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TOWN OF YARMOUTH
^ SEWAGE PLAN REVIEW CHECKLIST
. Location: A.M. '�y Lot �-- Zone of Contribution: In Out �Acrea
-�--- _ ge
Commercial: Residential:�
� Str�: �� , /
Village: Floor Plan: V #Bedrooms:�_
� Owner: � �� Installer: C- G (�,� i���
; Address: Phone: -- ?j- ��- , Z 7
� Phone:
Builder: Engineer: G��L � �
Address: Phone: -
Phone: -- /.� /�?�'�� c�!J/
N/A YES NO
1.R uired#of co ies received
2. Date of soils exa.m and ercolation test not older than 2 yea.rs Lr,f
3.4-5 ft of naturall occurrin ervious material, above water table �____
4.Founda.tion 2 ft above hi oint of road H.P.: Fnd: Var.:
5. Water line 10 ft from septic com onents Var.: �
6.Benchmark indica.ted and shown-NGVD if near wetlands ��
7. S tic tank minimum 10 ft from foundation, deck Var.:
8.Leaching 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 drinkin welU25 ft irri ation well Var.:
1 l.Tank/leaching minimum 10 ft from r erty line Var.: Lf
12. S stem meets all other setback r uirements Var.: 4__---
13.Uses ad'ustment for maximum hi oundwater Var.:
14.L,eachin set 4-5 ft above adj.water or bottom test hoi Var.: ��.,,_
15. S stem not in to or subsoil(A,B horizons) 5'remov
16.Pro sed contours are suitable �._
17. S stem meets slo e r uirements-min. 1/8", '/4" eferred �-,
18. System meets breakout r uirements PVC liner: Wall:
19. S ecified tee sizes are ro er, baffle on outlet tee �___--
20. Sewa e is under 10,000 d for arcel
_ 21.No arba e dis osa.l ���
22. S stem ad uatel sized for its intended use �,y
23.Minimum 6"stone or com acted below tank and dbox
. 24.Manhole covers withi.n 6"of ade,pump chamber cover to ade
25.Ins ion ort on plastic chambers/leach field J,
26.Electrical ermit for um chamber/S arate meter for du lexes
27.Pum s stem-2" li.ne,wee hole,check valve,tee in dbox, um size
28. S tic ta.nk/ ump chamber to be facto wat roofed
29.Vent rovided if leaching below 3 feet, under drivewa / arking �
30.Buo ancy calculations for tank/ um chamber
31.En ' eer to ins ect and c ' soils: wall: commercial:
32.En ' eer/Re ' tered Sa.nitazian and Land Surveyor stam s/signature
33.H-201oadin is subject to vehicular tr�c, oundwater
34.Title V A lication and ermit fee, insta.11er si ture i
35.Founda.tion footing min. 2 feet above adjusted ound water for new house I
36.Deed Restriction r ired max. #bedrooms: max. flow: d f
37.Check area lots for oundwater/Label oundwater in Assessor's Ma �
Plan reviewed by: 'x% I
6/03/03 ,
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