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1- ,6- i�
TOWN OF YARMOUTH
' : SEWAGE PLAN REV�W CFIECKLIST
Location: A.M. �L � Lot� Zone af Contribution: In Out �l Acrea.ge
` ' ,, �� Commercial: Residential: C,�
Street: �� ��^���,�u� i� �
Village: Floor Plan: Cj #Bedrooms: 2--
Owner: Insta.11er:
Address: Phone: - �
Phone:
Builder: Engineer: L s
Address: Phone:
Phone: _ ��✓'� 7 / „_�,-1 7 �.2
C ��
N/A YES NO
1.Required#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 materia.l, above water table �
4.Founda.tion 2 ft above hi oint of road H.P.: Fnd: Var.:
5. Water line 10 ft from septic components Vax.:
6.Benchmark indicated and shown-NGVD if near wetlands �/
7. S tic tank minimum 10 ft from founda.tion, deck Var.:
8.Leaching minimum 20 ft full, 15 ft crawl, 10 ft slab Var.:
9.Leachin minimum 100 ft from wetlands Var.:
10.Leaching minimum 150 ft from drinking welU25 ft nrigation well Var.:
11.Tank/leachin minimum 10 ft from ro erry line Var.:
12. S stem meets all other setback r irements Var.:
13.Uses adjustment for maximum hi oundwater Var.:
14.Leachin set 4-5 ft above ad'.water or bottom of test hole Var.:
15. System not in to or subsoil(A,B horizons)or 5'removal
16.Proposed contours are suitable ��
17. S stem meets slo e r uirements-min. 1/8", '/4" referred
18. System meets breakout r uirements PVC liner: Wall: ��
19. Specified tee sizes are roper, as baffle on outlet tee
20. Sewage is under 10,000 gpd for arcel ,L� �
= 21.No arbage disposal
22. S stem ad ua.tel sized for its intended use
23.Minimum 6"stone or com acted below tank and dbox
• 24.Manhole covers within 6"of grade, um cha.mber cover to grade ��
25.Inspection ort on pla.stic chambers/leach field
26.Electrical ermit for um chamber/S arate meter for du lexes
27.Pump system-2" line,wee hole,check valve,tee in dbo� um size -
28. S tic tank/p chamber to be factory wat roofed
29.Vent provided if leaching below 3 feet, under driveway/ arkin ,
30.Buoyancy calcula.tions for tank/ ump chamber ;
31.En ' eer to ins ect and c ' soils: wall: commerciaL•
i
32.Engineer/Re 'stered Sanitarian and Land Surveyor sta.m s/signature �
33.H-20 loadin is subject to vehicular traffic, groundwater ,,,_�
34.Title V A lication and ermit fee, installer si ture i
35.Founda.tion footing min. 2 feet above adjusted ground water for new house f
36.Deed Restriction r ired ma�r. #bedrooms: max. flow: d �-
37.Check area lots for oundwater/Label oundwater in Assessor's Map .�-�"
Plan reviewed by:_ (�� c�o3io3
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