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TOWN OF YARMOUTH
SEWAGE PLAN REV�W CHECKLIST
i Loca.tion: A.M.� Lot� Zone of Contribution: In Out '(" Acrea.ge
Commercial: Residential:�_ �
Street: � � �
Village: ` Floor P ooms:���j�/� i
o�n�: ���%� <� � ��.n�:��,,�- /. �G���;�� � '�
Address: Phone:
Phone: ^�' /���✓ �-�'1�
Builder: Engineer: ,�1�
Address: Phone: �' - Z �
Phone: �S ,�e �� " �,��
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N/A S NO
1.R uired#of ies received
2.Date of soils exam and ercolation test not older than 2 ears
3. 4-5 ft of naturall occurrin ervious material, above water ta.ble ��
4.Founda.tion 2 ft above hi oint of road H.P.: Fnd: Var.:
5. Water line 10 ft from s tic com onerns Var.: �
6.Benchmark indica.ted and shown-NGVD if nea.r wetlands �
7. S tic tank minimum 10 ft from foundation, de�k Vaz.: i
8.Leaching minimum 20 ft full, 15 ft crawl, 10 ft sla.b Var.: i
9.Lea.chin minimum 100 ft from wetlands Var.: �� �
10.Lea.chin minimum 150 ft from drinking welU25 ft irri tion well Var.: �
1 l.Ta.nklleachin minimum 10 ft from ro erry line Var.: f
12. S stem meets a11 other setback r ' ements Vaz.: ' d�,
13.Uses ad' errt for m��mum high oundwater Var.: � E
14.Leachin set 45 ft above adj.water or bottom of test hole Var.: ;
15. System not in to or subsoil(A,B horizons)or 5'removal
16.Pro osed contours are suitable ;
17. S stem meets sl e r irements-min. 1/8", 1/4" eferred � �
18. S stem meets brea.kout r ' ements PVC liner: Wall: I
19. S ecified tee sizes are ro er, baffie on outlet tee �
i
20. Sewa e is under 10,000 for arcel i
21.No garba e dis osal �
' 22. S stem ad ua.tel sized for its intended use ;
23.Minimum 6"stone or com ed below tank and dbox k
_ 24.Manhole covers within 6"of ade, um cha.mber cover to ade i
25.Ins ection ort on lastic chambers/leach field L,f j
26.Electrical ermit for um chamber/S arate meter for du lexes �
27.P stem-2"line,wee hole,check valve,tee in dbo� um size '
28. S tic tank/ um cha.mber to be factory wa roofed "
29.Vent rovided if leachin below 3 feet,under driveway/ arkin
30.Buoyancy calcula.tions for tank/ cha.mber
31.E ' eer to ins ect and c ' soils: wall: commercial: /
32.E ' eer/Registered Sanitarian and Land Surveyor stam s/si ture
33.H-201oadin is subject to vehicuIar traffic, groundwater � !
34.Title V A lication and ermit fee, installer s' ture
35.Founda.tion footin min.2 feet above ad'usted ound water for new house
36.Deed Restriction r ired max. #bedroams: ma.x.flow: d
37.Check area lots for groundwater/Label oundwater in Assessor's Ma
Plan reviewed bY: � �ro3
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