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' TOWN OF YARMOUTH � /,� �/
� � � SEWAGE PLAN REV�W CHECKLIST ���' � ` � �
, Location: A.M. w a I,ot �� Zone of Comn'burion: In_�Out Acreage�(�� �
7 � Commercial: Residernial: -
Street:
� /iti G/��/ �
Village: 0 � �' Floor Plan: �� #Bedrooms:
, Owner:��a�(�! �F���"�_ Installer: � � � G /�i[��1�. �(p�„P
Address: Phone: ���s-� ?j --- �7�� (I
Phone:
Builder: � Engineer: ��J<t�s �//� ���
Address: Phone: Sjj�� - -�¢
Phone:
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N/A YES O
1.R uired#of ies received
2.Date of soils eacam and olaHon test not older tUan 2 ears
3.45 ft of natura occurrin ervious material,above water table ,�
4.Foundation 2 ft above]v irn of road H.P.: Fnd: Vaz.: �✓
5. Water line 10 ft from s tic com onents Vaz.:
6.Benchwark indicated and shown-NGVD if near wetlands ��
7. S tic tank minimum 10 ft&om foundation, deck Vaz.: ✓
8.Leachin minimum 20 ft full, 15 ft crawl, 10 ft slab Vaz.: `J
9.Leachin minimum 100 ft from wetlands Vaz.: -
10. Leachin minimum 150 ft from drinkin we1U25 ft irri tion well Var.: �
11.Tank/leachin minimum 10 ft from r line Var.: L�
12. S stem meets all other setback r ' ements Vaz.:
13.Uses ad' tment for maximum hi oundwater Vaz.:
14.Leachin set 4-5 it above ad'.water or bottom of test hole Vaz.: „�
15. System not in or subsoil(A,B horizons)or 5'removal �.�
16.Pro ed contours are suitable
17. S stem meets sl e irements-min. 1/8", '/d' eferred ��
18. S stem meets breakout uirements PVC liner: Wall: L�
19. S ified tee sizes aze r er, baffle on outlet tee �,�
20. Sewa e is under 1Q000 d for cel
' 21.No I� e dis osal
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 e, chambe,r cover to ade `�
25. Ins ion rt on lastic chambers/leach field _�
26.Electrical ermit for um chamber/S meker for du lexes /
27•P system-2" line,wee hole,check valve,tee in dbo�t, um size j
28. S tic tank/ um chamber to be facto wa fed /
29.Vent rovided if leaching below 3 fe�,under drivewa / arkin /
30.Buo anc calculations for tank/ u chamba
31. En ' e�to ins ect and soils: wall: commercial: /
32.En ' cer/Re ' ered Sanitarian and Land Surv or stam s/si ture
33.H-201oadin is sub'ect to vehiculaz traffic, dwater �� .
34. Title V A lication and ermit fee, installer si ture �i
35.Foundation footin min, 2 feet above ad'usted ound water for new house
36.Deed Restriction uired max. #bedrooms: max, flow: d .✓ �
37.Check azea lots for oundwate,r/Label oundwat�in Assessor's M
Plan reviewed by: �`� ��