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TOWN OF YARMOUTH
; SEWAGE PLAN REVIEW CFIECKLIST
Location: A.M. �L� Lot/� '� Zone of Contribution: In Out�Acreage
; Commercial: ResidentiaL• ��
Street: �
Village: Floor Plan: #Bedrooms:
Owner: ,���� �j�ti�'� Installer: �G .�°��Q1'
Address: Phone: � 7' - �
Phone:
Builder: Engineer: � � >�
Address: Phone: - ('� -
Phone: ` /�/f �, �G?��-'� �z;� ������
N/A YES
1.Required#of co ies received
2.Date of soils exam and ercolation test not older than 2 years
3.45 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 indicated and shown-NGVD if near wetlands L,�
7. S tic tank minimum 10 ft from foundation, deck Var.: i/
8.Leaching minimum 20 ft full, 15 ft crawl, 10 ft slab Var.: ��i
9.Leachin minimum 100 ft from wetlands Var.: •
10.Leachin minunum 150 ft from drinkin welU25 ft irri tion well Vaz.:
_ 11.Tank/leachin minimum 10 ft from ro erty line Var.:
12. S stem meets all otlier setback r irements Var.:
13.Uses ad'ustment for maximum hi oundwater Var.:
- 14.Leachin set 4-5 ft above adj.water or botto st . V .:
15. S stem not in to or subsoil(A,B horizons) r 5'removal v�
16.Pro osed contours are suita.ble �----
17. S stem meets slo e r uirements-min. 1/8", '/4" eferred ��
18. S stem meets breakout r uirements PVC liner: Wall: C.�
19. S ecified tee sizes are ro , baffle on outlet tee ��
20. Sewa e is under 10,000 d 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
24.Ma.nhole covers within 6"of a.de, um chamber cover to grade
25.Ins ection ort on lastic chambers/leach field
26.Electrical ermit for um chamber/S arate meter for du lexes
27.P system-2"line,wee hole,check valve,tee in dbox, um size
28. S Lic tank/ um chamber to be facto wa roofed
29.Vent rovided if leachin below 3 feet,under driveway/ arkin
30.Buo anc ca.lculations for tank/ u chamber
31.En ' eer to ins ect and cert' soils: wall: commerciaL•
32.En ' eer/Re ' ered Sanitarian and Land Surv or stam s/si ature �----
33.H-201oadin is sub'ect to vehicular traffc, groundwater
34.Title V A lication and ermit fee, installer si ture ��
35.Foundation footin min.2 feet above adjusted ound water for new house �,
36.Deed Restriction r uired max. #bedrooms: max. flow:
37.Check area lots for groundwater/Label. oundwater in Assessor's Ma
Plan reviewed by: �,03�03