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� TOWN OF YARMOUTH � �,� y�,,�
SEWAGE PLAN REV�W CHECKLIST �- `/G'�` G��'' � ' /
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� g � Lot Zone of Contribution: In� Out Acrea. e �
i ; Loca.tion: A.M. �v _ g Q�-� �i��/��
: / Commercial: Residential: �
� Street: �� (�1 �-� ' �
; Village: � • Floor Plan: ,v� #Bedrooms:�
Owner: � � Installer: ��/�Cv �S�';��/
Address: Phone: � -�Y� - ��j�._
Phone:
Builder: Engineer: _�
Address: Phone: �Z�- - 7>�- 9?�_
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 �.�
3.4-5 ft of natura.11 occurrin ervious material, above water table
4.Founda.tion 2 ft above hi 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. Se tic tank minimum 10 ft from foundation, deck Var.:
8.Leachin minimum 20 ft full, 15 ft crawl, 10 ft slab Var.:
9.Leaching minimum 100 ft from wetlands Va.r.: �. �
10.Lea.chin minimum 150 ft from drinkin welU25 ft irriga.tion well Var.:
1 l. Tank/leachin minunum 10 ft from ro erry line Var.:
12. S stem meets all other setback re irements Var.:
13.Uses adjustment for ma�m_um hi groundwater Var.: .
14.Leaching set 4-5 ft above adj.water or bottom of test hole Vaz.:
15. System not in to or subsoil(A,B horizons)or 5'removal
16.Proposed contours are suita.ble
17. S stem meets slo e r irements-min. 1/8", '/4" referred �_.
18. S stem meets breakout r nirements PVC liner: Wall: �_
19. S ec�ed tee sizes are roper, as ba.$le on outlet tee
20. Sewage is under 10,000 d for arcel �";
� 21.No arbage dis osal .
22. S stem ade ua.tel sized for its intended use `f
23.Minimum 6"stone or com acted below tank and dbox ��
� 24.Manhole covers within 6"of grade, ump chamber cover to grade ��
25.Inspection ort on pla.stic chambers/leach field
26.Electrical ermit for um chaxnber/S arate meter for du lexes
27.Pump system-2" line,wee hole,check valve,tee in dbo� um size
28. S tic tank/ chamber to be factory watezproofed ��
29.Vent provided if leaching below 3 feet,under driveway/ arkin -
30. Buoyancy calculations for tank/pump chamber -
31.En ' eer to ins ect and c ' soils: wall: commercial:
32.En ' eer/Re ' ered Sanitarian and Land Surveyor stam s/si ture �...-�
33.H-20 loading is sub'ect to vehicular tr�c, groundwater �
34.Title V A lication and ermit fee, installer signature �
3 5.Founda.tion footin min. 2 feet above adjusted ound water for new house
36.Deed Restriction r ired max. #bedrooms: " . flow: � .� d �---�"
37.Check area.lots for groundwater/Label groundwater in Assessor's
Plan reviewed by: c�o3io3 �