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TOWN OF YARMOUTH
' SEWAGE PLAN REVIEW CHECKLIST f�� �f �.,�ci�����'�
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Location: A.M. �d Lot Zone of Contribution: In Out Acreage / ./� � �-
` Commercial: Residential: ` l `�
S�eet: �� - h
Village: Floor Plan: `� #Bedrooms: l'
Owner: /��!����il� l'��i��/Gj�� Insta.11er:
Address: Phone:
Phone:
Builder: Engineer: � S L��'l�/�"
Address: Phone: "
Phone: � �► '
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N/A S O
1.Re uired#of co ies received
2.Date of soils exa.m and ercolation test not older than 2 years
3.4-5 ft of natural occurrin ervious material, above water ta.ble ��
4.Foundation 2 ft above hi oint of road H.P.: Fnd: Var.:
5.Water line 10 ft from s tic com onents Vaz.:
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.Leachin minimum 100 ft from wetlands Var.: �.
10.Lea.ching minimum 150 ft from drinking welU25 ft irri ation well Var.:
11.Tank/leaching minimum 10 ft from ro erty line Var.: � t�/�'
12.S stem meets all other setback r uirements Var.:
13.Uses ad'ustment for maximum high groundwater Var.:
14.Leachin set 45 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 sed contours are suita.ble
17. S stem meets slo e re uirements-min. 1/8", '/o" eferred
18. S stem meets breakout r uirements PVC liner: Wall: � - '
19. S ecified tee sizes are ro er, ba.ffle on outlet tee `,_�
20. Sewa e is under 10,000 d for arcel �._.-.�
21.No ba e dis osal
� 22. S stem ad ua.tel sized for its intended use
23.Mmimum 6"stone or com acted below tank and dbox ,G,_._�
: 24.Manhole covers within 6"of ade, um cha.mber cover to ade
25.Inspection ort on lastic chambers/leach field C��
26.Electrical ermit for um cha.mber/S azate meter for du lexes
27.Pum s stem-2" line,wee hole,check valve,tee in dbox, um size
28. S tic tank/pump chamber to be factory wa roofed
29.Vent rovided if leachin below 3 feet,under drivewa / arkin
30.Buo anc ca.lculations for tank/pu chamber
31.En ' eer to ins ect and cert' soils: wall: commercial:
32.En ' eer/Re ' ered Sanitarian and Land Surve or stam s/si ture
33.H-20 loadin is sub'ect to vehicular�c, groundwater �---�'
34.Title V A lication and ermit fee, insta.11er si ature �
35.Foundation footin min.2 feet above ad'usted ound water for new house
36.Deed Restriction r ired max. #bedrooms: max. flow: d '
37. Check area lots for oundwater/Label oundwater in Assessor's Ma
Plan reviewed by: �� �,03�03