Review Checklist ��/� � �/ TOWN OF YARMOUTH
� SEWAGE PLAN REV�W CHECKLIST
� Location: A.M.
; . �� Lot Z�� Zone of Contribution: In Out � Acreage
Commercial: Residential: �-
Srreet: �
Villa.ge: li Floor Plan: �� #Bedrooms:
Owner: Insta.11er:
� Address: Phone: 3
� Phone:
Builder: Engineer: �' ��'iJ2 .� �
Address: Phone: -�
Phone:
N/A YES NO
1.Re uired#of copies received
2.Date of soils exam and ercolation test not older than 2 years �1
3. 4-5 ft of naturall occurrin ervious material, above water ta.ble �.�'
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 ��f
7. S tic tank minimum 10 ft from foundation, deck Var.:
8. Leachin minimum 20 ft full, 15 ft cra.wl, 10 ft slab Var.:
9.Leachin minimum 100 ft from wetlands Var.:
10.Leaching minimum 150 ft from drinkin welU25 ft irri ation well Var.:
1 l.Tank/leachin minimum 10 ft from ro erty line Var.:
12. S stem meets all other setback r uirements Var.: L1
13.Uses ad'ustment for ma�mum hi groundwater 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 sed contours are suitable
17. S stem meets slo e r uirements-min. 1/8", 1/a" eferred
18. S stem meets breakout r uirements PVC liner: Wall:
� - 19. S ec�ed tee sizes are ro er, baffle on outl�tee
20. Sewa e is under 10,000 d for arcel
21.No bage 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 L�
25.Ins ion ort on la.stic chambers/leach field �_�
26. Electrical ermit for um cha.mber/S arate meter for du lexes
27.Pum stem-2"line,wee hole,check valve,tee in dbo�r, um size
28. S tic tank/ um chamber to be facto waterproofed ./"
29.Vent rovided if leachin below 3 feet, under driveway/ azkin
30.Buoyancy calculations for tank/ um chamber
31.En ' eer to ins ect and cert' soils: wall: commercial:
' 32.En ' eer/Re ' ered Sanitarian and Land Surveyor sta.m s/si ature
33.H-20 load'm is sub'ect to vehicular traffic, oundwater
34.Title V A lication and ermit fee, installer si ature
35.Foundation footing min. 2 feet above ad'usted ound water for new house
36.Deed Restriction r ired max. #bedrooms: max. flow: d
37.Check area lots for oundwater/Label oundwater in Assessor's Ma
Plan reviewed by: �03�03