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TOWN OF YARMOUTH >
: SEWAGE PLAN REV�W CHECKLIST i��,/: � �'l��''��J
Location: A.M.� Lot �� Zone of Contribution: In,�(Sut_ Acrea.ge
. Commercial: Residential: __�
Street: C S '�
Village: !n Floor Plan: #Bedrooms:�
Owner: ����� ',�-✓%S Insta.11er: � /`�
Address: � Phone: '" -
Phone: , �1� £ �,�,�� C�-c �
Builder: Engineer: h .
Address: Phone: �_��� L- � � �j
Phone: -- �,�:{ fz' ��t'��` '' /�C'��C'�
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N/A YES NO
1.Required#of co ies received
2.Date of soils exam and ercolation test not older than 2 years �/�
3.4-5 ft of naturall occunin ervious material,above water table
4.Foundation 2 ft above high oint of road H.P.: Fnd: Var.:
5.Water line 10 ft from s tic com onents Var.: �/-
6.Benchmark indicated and shown-NGVD if near wetlands
7. S tic tank minimum 10 ft from foundation, deck Var.:
8.Leachin minimum 20 ft full, 15 ft crawl, 1Q ft sla.b Var.:
9.Leaching minimum 100 ft from wetlands Var.: �--- -
10.Leaching minimum 150 ft from drinking welU25 ft irrigation well Var.: �---
11.Tank/leaching minimum 10 ft from ro erty line Var.:
12. S stem meets all other setback r irements Var.:
13.Uses adjustment for ma�mum high groundwater Var.: �
14.Lea.ching set 4-5 ft above adj.water or bottom of t hole Var.:
15.System not in to or subsoil(A,B horizons)or 5 remov �1 ,
16.Proposed contours are suitable c�
17. S stem meets slo e r uirements-min. 1/8", '/4" referred C��
18. S stem meets breakout re irements PVC liner: Wall: i
19. S ec�ed tee sizes are ro er, as ba$le on outlet tee �
20. Sewage is under 10,000 d for arcel t`�-
21.No garbage dis osal ✓
22. S stem ad uately 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 grade '
25.Inspection ort 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 dbox, ump size
28. S tic tank/ um chamber to be factory waterproofed � '
29.Vent rovided if leaching below 3 feet,under driveway/ arking - -'
30.Buoyancy calculations for tank/ ump chamber .��'
31.En ' eer to ins ect and cert' soils: wall: commercial:
32.Engineer/Re ' ered Sanitarian and Land Surveyor stam s/signature --�
33.H-201oading is sub'�t to vehicular traffic, groundwater
34.Title V A lication and ermit fee, installer signature
35.Founda.tion footing mi.n. 2 feet above adjusted ground water for new house '
36.Deed Restriction r uired max. #bedrooms: max. flow: d :
37.Check area lots for groundwater/Label oundwater in Assessor's Ma I
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Plan reviewed by: � � s�o3�a� I
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