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� � r ,f� TOWN OF YARMOUTH
SEWAGE PLAN REVIEW CFIECKLIST
Location: A.M.� Lot �� Zone of Contribution: In Out �Acreage
� Commercial: Residential:_��
Street: �
Village: Floor Plan: i � #Bedrooms:�_ � , �c�
� � ����'` �2 Sj�l'I 7
Owner:_T1,r,�CSI �� Installer: �j '�i��
Address: Phone:
Phone:
Builder: Engineer: �S
Address: Phone: f �
Phone: �.- ,�,�' � G,'.���j-� ` ��'����/
N/A YES NO
1.Required#of co ies received
2.Date of soils exam and ercolaxion test not older than 2 years
3.4-5 ft of natura.11 occurrin ervious material, above water ta.ble �f�
4.Foundation 2 ft above hi oint 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 tank minimum 10 ft from founda.tion, deck Var.:
8.Lea.ching minimum 20 ft full, 15 ft crawl, 10 ft slab Var.:
9.Leaching minimum 100 ft from wetlands Var.:
10.Leaching minimum 150 ft from drinking welU25 ft irriga.tion well Var.:
11. Tank/leaching minimum 10 ft from roperty line Var.: �i
12. S stem meets all other setback r uirements Var.:
13.Uses adjustment for m�x;mum high oundwater Var.:
14.Leaching set 4-5 ft above adj.water or bottom o st hole ' �/
15. System not in to or subsoil(A,B horizons)or 'rem
16.Proposed contours are suitable
17. S stem meets slo e r uirements-min. 1/8", I/4" referred
18. System meets breakout re uirements PVC liner: Wall:
19. Spec�ed tee sizes are roper, gas baffle on outlet tee
20. Sewa e is under 10,000 d for arcel �.---
• 21.No arba e disposal
22. S stem ade ua.tely sized for its intended use
23.Minimum 6"stone or com acted below tank and dbox �-
� 24.Manhole covers within 6"of grade, ump cha.mber cover to ade :_�
25.Inspection port on la.stic cha.mbers/leach field
26.Electrical ermit for um chamber/S arate meter for du lexes
27.Pump system-2" line,wee hole,check valve,tee in dbo� um size
28. S tic tank/ um chamber to be factory wat roofed
29.Vent rovided if leaching below 3 feet,under drivewa /parking _____-
30. Buoyancy calculations for tank/ um cha.mber
31.En ' eer to ins ect and c ' soils: wall: commercial: -
32.Engineer/Registered Sanitarian and Land Surveyor sta.m s/si ature �_,�
33. H-20 loading is subject to vehicular traffic, groundwater
34. Title V A plication and ermit fee, installer si ture ;
35.Founda.tion footing min. 2 feet above adjusted ound water for new house
36.Deed Restriction r uired max. #bedrooms: max.flow: d
37.Check area.lots for oundwater/Label groundwater in Assessor's Map
Plan reviewed by: C-'�' �03�03 �