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� TOWN OF YARMOUTH
SEWAGE PLAN REVIEW CHECKLIST
Location: A.M. � 3 Lot �� Zone of Contribution: In_ Out� Acreage .
. Commercial: Residernial:�_
1 str�: ��
Village: �� Floor Plan: #Bedrooms:
.
� Ownei':_T�� /--IGC Installer: �
Address: Phone:
� Phone: ' �'0� T(� i4 �r��� �.,f�d/�,L�'��
Builder: Engineer:
Address: Phone: - �
Phone: �- ��2� - c` �a��� (1,'-��
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N/A YE NO
� 1.R uired#of co ies received
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2.Date of soils exam and colation test not older than 2 ears
3.4-5 ft of naxurall occurrin ervious material,above water table �'
4.Foundation 2 ft above hi int 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
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.Leaching minimum 100 ft from wetlands Var.: �✓
10.Leachin minimum 150 ft from drinkin welU25 ft irri tion well Var.:
11.Tank/leachin minimum 10 ft from ro line Var.: � � �
12. S stem meets all other setback r irements Var.:
13.Uses adjustment for maximum hi oundwater Var.:
14.Leachin set 4-5 ft above adj.water or bottom o `Ti Var.: , ./
15. System not in to or subsoil(A,B horizons)or 'remo
16.Pro osed contours are suitable
17. S stem meets sl e r irements-min. 1/8", '/a" eferred
18. S stem meets breakout re irements PVC liner: Wall:
19.S ecified tee sizes are roper, gas baffie on outlet tee
20.Sewa e is under 10,000 d for arcel �
21.No garba e dis osal
22. S stem ad ua.tel sized for its intended use
23.Minimum 6"stone or com acted below tank and dbox �
24.Manhole covers within 6"of ade, um chamber cover to grade
i 25.Ins ection ort on lastic chambers/leach field
� 26.Electrica.l ermit for um chamber/S arate meter for du lexes
27.Pum system-2"line,weep hole,check valve,tee in dbox, um size `/
; 28. Septic ta.nk/ um chamber to be factory wat roofed ✓
29.Vent rovided if leachin below 3 feet,under drivewa / arkin
� 30.Buoyancy calculations for tank/ um chamber
i3 I.En ' eer to ins ect and cert' soils: wall: commercial:
32.En ' eer/Re 'stered Sanitarian and Land Surveyor stam s/si ature �./
33.H-201oa.din is sub'ect to vehicular tra.ffc, groundwater
34.Title V A lication and ermit fee,installer si ature
35.Founda.tion footin min. 2 feet above ad"usted ound water for new house
36.Deed Restriction r ired max. #bedrooms: max.flow:
37.Check area lots far groundwater/Label oundwa.ter in Assessor's Ma
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Plan reviewed by: ���'�' �� � �o�io�