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/� � �� TOWN OF YARMOUTH
� SEWAGE PLAN REVIEW CHECKLIST
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Location: A.M. � � Lot�� J Zone of Contribution: In Out ( Acreage
Commercial: Residential:�-
� Street: Z� C/
Village: ` Floor Plan: ✓ #Bedrooms: �
� ��e�'����2%1�� ,�Z.� �G� Ins#aller: L'
Address: � � Phone: ��Z Z .���
Phone: /� � � -- j�'-��.�--�4.'�Ll�-�j e'
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Builder: Engineer: � �2��%�
Address: Phone: � 8S-
Phone:
N/A YES NO
1.R uired#of co ies received
2.Date of soils exam and percolation test not older than 2 ears �/
3.4-5 ft of naturall occurrin ervious material, above water table ��
4.Founda.tion 2 ft above high oint of road H.P.: Fnd: Var.: .
5. Water line 10 ft from s tic components Var.:
6.Benchmark indicated and shown-NGVD if near wetlands ��
, 7. S tic tank minimum 10 ft from founda.tion, deck Var.:
8.Leachin minimum 20 ft full, 15 ft crawl, 10 ft slab Var.:
9.Leachin minimum 100 ft from wetlands Var.: ��
10.Leachin minimum 150 ft from drinicing welU25 ft irri tion well Var.:
11.Tank/leaching minimum 10 ft from ro line Var.: ��'
12. S stem meets all other setback r uirements Var.:
13.Uses ad' stment 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 osed contours are suitable
17. S stem meets sl e r uirements-min. 1/8", '/a" referred
18. S stem meets breakout r uirements PVC liner: Wall: �.�
19. S ified tee sizes aze ro er, gas baffle on outlet tee
20. Sewa e is under 10,000 d for arcel
' 21.No ba e dis osal �.�
22.S stem ad uatel sized for its intended use
23.Mmimum 6"stone or com acted below tank and dbox �/
24.Manhole covers withi.n 6"of ade, um cha.mber cover to ade
25.Ins ection ort on lastic chambers/leach field
26.Electrical ermit for um cha.mber/S arate meter for du lexes
27.Pum stem-2" line,w hole,check valve,tee in dbox, um size �-
28. S tic tank/ um chamber to be factory wat roofed -�--�-
29.Vent rovided if leachin below 3 feet,under drivewa / arkin
3Q.Buoyancy calcula.tions for tank/pump chamber -�-
31.En ' eer to ins ect and c ' soils: wall: co ercial:
32.En ' eer/Re ' tered Sanitarian and Land Surve or s/si ture ��� ,
33.H-20 loading is sub'ect to vehicu�ar tra.ffc, oundwater . •
34. Title V A lication and ermit fee, insta.11er si ture .��'
35.Foundation footin min.2 feet above ad'usted ound water for new house -�-
36.Deed Restriction r uired max. #bedrooms: m�. flow: d
37.Check area lots for oundwater/Label oundwater in Assessor's Ma
Plan reviewed by: ( (,�''`-� wo3io3