IST ��� � ��"�'2�
� Location: A.M.� Lot� ZoneofContrbution: In� Out_ Acreage�/f� �
Commercial: Reside�ial:�_
Stre�:
Village: � ' Floor Plan: ' #$edrooms:
Owner: /�p r/JC� �CQS'/T.//� Installer: !! S �!`�l- ���li'C"
Address: Phone: D - - /
Phone:
Builder: / Engineer: c�6
Address: l Phone: -�8 - -� 9�0
Phone: � -/1G1�.�� y�'1'"`�'zC l� 4�%G dt
N/A YES NO
1.R uued#of ies received
2.Da1e of soils exam and colation test not older than 2 ears
3.45 ft of natura occutrin ervious material,above watea table t/
4.Foundation 2 ft above]ri oi�of road H.P.: Fnd: Vaz.:
5. Water line 10 ft from s tic com nents Vaz.:
6.Benchmark indicated and shown-NGVD if near wetlands
7. S 'c tank minimum 10 ft from foundation, deck Vaz.:
8.I,eachin minimum 20 ft fiill, 15 ft crawl, 10 ft slab Vaz.:
9.I.eachin minimum 100 ft from wetlands Vu.:
10.Leacbin minimum 150 ft from drinkin we1ll25 ft irti tion well Var.:
1 I.Tank/leachin minimum 10 ft from line Vaz.:
12. S stem meets all other sexback ' ements Var.:
13.Uses ad' stme�rt for maximum hi groundwate,r Vaz.: �.-
14.Leachin set 4-5 it above adj.wat�or bottom of test hole Var.:
15.S em not in or subsoil(A,B horizons)or 5'removal ,
16.Pr sed contours aze suitable '
17. S stem meets sl e r irements-min. 1/8", �/d' eferred
18. S stem meets breakout ' ements PVC liner: Wall: •
19. S ified tee sizes are r , baffie on outlet tee
20.S e is under 10,000 for cel i
21.No dis osal Li
22. S stem ad uatel sized for its imended use '
� 23.Minimum 6"stone or com ed below tank and dbox
24.Manhole covers within 6"of , chamba cov�to gade
25.Ins ion rt on lastic chamb�s/leach field �/
26.Electrical ennit for chamber/S ate mexer for d lexes
27• system-2" line,w hole,check valve,tee in dbox, um size
28.S 'c tank/ chamb�to be wa roofed
29.Vent rovided if leaehin below 3 feet, und�drivewa / kin
30.Buoyanc calculations for tank/ um chamber
31.En ' eer to ins ect and cert' soils: wall: commerciai:
32.E 'neer/Re ' eted Sanitazian and Laud Surv or stam s/si ture �,
33. H-201oadin is sub'ect to vehicutar traffic, oundwater '
34.Title V lication and ermit fee,installer si ture
35.Foundation footin min. 2 feet above ad'usted ound water for new house
36.Deed Restriction ired maac. #bedrooms: max. flow:
37. Check azea lots for oundwatedLabel oundwat�in Assessor's M
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Plan reviewed by: �,
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