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: (� � ZZ -��
; TOWN OF YARMOUTH
� � SEWAGE PLAN REVIEW CHECKLIST
Location: A.M. '� Z Lot� Zone of Contribution: In Out�Acreage
� CommerciaL• Residential: �
Street: � /
Village: r Floor Plan: Y #Bedrooms:�_
Owner: l S Installer: �
Address: Phone: S�� - �Z� � "
Phone:
Builder: Engineer: s S
Address: Phone: _ � �
Phone: ,/�' `
Y"�' J ;� -
N/A YES �O
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 material, above water ta.ble
4.Foundation 2 ft above hi int of road H.P.: Fnd: Var.:
5.Water line 10 ft from s tic com onents Var.:
6.Benchmark indicated and shown-NGVD if near wetlands
7. S tic tanlc minimum 10 ft from founda.tion, deck Var.:
8.Leachi.n minimum 20 ft full, 15 ft crawl, 10 ft sla.b Var.:
9.Leaching minimum 100 ft from wetlands Var.: _
� 10.Lea.chin minimum 150 ft from drinkin welU25 ft irrigation well Vaz.: --
1 l.Tank/leachin minimum 10 ft from r erty line Var.: `,�
12. S stem meets all other setback r ' ements Var.:
13.Uses ad'ustmeirt for ma�mum hi oundwater Var.: ,
14.Leachin 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 contours aze suitable �-
17. S stem meets slo e r uirements-min. 1/S", '/a" refeired c_--
18. S stem meets breakout r irements PVC liner: Wall: ��
I 19. S ecified tee sizes are roper, baffle on outlet tee
j 20. Sewa e is under 10,000 d for arcel
• 21.No arba 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 F
` 24.Manhole covers within 6"of ade, um cha.mber cover to e
25. ection on la.stic chambers/leach field
26.Electrica.l ermit for um chamber/S azate meter for du lexes � '
27.P system-2"line,w hole,check valve,tee in dbox, um size �-
28. S tic tank/ um chamber to be facto waterproofed .�'
29.Vent rovided if leachin below 3 feet,under driveway/ arkin �
30.Buoyancy calcula.tions for ta.nk/ u chamber �`
31.En ' eer to ins ect and c ' soils: wall: commercial:
32.En ' eer/Re 'stered Sanitarian and Land Surveyor stam s/signature
33.H-201oadin is sub'ect to vehicular tra.ffic, groundwater
34.Title V A lication and ermit fee,installer signature �,/
35.Foundation footin min.2 feet above ad'usted ound water for new house
36.Dced Restriction r ired max. #bedrooms: max.flow:
37.Check azea lots for oundwater/Label groundwater in Assessor's Ma
Plan reviewed by: �o3ro3