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TOWN OF YARMOUTH IST ��'���` � �v�-�C j
SEWAGE PLAN REVIEW CHECKL
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. Location: A.M.� Lot-�� Zone of Contribution: In/Out_ Acreage ��' �7 � �
Commercial: Residential: �
Street:
Village: �(/ �t' ' Floor Plan: �// #Bedrooms: �
Owner: �.�=�s� `-,���,i�iZ�2�/� Installer: t�
Address: Phone: d - �
Phone:
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Builder: Engineer:
Address: Phone: -� � �--
Phone: , ��� � ��,� � � ��
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N/A YES NO
1.Re uired#of co ies received
; 2.Date of soils exam and ercolation test not older than 2 ears
' 3.4-5 ft of natura occurrin ervious ma.terial,above water table `--' '
� 4.Foundation 2 ft above hi oint of road H.P.: Fnd: Var.:
5.Water line 10 ft from s tic com onents Var.: �/
6. Benchmark indica.ted and shown-NGVD if near wetlands t/
7. S tic tank minimum 10 ft from founda.tion, deck Var.: �-�" ,
8. Leachin minimum 20 ft full, 15 ft crawl, 10 ft slab Var.: Z ! � ' C._/
9.Leachin minimum 100 ft from wetlands Var.: • '
10.Leaching minimum 150 ft from drinking we1U25 ft irrigation well Var.:
11.Tank/leachin minimum 10 ft from r erry line Var.: {�v
12. S stem meets all other setback r uirements Var.:
13.Uses adjustment for maximum hi groundwater Var.:
14.Leaching set 4-5 ft above adj.water or bottom of test hole Var.: '
15. System not in to or subsoil(A,B horizons)or 5'removal j
16.Pro osed contours are suitable L.y.�"
17. S stem meets slo e r uirements-min. 1/8", 1/4" referred `____---
18. System meets breakout r irements PVC liner: Wall: �.�---
19. Spec�ed tee sizes are ro er,gas bai�le on outlet tee
20. Sewa e is under 10,000 gpd for arcel
- 21.No garbage dis osa.l �
22. S stem ad uatel sized for its intended use �`-� ,
23.Minimum 6"stone or com acted below tank and dbox
4 24.Manhole covers within 6"of ade, um cha.mber cover to grade - '
25.Inspection rt on lastic chambers/leach field
26.Electrical ermit for um chamber/S arate meter for du lexes
27.Pum system-2" line,wee hole,check valve,tee in dboa�, um size
28. S tic tank/ um chamber to be facto wat roofed
29.Vent rovided if leachin below 3 feet,under driveway/parkin '
30.Buoyancy calculations for tank/pump cha.mber
3 l.En ' eer to ins ect and cert' soils: wall: commercial:
32.Engineer/Registered Sanitarian and Land Surveyor stam s/si ture _�
33.H-201oading is subject to vehicular traffic, oundwater
34.Title V A lication and ermit fee, installer si ture ��
35.Foundation footin min.2 fe.et above ad'usted ound water for new house
36.Deed Restriction re uired max. #bedrooms: max. flow: d _�- '
37.Check area lots for oundwater/Label oundwater in Assessor's Ma
Plan reviewed by: �(��`'' W03/03
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