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�' � ���� � TOWN OF YARMOUTH
SEWAGE PLAN REVIEW CHECKLIST
Location: A.M. /G / Lot �� Zone of Contribution: In Out�✓Acreage
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lj �`s�%�� Commercial: Residential:�_
Street: (/
Village: Floor Plan: #Bedrooms: �
Owner: � c��,�f��1��`� Installer: /��2� (/GTl/
Address: Phone: - - �
Phone: r--��'�1 }�: �- •-��,�,�+, vn`
ry �
Builder: Engineer: d G�
Address: Phone: - � �
Phone: " l�'�"�`' .>�L��'�---
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N/A YES NO
1.R uired#of co ies received
2.Date of soils exam and ercolation test not older than 2 ears ��
i 3.4-5 ft of na.turall occurrin ervious material,above water table
4.Fouudation 2 ft above hi oint of roa.d H.P.: Fnd: Var.:
5. Water line 10 ft from s tic com onents Var.: ,�
6.Benchmark indicated and shown-NGVD if near wetlands (J/
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.Lea.chin minimum 150 ft from drinkin welU25 ft irrigation well Var.:
11.Tank/leachin minimum 10 ft from ro line Var.:
12.S stem meets all other setback r uirements Var.:
13.Uses ad'ustment for maximum hi groundwater Var.:
14.Le�achin set 4-5 ft above adj.water or bottom of test hole Vaz.:
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 irements-min. 1/8", '/4" referred
18. System meets breakout r uirements PVC liner: Wall:
19. S �ed tee sizes aze roper, s baffle on outlet tee
20. Sewa e is under 10,000 for arcei
21.No garba e dis osal "
22. S stem ad uatel sized for its intended use
23.Minimum 6"stone or com acted below tank and dbox ,,��' _
24.Manhole covers within 6"of ade, um chamber cover to ade
25.Ins ion ort on lastic chambers/leach field
26.Electrica.l ermit for um chamber/S arate meter for du lexes .
27.P stem-2"line,wee hole,check valve,tee in dbox, um size
28. Septic tank/ um chamber to be factory wa roofed
29.Vent rovided if leaching below 3 feet, under drivewa / arkin
30.Buo ancy ca.lculations for tank/ um chamber
31.En ' eer to ins ect and cert' soils: wall: commercial:
32.En ' eer/Re 'stered Sanita.ria.n and Land Surve or stam s/si ture
33.H-201oading is subject to vehicular traffic, oundwater
34.Title V A lication and ermit fee,installer si ture •
35.Foundation footin min. 2 feet above ad'usted ound water for new house -�'
36.Deed Restriction r uired max. #bedrooms: ma�c:flow: .�-�'
3.7.Check area lots for oundwater/Label oundwater in Assessor's Ma
Plan reviewed by: C ' W03/03