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TOWN OF YARMOUTH ��.
SEWAGE PLAN REV�W CHECKLIST �pr�(��-- ��-'
Location: A.M. � �o Lot��� Zone of Contribution: In � :Out �Acrea.ge
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/� Commercial: Residential: � •
Street: C� lzC� ,
Village: Floor Plan: (� #Bedrooms: �
Owner: Installer: �
Address: Phone:
Phone:
Builder: Engineer: ��
Address: Phone: �7 -
Phone: `�" �� . �L' j�� ���'� /l�l���`�/
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N/A YES NO
1.R uired#of co ies received
2.Date of soils e�m and colation test not older than 2 ears
3.45 ft of natura. occurrin ervious material,above water ta.ble
4.Founda.tion 2 ft above hi int of road H.P.: Fnd: Var.:
5.Water line 10 ft from s tic com onents Var.: �/
6.Benchmark indica.ted and shown-NGVD if near wetlands
7. S tic tanlc minimum 10 ft from foundation, deck Var.: ✓
8.Leachin 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 tion well Var.:
11.Tank/leachin minimum 10 ft from ro line Var.: .��
12.S stem meets all other setback r ' ements Var.:
13.Uses adjustment for maximum hi oundwater Vaz.:
14.Leachin set 4-5 ft above ad'.water or botto of te e Var.:
15.S stem not in to or subsoil(A,B horizons or 5'removal
16.Pro osed contours are suita.ble
17. S stem meets slo e r uirements-min. 1/8", '/<" eferred ��
18. S stem meets breakout r uirements PVC liner: Wall:
19. S ec�ed tee sizes are ro er, s ba.ffle on outlet tee t/
20. Sewa e is under 10,000 d for arcel �/' `
21.No ba. 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 ection on lastic chambers/leach field
26.Electrical ermit for um chamber/S a.rate meter for du lexes -
27.P system-2" line,wee hole,check valve,tee in dbox, um size �/
28. S 'c tank/ um chamber to be facto wa roofed
29.Vent rovided if leachin below 3 feet,under driveway/ arkin
30.Buo anc ca.lcula.tions for tank/ um chamber
31.En ' eer to ins ect and cert' soils: wall: commercial:
32.En ' eer/Re ' ered Sanitarian and Land Surv or stam s/si ture
33.H-20 loadin is subject to vehicular tr�c, 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 ired max: #bedrooms: max.flow: d
37.Check area lots for oundwater/Label oundwater in Assessor's Ma
Plan reviewed by: �-�'�/ �o3ros
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