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{ � ���Z �� TOWN OF YARMOUTH
� SEWAGE PLAN REV�W CHECKLIST
�
� ` Location: A.M. � 7 Lot l� �� Zone of Contribution: In Out�Acreage�
� �// ���i�� � Commercial: Residential
Street: `"7'- /
Village: /A�_ �a�'/ Floor Plan: ✓ #Bedroo s: ,�
Owner: �p���� Installer: � � Z� � � G � �r-��-�`�`'���
Address: Phone� � �y�� / �"��y�
Phone:
' Builder: Engineer:
Address: Phone: - 7 7 �
Phone: .- �'� :' �'�� C�� �
N/A YES NO
1.R uired#of co ies received
2.Date of soils exam and ercolation test not older than 2 years �-
3.4-5 ft of natura occurrin ervious ma.terial, above water ta.ble ✓
� 4.Foundation 2 ft above hi oint of road H.P.: Fnd: Var.:
i 5.Water line 10 ft from s tic com onents 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.Leaching minimum 1 UO ft from wetlands Var.: �---� .
10.Leachin minimum 150 ft from drinkin we1U25 ft irrigation well Var.:
11.Ta.nk/leachin minimum 10 ft from ro eriy line Var.: �
12. S stem meets all other setback r uirements Var.:
13.Uses adjustment for maximum hi oundwater Var.: .
14.Leaching set 4-5 ft above ad'.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 slo e r irements-min. 1/8", '/4" eferred
18. System meets breakout r irements PVC liner: Wall: �_,
19. S ecified tee sizes are roper,gas ba�le an outlet tee
20. Sewa e is under 10,000 d for arcel '
• 21.No garba e 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 cha.mber cover to ade
25.Ins ection ort on lastic chambers/leach field `„1
26.Electrical ermit for um chamber/S arate meter for du lexes __-.
27.Pum s stem-2"line,w hole,check valve,tee in dbox, um size _._---
28.S tic tank/ um cha.mber to be factory wat roofed
29.Vent rovided if leachin below 3 feet,under driveway/ arkin
30.Buoyancy calculations for tank/ um chamber
31.En ' eer to ins ect and cert' soils: wall: commercial:
32.En ' eer/Re 'stered Sanitarian and Land Surv or stam s/signahue
33.H-201oa.din is sub'ect to vehicular traffc, groundwater '
34.Title V A lication and ermit fee, installer si ture �
35.Foundation footin 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 oundwaterlLabel oundwater in Assessor's Ma
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Plan reviewed by: ��� 6/03/03