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TOWN OF YARMOUTH �����'�"��"�'
SEWAGE PLAN REVIEW CHECKLIST -,�� � �
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� Location: A.M.� Lot �%7 Z-- Zone af Contribution: In ut Acreage ��j<' �-/ :
� Commercial: Residential: �
Street: �i�/`�S� `� �
Village: Floor Plan: #Bedrooms: �
Owner: \�Gf.�S ,���f� Insta.11er: 7
Address: Phone:
Phone:
Builder:_ ������ Engineer:
Address: Fhone: - ->' �
� Phone: �v
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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 years �,,�
3.4-5 ft of na.turall occurrin ervious material, above water ta.ble
4.Foundation 2 ft above hi oint of road H.P.: Fnd: ar.: ��� j
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.Leachin minimum 100 ft from wetlands Var.:
10.Leaching minimum 150 ft from drinkin welU25 ft irri` tion well Var.: --�-
11.Tank/leaching minimum 10 ft from ro 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 Vaz.: ��
15.System not in to or subsoil(A,B horizons}or 5'removal
16.Pro sed contours are suitable �i
17. S stem meets slo e r irements-min. 1/8", '/4" referred ,�'
18. System meets breakout re irements PVC liner: Wall: �..�'
19. Specified tee sizes are ro er, gas baffle on outlet tee
20. Sewa e is under 10,000 gpd 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 ort on lastic chambers/lea.ch field `�
26.Electrical ermit for um chamber/S arate meter for du lexes .
27.Pum system-2"line,w hole,check valve,tee in dbox, um size -�'�
28. S tic tank/ um chamber to be facto wat roofed
29.Vent rovided if leachin below 3 feet, under drivewa /parkin
30.Buoyancy calculations for tank/ ump chamber /
31.En ' eer to ins ect and cert' soils: wall: commercial:
32.En ' eer/Registered Sanitarian and Land Surveyor staxn s/si ture �/
33.H-201oading is subject to vehicular traffic,groundwater _,�-
34.Title V A lication and ermit fee,installer signature
35.Foundation footin min. 2 feet above ad'usted 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 Ma
Plan reviewed by: ( t-'� �,o3io3 _