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TOWN OF YARMOUTH
� SEWAGE PLAN REV�W CHECKLIST
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, Location: A.M._1� Lot_�� Zone af Contribution: In Out`T Acrea.ge
� Commercial: Residential: �` i
Street: / �
Villa.ge: Floor Plan: c/ #Bedrooms: �
Owner: A�G��:r-/' Installer: ;
Address: Phone: �- �i /
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Phone: f�'" /%�'��� `�'�� � �
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Builder: Engineer:
Address: Fhone: -
Phone: - � � .���
N/A YES NO
1.R uired#of co ies received
2.Date of soils exam and percolation test not older than 2 years c/ '
3.4-5 ft of natura occurrin ervious material,above water ta.ble �-�
4.Foundation 2 ft above hi int 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, 10 ft slab Var.: '
9.Leactun 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 erty line Var.: ��-
12. S stem meets all other setback r uirements Var.:
13.Uses adjustment for maximum hi oundwater Var.: ',
14.Leaclun 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 l� '
16.Pro sed contours are suita.ble
17.S stem meets slo e r uirements-min. 1/8", 1/4" eferted
18. S stem meets breakout r irements PVC liner: Wall: �
,
19. S ecified tee sizes are ro er, gas baffle on outlet tee �
20. Sewa e is under 10,000 d for arcel �;
21.No garba. 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 ection 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 dbo� um size
28.S tic tank/ um chamber to be factory wat roofed ,
29.Vent rovided if leaching below 3 feet,under driveway/ arkin
30.Buo ancy calcula.tions for tank/ u chamber c.f
31.En ' eer to ins ect and cert' oils: 'wall: commerciaL-
32.En ' eer/Re ' ered Sanitarian and Land Surveyor stam s/si ture
33.H-201oading is subject to vehicular traffic,groundwater �� �f
34.Title V A lication and ermit fee, installer si ture i
3 5.Foundation footin min. 2 feet above adjusted ound water for new house ',
36.Deed Restriction r uired max. #bedrooms: ma�c. flow: d i
37.Check area lots for oundwater/Label groundwater in Assessor's Ma '
Plan reviewed by: C�' �o3ios ;
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