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TOWN OF YARMOUTH
� SEWAGE PLAN REVIEW CHErui•IST
Location: A.M. �/ Lot� Zone of Contriburion: In Out 1 Acreage
Street:� 7 �q/�,j� �� Commercial: Residern9al: �
Village:__ (� � Floor Plan: #Bedrooms: �
Owner: /��l�/ Installer: ���LGO � S
Address: Phone: -��Z - � �
Phone: � �
�C� z �"! ���u �/�'C%= 7
Builder: Enginea:_� ��
Address: Phone: - l
� Phone: �'t'/`�-/,�'yv�-z� CQj�G�
✓
N/A YES NO
1.R ired# of ies received
2.Date of soils exam and colation test not older than 2 years
3.4-5 ft of naturall occurrin ervious material, above water table
4.Foundation 2 8 above hi im of road H.P.: Fnd: Vaz.:
5.Water line 10 8 fi-om s tic com onents Vaz.:
6. Benchmark indicated and shown-NGVD if near wetlands ��
7. S tic tank minimum 10 ft from foundation, deck Vaz.:
8. Leackung minimum 20 ft full, 15 ft c[awl, 10 ft slab Var.:
9.I,eachin minimum 100 ft&om wetlands Vaz.:
10. Txao ' minimum 150 ft from drinkin welU25 ft irri tion well Var.:
11.Tank/leaching minimum 10 ft from r erry Iine Var.:
12. S meets all other setback r ' ements Vaz.:
13.Uses ad' stment for maxim�� oundwater Vaz.:
14.Leaching set 4-5 ft above ad'.water or bottom of test hole Vaz.:
15. System not in to or subsoil(A,B horizons)or 5're.moval
16.Pr sed contours aze suitable
17. S meets slo e irements-min. 1{8", '/d' eferred
18. System meets breakout r irements PVC liner: Wall: ��/
19. S ecified tee sizes aze ro er, baffle on ouU�tee
20. Sewa e is under 10,000 for azcel ��
21.No ba e dis osal f
22• S stem ad uatel sized for its intended use
23.Minimum 6"stone or com acted below tank and dbox �,
. 24.Manhole covers within 6"of grade, um chamber cover to e
25. ion on lastic chambers/leach field
26.Electrical �mit for um chamber/S azate meter for du lexes
27•Pum system-2"line,w hole,check valve,tee in dbo�c, size
28. S tic tank/ um chamber to be facto waterproofed _�i
29.Vc,vt rovided if leachin below 3 fe�,under drivewa / azkin �1
30.Buo ancy calculations for tank/ u chamb� _i
31.En ' eer to ins ect and c ' soils: wall: commeaoial:
32.E ' eer/Re 'stered Sanitarian and Land Surveyor s/si ture
33.H-201oadin is sub'ect to vehicular traffic, oundwater �
34.Title V A lication and ermit fee, installer si e `�
35.Foundation footin min. 2 feet above ad'usted ound water for new house
36.Deed Restriction r ired max. #bedrooms:a�max flow: �� � d c_
37.Check azea lots for undwata/Label oundwater in Assessor's Ma
Plan reviewed by: ��yj
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