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TOWN OF YARMOUTH {
SEWAGE PLAN REV�W CHECKLIST '� � � � �
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' Location: A.M. �d �P Lot�� Zone of Contribution: In " Out_ Acreage���� ,
Commercial: Residential: 2� i
street: � ��S 0 ,
� Village: � Floor Plan: � #Bedrooms: � '
j�W �4 � �
o.uner:� ����v.-,� Installer: �
Address: � Phone: �7 7 -
Phone:
Builder: Engineer: �
Address: Phone: ' -
Phone: - 1�.�4r � ��' � (� , -�'j
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N/A YES NO
1.R uired#of copies 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.Founda.tion 2 ft above hi int 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 foundaxion, deck Var.: _
8.Leaching minimum 20 ft full, 15 ft crawl, 10 ft slab Var.: �, �-� ,
9.Lea.chin minimum 100 ft from wetlands Var.: '
10.Lea.chin minimum 150 ft from drinking welU25 ft irriga.tion well .;� Var.:
1 l.Tank/leaching minimum 10 ft from pro erty line Var: c_/
12. S stem meets all other setback r uirements Var.:
13.Uses adjustment for maximum hi groundwater Var.: .
14.Leachin 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 are suitable �
17.S stem meets slo e r irements-min. 1/8", '/a" referred � -
18. System meets breakout r uirements PVC liner: Wall: �j
19. S ecified tee sizes are roper, as baffle on outlet tee
20.Sewa e is under 10,000 d for arcel ��'
21.No ba 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 cha.mber cover to ade ��
25.Ins ection ort on lastic chambers/leach field �---��
26.Electrical ermit for um chamber/S arate meter for du lexes - �
27.Pum s stem-2" line,wee hole,check valve,tee in dbo� um size -`
28.S tic tank/ um chamber to be factory waterproofed '�--
29.Vent rovided if leachin below 3 feet,under driveway/parkin �'-
30.Buo ancy ca.lcula.tions for tank/pump chamber
31.En ' eer to ins ect and cert' soils: wall: commercial: ��
32.Engineer/Re ' tered Sanitarian and Land Surve or stam s/signature ��
33.H-20 loading is subject to vehicular traffic, oundwater '`��
34.Title V A lica.tion and ermit fee, installer si ture
� 35.Foundation footin min. 2 feet above adjusted ground water for new house
36.Deed Restriction r uired ma.x. #bedrooms: m�. flow: d
i 37.Check area lots for oundwater/Label oundwater in Assessor's Ma .-�'�
d �% Plan reviewed by: �o3io3
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