Review Checklist TOWN OF YARMOUTH
� SEWAGE PLAN REVIEW CHECKLIST
Location: A.M. � Lot� ZoneofContribution: In_ Out�Acreage
' Commercial: Re3idential:�
Street: 2-`� f7�v � /
Village: � y Floor Plan: C/ #Bedrooms:�_
Owner: �✓� /�I�d�Gt�(/��✓i Installer: � ��i '��GL7
Address: ' Phone: -- /�'/
`Phone:
, Builder: Engineer: �J-/� C/ ��j,/�L�
Address: Phone: � lJ'/
Phone: '
N/A YES NO
I. R uued#of co ies received
2. Date of soils exam and colation test not older than 2 ears
3. 4-5 ft of natural occurrin ervious material, above water table 'L--
4. Foundation 2 ft above hi int of road H.P.: Fnd: Vu.:
5. Water line 10 ft from s ic com nents Vaz.:
6. Benchmark indicated and shown-NGVD if near wetlands
7. S tic tank minimum 10 ft from foundation, deck Vaz.:
8. I,eachin minimum 20 ft full, 15 ft crawl, 10 ft slab Var.:
9. Leachin minimum 100 ft from wetlands Vaz.: -�
10. L,eachin minimum I50 ft from drinkin we1V25 ft irri tion well Var.:
1 l. Tank/Ieachin minimum 10 ft from r line Var.: v-
12. S stem meets aIl other setback r u'vements Var.:
13. Uses ad'ustment for maximum hi oundwater Vaz.: ��
14.I,eachin set 4-5 ft above ad'. water or bottom of test hole Var.:
15. S stem not in to or subsoil(A,B horizons)or 5'removal
16.Pr ed comours are suitable L�
17. S stem meets slo e r irements-min. 1!8", Y<" eferred �i
18. S stem meets breakout uirements PVC 6ner: Wall: u-
19. S ified tee sizes are ro battle on ouUet tee
20. Sewa e is under 10,000 for cel �i
21.No ba 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 ade, um chamber cover to ade
25. Ins tion rt on lastic chambers/leach field
26. Electrical ermit for um chamber/S e met�for du leaces
27.Pum stem-2" Iine,wee hole,check valve,tee in dbox, um size ��
28. S tic tank/ um chamb�to be fact wa roofed ✓
29.Vent rovided if leachin below 3 fcet, under drivewa / arkin ✓
30. Buo anc calculations for tank/ u chamber
31. En ' eer to ins ect and certi soils: wall: comm�cial:
32.En 'needRe 'stered Sanitarian and Land Surve or stam s/si ture
33. H-201oadin is sub'ect to vehicular traffic, ndwater
34. Title V A lication and ermit fee, installer si ture
35. Founda6on footin min. 2 feet above ad'usted ound water for new house
36. Dead Restriction r uired max. #bedrooms: ma�t. flow:
37. Check area lots for oundwater/Label oundwater in Assessor's Ma
Plan reviewed by: �� d��3