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TOWN OF YARMOUTH
� ' SEWAGE PLAN REVIEW CHECKLIST
j �� Location: A.M. `�� Lot � � Zone of Contribution: In Out/ Acreage
� � Commercial: Residential: �
Street: � � G
Village: �Y" Floor Plan: � #Bedrooms:
�
Owner: � Installer: � � �
Address: � Phone: � ��7 - D��3
Phone: �
Builder: Engineer:
Address: Phone: � -
Phone: -�'-�f'`� _�� �''�,��j �
N/A YES O
1.Required#of co ies received
2.Date of soils exam and ercolation test not older than 2 years
3.4-5 ft of naturall occurrin ervious material,above wa.ter ta.ble
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
7. S tic tanlc minimum 10 ft from foundation, deck Var.:
8.Leachin mini.mum 20 ft full, 15 ft crawl, 10 ft slab Var.:
9.Leachin minimum 100 ft from wetlands Var.: n ✓-
10.Lea.ching minimum 150 ft from drinkin welU25 ft irri tion well Var.:
11.Tank/leachin minimum 10 ft from r line Var.:
12.S stem meets all other setback r irements Var.:
13.Uses ad'ustment for maximum hi oundwater 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 re irements-min. 1/8", '/<" referred `�
18. System meets breakout r uirements PVC liner: Wall:
19. Specified tee sizes are ro , s baffle on outlet tee c��
20. Sewa e is under 10,000 d for arceT
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.Manhole covers within 6"of ade, um cha.mber cover to ade
25. ection rt on lastic chambers/leach field
26.Electrical ermit for um chaxnber/S arate meter for du lexes
27.Pum stem-2"line,wee hole,check valve,tee in dbo� um size
28. S tic tank/ um chamber to be facto wa roofed
29.Vent rovided if leachin below 3 feet,under driveway/ arkin
30.Buoyancy ca.lculations for tank/ um cha:mber
31.En ' eer to ins ect and cert' soils: wall: commercial:
32.En 'neer/Re ' ered Sanitarian and Land Surveyor stam s/si ture ��
33.H-20 loadin is sub'ect to vehicular traffic, oundwater ,
34.Title V A lication and ermit fee, insta.11er si ture �� '
35.Founda.tion footin min. 2 feet above ad"usted ound water for new house �
36.Deed Restriction r uired max. #bedrooms: max. flow: d
37.Check azea lots for oundwater/Label oundwater in Assessor's Ma
Plan reviewed by: �.� s�osro3 !
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