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� �`� � � TOWN OF YARMOUTH � �' / r
SEWAGE PLAN REY�W CHECKLIST ���X� ��������
Loca.tion: A.M. �� Lot �� Zone of Contribution: In� Out Acreage�`' .�l�'�
/,, �/� Commercial: Reside�tial:�_
� Street: � l��/�(L%P/G-- 'i
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Village: Floor Pl : #Bedrooms: �
o��: �t C L ��ii�:
� C � s ;�s��= �
Address: Phone: �- -�
Phone: � � �j7��' O� -
Builder: Engineer: �
Address: Phone: - �'
Phone: `� � �, �,�. c
N/A YES NO
l.R ired#of co ies received
2.Date of soils exam and ercolation test not older than 2 years
3.4-5 ft of na.tura occurrin ervious ma.terial, above water table �,f
4.Foundation 2 ft above hi oint of road H.P.: Fnd: Vaz.: , L�
5.Water line 10 ft from s tic com onents Var.: �-� '
6.Benchmark indica.ted and shown-NGVD if near wetlands
7. S tic tank m;nimum 10 ft from foundation, deck Vaz.: ��,t,y , i.-�-�
8.Leaching minimum 20 ft full, 15 ft crawl, 10 ft slab Var.: �---
9.Leachin minimum 100 ft from wetlands Var.: �� .
10.Leaching minimum 150 ft from drinkin welU25 ft irri tion well Var.: �� ;
11. Tank/lea.ching mi.nimum 10 ft from r erty line Var.: �
12. S stem meets all other setback r uirements Vaz.: c,,,_� ;
13.Uses ad' ent for maxinium hi oundwater Var.: . �
14.Le�achin set 4-5 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 coirtours are suitable �
17. S stem meets slo e r uirements-min. 1/8", '/<" referred �/ j
18. System meets breakout re uirements PVC liner: Wall: �� r
19. S ecified tee sizes are r er, gas ba.ffle on outlet tee f= �
20. Sewa e is under 10,000 d for arcel ;
21.No bage 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 de
- 25.Ins ection ort on la.stic chambers/leach field '
26.Electrical ermit for um chamber/S arate meter for du lexes
27.P system-2"line,w hole,check valve,tee in dbox, um size '
28. S tic tank/ chamber to be factory wa roofed `/
29.Vent rovided if leachin below 3 feet,under driveway/ arkin _/
30.Buoyancy calculations for tank/pu chamber -
31.E ' eer to ins ect and c ' soils: wall: commerciaL•
32.En ' eer/Re ' ered Sanitarian and Land Svrveyor s/si e �,� ;
33.H-201oadin is sub'ect to vehicuIar traffc, oundwater � ?
34.Title V lica.tion and ermit fee, installer si ture
35.Foundation footin min. 2 feet above ad'usted ound water for new house i
36.Deed Restriction r ired max. #bedroams: max. flow: d .,�-- C
37. Check area lots for groundwater/Label oundwater in Assessor's Ma. �
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Plan reviewed bY: wo3,o� '