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• TOWN OF YARMOUTH
SEWAGE PLAN REVIEW CHECKLIST
� Location: A.M. �� Lot �� Zone of Contribution: In Out vAcreage
� Commercial: Residential:��
Street: /
Village: „ Floor Plan: ✓ #Bedrooms:_�
Owner: Installer: � � a�e�'(/�'�
Address: Phone: 7 -D �
Phone:
Builder: Engineer: � �'
Address: Phone: "! '-.�---
Phone: - ��' �c* G1��.� ,�y/!'�G2�2�
N/A YES NO
l.Re uired#of co ies received �../
2.Date of soils exam and ercolation test not older than 2 ears L�
3.4-5 ft of naturall occurrin ervious material,above water table �--�
4.Founda.tion 2 ft above hi oint of road H.P.: Fnd: Var.:
5.Water line 10 ft from s tic components Var.: ✓
6.Benchmark indicated and shown-NGVD if near wetlands �/
7. S tic tank minimum 10 ft from foundation, deck Var.: c/
8.Leachin minimum 20 ft full, 15 ft crawl, 10 ft slab Var.: �/
9.Leaching minimum 100 ft from wetlands Var.: �
10.Leaching minimum 150 ft from drinkin welU25 ft irrigation well ar.:
11.Tank/leaching minimum 10 ft from rop line Var.: ��
12. S stem meets all other setback r uirements Var.:
13.Uses ad'ustment for maximum hi groundwater Var.:
14.Leaching set 4-5 ft above adj.water or botto te tTio�� Var.:
15. System not in to or subsoil(A,B horizons) 5'remov
16.Pro osed contours are suitable ✓
17. S stem meets slo e r irements-min. 1/8", '/4" eferred t-��'
18. S stem meets breakout requirements PVC liner: � � all: �.-.-�
19. Spec�ed tee sizes are roper, gas baffle on outlet tee t�
20. Sewa e is under 10,000 gpd for axcel
21.No garba e disposal �--�
22. S stem ade uatel sized for its intended use �-�-�'
23.Minimum 6"stone or compacted below tank and dbox
�,
� 24.Manhole covers within 6 of grade, um chamber cover to ade ��
25.Ins ection ort on lastic chambers/leach field �-�
� lexes
26.Electrical ermit for um chamber/S arate meter for du
27.Pump system-2" line,wee hole,check valve,tee in dbox,pum size _
, 28. S tic tank/ um chamber to be factory waterproofed �--'
29.Vent rovided if leachin below 3 feet,under driveway/parking �"
30.Buoyancy calculations for tank/ ump cha.mber l�
31.En ' eer to ins ect and cert' soils: wall: commercial:
32.En ' eer/Re ' ered Sanitarian and Land Surveyor stam 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.De,ed Restriction r uired max. #bedrooms: max. flow: d =--
� 37.Check area lots for oundwater/Label oundwater in Assessor's Ma �-
Plan reviewed by: � �,osioa