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�� � � �� TOWN OF YARMOUTH
SEWAGE PLAN REVIEW CHECKLIST
� �
Location: A.M.� Lot �7 � Zone of Contribution: In Out Acreage
I / Commercial: Residential:_L�
i Street: L
Village: �_�. Floor Plan: � #Bedrooms: �
Owner: ���� �Q�l�(. Installer: �
�� Address: a�� �/E y, �,� , -� � Phone: / �
Phone:
Builder: Engineer: " �
Address: Phone: -
Phone: ��� - � � �
( N/A YES NO
; 1.R ired#of co ies received
2. Date of soils exam and ercolation test not older than 2 ears
� 3.4-5 ft of naturall occurrin ervious material, above water table
4.Foundation 2 ft above hi oint of road H.P.: Fnd: Vaz.:
' S. Water line 10 ft from s 'c com onents Vaz.:
i 6.Benchmark indicated and shown-NGVD if near wetlands y`�
7. S tic tank minimum 10 ft from foundation, deck Vaz.: �/
8.I.eachin minimum 20 ft full, 15 ft crawl, 10 ft slab Vaz.: �� �f
9.Leachin minimum 100 ft from wetlands Var.:
10.I,eachin minimum 150 ft from drinkin weIU25 ft irrigarion well Vaz.: •--
I 1. Tank/leachin minimum 10 ft from r erty line Var.: '� � `�
12. S stem m�ts all othea s�back r irements Vaz.:
13.Uses ad'ustment for max;m�big� oundwater Vaz.:
14. Leachin set 45 ft above adj.water or bottom of test hole Vaz.: t/
15. S stem not in to or subsoil(A,B horizons)or 5'removal
16.Pro sed coirtours aze suitable `�
17. S stem meets slo e r uuements-min. 1/8", '/<" eferred ��
18. S stem meets breakout r 'uements PVC linea�: Wall: `�
19. S ecified tee sizes are r , baffle on outl�tee L J, ,
20. Sewa e is under 10,000 d for arcel `�
21.No ba e dis osal ��
22. S stem ad uatel sized for its intended use .L� �
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 ection on lastic chambers/leach field `�
26.Elecirical ermit for um ct�amber/S ate meter for du lexes
27•Pum stem-2" line,w hole,check valve,tee in dboic, um size
28. S tic tank/ um chamber to be facto wa roofed
29. Vent rovided if leachin below 3 feet,und�drivewa / azking
30.Buoyancy calculations for tank/ um chamber
31.En ' eer to ias ect and cert' soils: wall: commercial:
32.En ' eer/Re ' ered Sanitarian and Land Surv or s/si ture
33.H-201oadin is subject to vehicular traffic, oundwater
34.Title V A lication and ermit fee, install�si ture
35,Foundafion footin min. 2 feet above ad'usted ound wat�for new house �
36.Deed Restriction ired maac. #bedrooms: max. flow
37. Check azea lots for oundwat�/Label oundwater in Assessor's Ma
Plan reviewed by: �y"_ ��