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j TOWN OF YARMOUTH
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SEWAGE PLAN REVIEW CHECKLIST
Location: A.M. � 2j Lot�'J�� Zone af Contribution: In Out creage
_ `��� A, Commercial: Residential:��
Street:_r� ��j'(�i y`� �
Village: ' l/p` Floor Plan: �� #Bedrooms:
Owner: Insta.11er:
Address: Phone: -�-' � .Z
Phone:
Builder. Engineer:
Address: Phone: � -" �
Phone: _ �,�/ � /6 �,2,��ti�G�'�`'��
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N/A YES NO
1.Required#of co ies received
2. Date of soils exam and ercolation test not older than 2 years
3.4-5 ft of naturall occurrin ervious material, above water table ;
4.Foundation 2 ft above hi int 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 c_.--'
7. Se tic tank minunum 10 ft from founda.tion, deck Var.: i
8.Leachin minimum 20 ft full, 15 ft crawl, 10 ft slab Var.: , 4
9.Lea.ching minimum 100 ft from wetlands Var.: ,. '
10.Leachin minimum 150 ft from drinking welU25 ft irri ation well Var.: �'�!
11.Tank/lea.ching minimum 10 ft from ro eriy line Var.: ✓''' ;
12. S stem meets all other setback r uirements Var.: i
13.Uses ad'ustment for maximum hi groundwater Var.:
14.Leaching set 4-5 ft above adj.water or bottom e ar.: �--- f
15. System not in to or subsoil(A,B horizons)or 'removal f
16.Pro osed contours are suitable �
17. S stem meets slo e r uirements-min. 1/8", 1/4" eferred ;
18. System meets breakout requirements PVC liner: G " all: (�/ `
� 19. Specified tee sizes are roper, gas baffle on outlez tee �
2Q. Sewa e is under 10,000 d for parcel ���'
21.No ba.ge dis osal [
� 22. S stem ade 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,pum cha.mber cover to grade
25. ection ort on plastic chambers/leach field
26.Electrical ermit for um chamber/S arate meter for du lexes .`.:? ,
27.Pum system-2" line,wee hole,check valve,tee in dbox, ump size
28. S tic tank/pum chamber to be factory waterproofed i
29.Vent rovided if leaching below 3 feet,under driveway/ arkin '
30.Buo ancy calculations for tank/pum chamber �_� `
31.En ' eer to ins ect and c ' soils: wall: commercial:
32.Engineer/Re 'stered Sa.nitarian and Land Surveyor stam s/si ture
33.H-20 loadin is sub'ect to vehicular trai�ic, oundwater
34. Title V A lication and ermit fee,installer signature
35.Foundation footin mi.n.2 feet above adjusted ground water for new house
36.Deed Restriction re uired ma��. #bedrooms: ma�c.flow: d
37.Check area lots for oundwater/Label groundwater in Assessor's Map
Plan reviewed by: � wo3,o3
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