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� `L-/-/ � s �,�� _-�� ,
. TOWN OF YARMOUTH ��'�" ��
SEWAGE PLAN REVIEW CHECKLIST , ��� �
• Location: A.M. � Lot � Zone of Contribution: In�`"�Out Acreage `/ �z'�-
�r Commercial: Residential: -�.��
Street: � � ���/ � ,�� �/ �/�":"%
Village: Floor Plan: �73ed�ioms.
Owner: J/Gt%j 4, ,��QG�,1 �n"�6► i�!�9 � Installer: �
Address: �-T- Phone:
Phone:
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� Builder: Engineer: 7 ''/
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Address: Phone: - - '�
Phone: .- �/l,� j� L 6,�� ��G-G j"��
� N/A YES NO
� 1.R uired# of copies received
� 2.Date of soils exam and ercolation test not older than 2 ears ��
� 3. 4-5 ft of naturall occurrin ervious material, above wa.ter table �,,....--
4.Foundaxion 2 ft above high oint 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 tank minimum 10 ft from foundation, d�k Var.: �.�
� 8.Lea.ching minimum 20 ft full, 15 ft crawl, 10 ft slab Var.: .,_�/
� 9.Leaching minunum 100 ft from wetlands Var.:
10.Leaching minimum 150 ft from drinkin we1U25 ft irri ation well Var.: �"�
� 11. Tank/leaching minimum 10 ft from roperty line Var.: :✓
( 12. S stem meets all other setback re uirements Var.:
; 13.Uses adjustment for maximum high oundwater Var.:
14.Leaching 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.Proposed contours are suitable
17. S stem meets slo e r uirements-min. 1/8", '/4" referred L_..-�'
'. 18. System meets breakout re irements PVC liner: Wall:
' 19. Specified tee sizes are proper, gas baffle on outlet tee �'
20. Sewa e is under 10,000 d for parcel
21.No garbage disposal
i22. S stem ad uatel sized for its intended use
� 23.Minimum 6"stone or compacted below tank and dbox ��
� 24.Manhole covers within 6"of ade,pum cha.mber cover to grade �-'�
25.Inspection port on lastic chambers/leach field
26.Electrical ermit for um cha.mber/S arate meter for du lexes •
27.Pump system-2" line,wee hole,check valve,tee in dbox, um size ------'
28. S tic tank/ um chamber to be factory wat roofed ----�
29.Vent rovided if lea.ching below 3 feet,under driveway/ arking
30. Buoyancy calculations for tank/ ump chamber _/''
31.En ' eer to ins ect and cert' soils: wall: commercial: �./
32.Engineer/Registered Sanitarian and Land Surveyor stam s/si ature �/
33. H=201oadin is sub'ect to vehicular tra�c, oundwater
34.Title V A plication and ermit fee,installer signature
35.Founda.tion footing min. 2 feet above adjusted ground water for new house
36.Deed Restriction r uired maa�. #bedrooms: ma�L. flow: d �-'""�
37.Check area.lots for groundwater/Label groundwater in Assessor's Ma
Plan reviewed by: � �osro3