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' . TOWN OF YARMOUTH
SEWAGE PLAN REVIEW CHECKLIST
, • Location: A.M.�_ Lot �/ Zone of Contribution: In Out `� Acrea e
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Commercial: Residential:
Street: �� � S
Village: , Floor Plan: #Bedrooms: �
� Owner: ��'/ `�/���/!�"Li ^ Insta.11er: S'
� Address: Phone: � �" Q
Phone:
�r�--c' - 1 s���� �
Builder: Engineer: �
Address: Phone: -�
Phone: '� � �
�I7/C���r �/� �'�r2fr !2'' ��1
_'sl��� s.���.� lr�
� 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 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 foundation, deck Var.: ��.
8.Leaching minimum 20 ft full, 15 ft crawl, 10 ft slab Vax.: 5 ��
9.Leaching minimum 100 ft from wetlands Var.:
� 10.Lea.ching minimum 150 ft from drinkin welU25 ft irrigation well Var.:
i 11. Tank/leaching minimum 10 ft from ro erry line Var.: �
12. S stem meets all other setback r uirements Var.: `��
� 13.Uses ad'ustment for maximum high oundwater Var.:
14.Leachin set 4-5 ft above ad'.water or bottom of test hole Var.: `,_i
15. System not in to or subsoil(A,B horizons)or 5'removal
16.Pro osed contours are suita.ble �,i
17. S stem meets slo e r uirements-min. 1/8", '/4" referred
18. System meets breakout requirements PVC liner: Wall: ��
19. S ecified tee sizes are proper, gas ba.ffle on outlet tee .
20. Sewa e is under 10,000 d for arcel
21.No arba e dis osal `�
- 22. S stem ade uatel sized for its intended use L�,
23.Minimum 6"stone or com acted below tank and dbox �/
24.Manhole covers within 6"of ade, ump chamber cover to ade
' 25.Ins ection ort on lastic chambers/leach field
26.Electrica.l ermit for um chamber/S azate meter for du lexes
27.Pum system-2" line,wee hole,che�k valve,tee in dbox,pump size -
28. S tic tank/ um chamber to be factory wat roofed ��
29.Vent rovided if leachin below 3 feet,under drivewa /parkin
30.Buoyancy calculations for tank/ um chamber ���
31.En ' eer to ins ect and cert' soils: wall: commercial:
32.En ' eer/Registered Sanitarian and Land Surveyor stam s/si ture •��
33.H-201oadin is sub'ect to vehicular traffic, oundwater ���
34.Title V A plication and ermit fee, installer signature
35.Foundation footin min. 2 feet above ad'usted ground water for new house
36.Deed Restriction r uired max. #bedrooms: max, flow: d
37.Check area lots for oundwater/Label goundwater in Assessor's Ma -
Plan reviewed by: }
6/03/03
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