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� �, � -, �
, TOWN OF YARMOUTH
� SEWAGE PLAN REV�W CHECKLIST
, Location: A.M.___%� Lot Z� Zone of Contribution: In Out V Acreage�
° Commercial: Residential: t�
� Street: (�
Village: Floor Plan: � #Bedrooms: �
� Owner: � Installer:
Address: , Phone:
�
Phone: '
Builder: Engineer: �1��/(Gf
Address: Phone: ' �-
Phone: _ �` �' ��/� ;.
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N/A YES NO
l.Required#of co ies received
2.Date of soils exam and ercolation test not older than 2 years ✓
3.4-5 ft of naturall occurrin ervious material,above water table ✓
4.Foundation 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. S tic tank minimum 10 ft from foundation, deck Var.:
8.Leaching minimum 20 ft full, 15 ft crawl, 10 ft slab Var.:
9.Leaching minimum 100 ft from wetlands Var.:
10.Lea.ching minimum 150 ft from drinking welU25 ft irri ation well Var.:
11.Tank/leachin minimum 10 ft&om ro erty line Var.:
12. S stem meets all other setback r uirements Var.:
13.Uses adjustment for maximum hi oundwater Var.:
14.Leachin set 4-5 ft above adj.water or bottom of test hole Var.: ;,��
15. System not in to or subsoil(A,B horizons)or 5'removal ��-
16.Pro osed contours are suita.ble �_.i
17. S stem meets slo e r uirements-min. 1/8", '/4" referred
18. S stem meets breakout r irements PVC liner: Wall: tif
19. S ec�ed tee sizes are ro , as baffle on outlet tee
20. Sewa e is under 10,000 d for arcel
-^ 21.No garbage 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 ade, um cha.mber cover to grade
25.Ins ection ort on plastic 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� ump size
28. S tic tank/ ump chamber to be factory waterproofed C,/'
29.Vent provided if leachin below 3 feet,under drivewa /parking
30.Buoyancy calculations for tank/pump chamber
31.En ' eer to ins ect and cert' soils: wall: commercial:
32.Engineer/Registered Sanitaxian and Land Surveyor sta.m s/si ature
33.H-201oadin is subject to vehicular traffic, oundwater
34.Title V A lication and ermit fee, installer signature ___,-'
35.Foundation footin min.2 feet above adjusted ound water for new house /
36.Deed Restriction r uired max. #bedrooms: max. flow: d J
37.Check area lots for oundwater/Label oundwater in Assessor's Ma
Plan reviewed by: �` ` wo3io3