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�' � ���� TOWN OF YARMOUTH �`��`� ,( �
SEWAGE PLAN REV�W CHECKLIST �� � /�.�eE��'✓✓(
Location: A.M. 7� Lot � � Zone of Contribution: In� put Acreage ��S� d� �
/C �- �� Commercial: Residential:�
Street:___( / (/,t� J�
Village: ��� Floor Plan: ( #Bedtooms:
Owner:_��v�� „DZ/J'� Installer: �17���
Address:_ ' Phone: - n /
Phone:
Builder: Engincer:
Address: Phone: - � -
Phone:_ � ��`
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N/A YES O
1.R uired#of co ies received
2.Date of soils ezcam and olation test na[older than 2 ears �J
3. 45 ft of natura occurrin ious material, above water table
' 4.Foundation 2 ft above hi i�rt of road H.P.: Fnd: Vaz.:
5. Water line 10 ft from septic com onents Vaz.: `�
6.Benchmazk indicated and shown-NGVD if near wetlands
7. S tic tank minimum 10 ft from foundation, deck Var.:
8.Izachin minimum 20 ft full, 15 ft crawl, 10 ft slab Vaz.:
9. Leachin minimum 100 ft from wetlands Var.:
10. Leachin minimum 150 ft&om drinkin weIU25 ft irri tion well Var.: ��
11. Tank/leaching minimum 10 ft from r line Vaz.: ,�
12. S stem meets all other setback irements Var,;
13. Uses ad'ustment for maximum]v undwater Vaz.:
14.I,eaching set 4-5 ft above adj.water or bottom of test hole Vaz.: �
15. S stem not in to or subsoil A,B horizons)or 5'removal `�
16.Pro ed co�ours aze suitable
17. S stem meets slo e r irements-min. 1/8", '/a" ef�red
18. S stem meets breakout r uirements PVC liner: Wall:
19. S ecified tee sizes aze ro , baffle on ouUe,t tee
20. Sewage is under 10,000 d for azcel �-
21.No ba e dis osal
22• S stem ad uatel sized for its intended use
� 23•Minimum 6"stone or com cted below tank and dbox
24.Manhole covers within 6"of e, um chamb�cover to e `�
• 25. ion ort on lastic chambers/leach field
26.Elechicat ermit for chaznber/S azate meter for du leses
27.Pum system-2"]ine,wee hole,check vaive,tee in dbox, um size
28. S tic tank/ um chamber to be fact wa roofed
29.Vent rovided if leachin below 3 feet,under driveway/ arkin /
30.Buo anc calculations for tank/ um chamber
31.E ' eer to ins ect and c ' soils: wall: commercial:
32.En ' eer/R 'stered Sanitarian and Land Surve or stam s/si ture _/
33.H-201oadin is sub'ect to vehicular traffic, oundwater
34.Title V A lication and ermit fee, installer si ture
35.Foundarion footin mia 2 feet above ad'usted ound water for new house �'
36.Deed Restriction r ired ma�c, #bedrooms; max, flow: d
37. Check azea lots for oundwatedL,abel oundwater in Assessor's Ma �-
Plan reviewed by: �'y7�
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