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_ TOWN OF YARM�UTH �
SEWAGE PLAN REVIEW CHECKLIST l
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' Location: A.M. � Lot �d Zone of Contribution: In Out� Acreage
�,/ Commercial: Residential:
Street: �D o�C �� �
Village: I� Floor Plan: #Bedrooms: ,,�
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Owner: �2�y/ /�C�-4' �S Installer: j��
Address: � Phone: �t3 -"
Phone: �
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Builder: Engineer: � �Q
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Address: Phone: --
Phone: �S - � �j 7 l.,� 7��'
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N/A YES NO �
1.Required#of co ies received �
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2. Date of soils e�m and erco.lation test not older than 2 years t-�' ;
3. 4-5 ft of natural occurrin ervious material,above water table V `
4.Foundation 2 ft above hi oint of rpad H.P.: Fnd: Var.: ,
5. Water line 10 ft from s tic com onents Var.: �� '
6. Benchmark indicated and shown-NGVD if near wetlands (/� j
7. S tic tank minimum 10 ft from foundation,de�k Var.: �
8. Leaching minimum 20 ft full, 15 ft crawl, 10 ft slab Var.:
9.Leachin minimum 100 ft from wetlands Var.: �-
10. I,eachin minimum 150 ft from drinkin welU25 ft irri tion well Var.:
1 l. Ta.nk/leaching minimum 10 ft from ro line Var.: �.-
12. S stem meets all othet setback r uirements Var.: -
13. Uses ad'ustment for maximum hi oundwater Var.: ;
14. Leachin set 4-5 ft above ad'.water or bottom of test hole Var.: �-'
15. S stem not in to or subsoil' A,B horizons)or 5'removal - -
16.Pro sed.contours are suitable � - 4
17. S stem meets slo e r uirements-min. 1/8", '/4" eferred �
1$. System meets breakout r uirements - PVC liner: Wall: ------ i
19. S ified tee sizes are roper, as baffle on outlet tee �� i
' 20. Sewa e is under 10,000 for arcel �� i
21.No arba. e dis osa.l i
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 chamber cover to ade -
25. Ins tion ort on lastic chambers/leach field
26. Electrical ermit for um cha.mber/S arate meter for du lexes -�-
27.Pum system-2"line,wee hole,check valve,tee in dbo� um size �-
28. Septic tank/ um chamber to be factory waterproofed l
29.Vent rovided if leachin below 3 feet,under drivewa / arking I '
30. Buoyancy calculations for tank/pum chamber
31. En 'neer to ins ect and cert' soils: wall: commerciaL•
32. En 'neer/Re 'stered Sanitarian and Land Surve or stamps/si ture ;
33. H-20 loadin is subject to vehicular traf�ic, oundwater !
34. Title V Ap lication and ermit fee, installer si ture ;
35.Foundation footing min. 2 feet above ad'usted ound water for new house � ',
36.Deed Restriction r uired max. #bedrooms: max. flow: d `--
37.Check area lots for groundwater/Label oundwater in Assessor's Ma '
Plan reviewed by: � ___ �o3ios ,I
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