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TOWN OF YARMOUTH � �����
� SEWAGE PLAN REV�W CHECKLIST ,2��,� �. ���'--�`
Location: A.M. �Z Lot�� Zone of Contribution: In L'�Out ~ Acreage���l��'�9�-
Comm ResidentiaL• c_�
� Street: ��� ',
Village: � Floor Plan. #Bedrooms: '
Owner: � Insta.11er: � ��C�� ��
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Address: Phone: '
Phone: ,� /��� �/ ��?���-� l7'L�/
Builder: Engineer: �till��d Z�/G�l./�
Address: Phone: � �
Phone: �" . �'X S �,��r „y
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N/A NO
l.R ired#of ies received
2.Date of soils exam and ercolation test not older than 2 years
3. 4-5 ft of na.turall occurrin ervious material, above water table
4.Founda.tion 2 ft above hi int 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
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.:
9.Leachin minimum 100 ft from wetlands Var.:
10.Leachin minimum 150 ft from drinkin welU25 ft irri tion well Var.: -
11.Tank/leaching minimum 10 ft from ro line Vaz.: - ;
12. S stem meets all other setback r irements Var.: �
13.Uses ad' stment for maximum hi oundwater Var.: •-' t,� �
14.Leachin set 45 ft above ad'.water or botto ole Var.: '
15. System not in to or subsoil(A,B horizon or 5'remov�h ,,�-�' �
16.Pro osed contours are suita.ble �,�
17. S stem meets slo e r irements-min. 1/8", a referred �-
18. S stem meets breakout r uirements PVC liner: Wall:
19. S ecified tee sizes are ro er, baffle on outlet tee
20. Sewa e is under 10,000 d for arcel �
21.No e dis osal �
- 22. S stem ad uatel sized for its intended use �
23.Minimum 6"stone or com acted below tank and dbox R
. 24.Manhole covers within 6"of ade, um chamber cover to ade
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25.Ins ection ort on lastic chamberslleach field �
26.Electrica.l ermit for um cha.mber/S arate meter for du lexes
27.Pum system-2"line,wee hole,check valve,tee in dbo� um size �_
28. S tic tank/ um chamber to be fa.cto wa roofed ;
29.Vent rovided if leachin below 3 feet,under driveway/ arkin ...�--- ;
30.Buoyanc calculations for tank/ u cha.mber �
31.En ' eer to ins ect and cert' soils: wall: commercial: �
32.En ' eer/Re ' ered Sanitarian and Land Surve or stam s/si ture '
33.H-20 loadin is sub'ect to vehicular traffic, oundwater �
34.Title V A lica.tion and ermit fee,installer si ature�
35.Foundation footin min.2 feet above ad'usted ound water for new house �
36.Deed Restriction r uired max. #bedrooms: max.flow: Z�j d ;
37.Check area lots for oundwater/Label oundwater in Assessor's Ma '
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Plan reviewed by: � L-�-'`�' �ro3io3
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