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'�° TOWN OF YARMOUTH
" SEWAGE PLAN REV�W CHECKLIST
Location: A.M.� Lot�_ Zone of Contribution: In Out �/Acreage
' CommerciaL• Residential:_�/
S�eet:
Village: Y Floor Plan: #Bedrooms:
Owner: y�/ �l' � Installer: /
Address: �� Phone: `
Phone:
Builder: _ � Engineer: ,�/ �� ����� C�� �
Address: Phone: - Z =
Phone: 11 Z - r �a/ ���� ��"�'�-
N/A YES NO
1.Required#of copies received
2.Date of soils exa.m 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 indica.ted and shown-NGVD if near wetlands
7. S tic tank minimum 10 ft from foundation, deck Var.: `„/
8.Leachin minimum 20 ft full, 15 ft crawl, 10 ft slab Var.:
9.Leaching minunum 100 ft from wetlands Var.: •
10.Lea.ching minimum 150 ft from drinkin welU25 ft im ation well Var.:
11.Tank/leachin minimum 10 ft from r line Var.:
12. S stem meets all other setback r uirements Var.:
13.Uses ad'ustment for maximum high 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.Pro osed contours are suita.ble
17. S stem meets slo e r uirements-min. 1/8", '/a" eferred
18. S stem meets breakout r uirements PVC liner: Wall:
19. S ec�ed tee sizes are ro er, baffle on outlet tee
20. Sewa e is under 10,000 for arcel
, 21.No ba e dis osal
22. S stem ad uatel sized for its intended use
23.Minimum 6"stone or com acted below tank and dbox � ,_._i
` 24.Manhole covers within 6"of ade, um chamber cover to ade
25.Ins ection ort on lastic chambers/leach field
26.Electrica.l ermit for um cha.mber/S arate meter for du lexes
27.Pum system-2"line,wee hole,check valve,tee in dbox, ump size
28. S tic tank/ um chamber to be factory wat roofed
29.Vent rovided if leachin below 3 feet,under driveway/ azking
30. Buoyancy calculations for ta.nk/ um chamber
31.En ' eer to ins ect and cert' soils: wall: commercial:
32.En ' eer/Re ' tered Sanitarian and Land Surve or s s/si ature
33.H-20 loadin is subject to vehicular traffic, oundwater
34.Title V A lication and ermit fee, insta.11er si ture
35.Foundation footin min. 2 feet above ad'usted ound water for new house
36.Deed Restriction r uired max. #bedrooms: ma�c. flow: d
37.Check arealots for oundwater/Label oundwater in Assessor's Map -
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Plan reviewed by: ( (�'� wosio3