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TOWN OF YARMOUTH �,- ����,��
j SEWAGE PLAN REV�W CHECKLIST ��',(�'�, ,� , ��
I� , Location: A.M.� Lot��`" Zone of Contribution: In� Out_ Acreage%� (Q�0�
Commercial: Residential: l�
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� Street: ��
Village: - Floor Plan: l�y #Bedrooms:_�
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o��: ��elt ��d�� �S�u�: u
Address: Phone: S� � -Z --
Phone:
Builder: Engine,er: f-`T� ���
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Address: Phone: 57/� - '� '- U
I Phone: - / 1�:�C � �.-c�'��•Uj' �`C�
N/A YES NO
1.Required#of co ies received
2.Date of soils exam and percolation test not older than 2 ears Z/
3.4-5 ft of natural occurrin ervious material,above water table
4.Founda.tion 2 ft above high oint of road H.P.: Fnd: Var.:
5. Water line 10 ft from s tic com onents Var.:
6. Benchmark indica.ted and shown-NGVD if near wetlands C..�
7. S tic tank minimum 10 ft from foundadon, d�k 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 drinkin welU25 ft irrigation well Var.:
11.Tank/leachin minimum 10 ft from ro erty line Var.:
12. S stem meets all other setback r uirements Var.:
13.Uses ad'ustment for maximum hi oundwater Var.:
14.Leaching set 4-5 ft above adj.water or bottom of test hole Var.: ��
15. S stem not in to or subsoil(A,B horizons)or 5'removal
16.Pro osed contours aze suitable �./�
17. S stem meets slo e r uirements-min. 1/8", '/4" referred
18. System meets breakout r uirements PVC liner: Wall:
19. Spec�ed tee sizes are ro er, gas baf�le on outlet tee
20. Sewage is under 10,000 for arcel
21.No arba e dis osal
" 22. S stem ade ua.tel sized for its intended use �----'
23.Minimum 6"stone or compacted below tank and dbox �../
_ 24.Manhole covers within 6"of ade, um chamber cover to grade ��-�
25.Inspection ort on plastic chambers/leach field
26.Electrical ermit for um chamber/S arate meter for du lexes
27.Pum stem-2" line,wee hole,check valve,tee in dboa�, um size
28. S tic tank/ um chamber to be factory wat roofed !�
29.Vent rovided if leachin 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 'stered Sanitarian and Land Surveyor sta.m s/si ture �--
33.H-201oading is sub'ect to vehicular traffic, groundwater -----'
34.Title V A lication and ermit fee, insta.11er signature _--�-�
35.Foundation footing min. 2 feet above ad'usted ound water for new house
36.Deed Restriction r uired max. #bedrooms: -��max. flow: ��2-C:l d ---/
37.Check area lots for oundwater/Label oundwater in Assessor's Ma
� Plan reviewed by: �i%� s�osio3