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. � � // ! �� TOWN OF YARMOUTH
- SEWAGE PLAN REV�W CHECKLIST
Location: A.M.� Lot Z�- Zone of Contribution: In Out A ge
Commercial: Residential. �
street: //b - /+�' �-2���� �,,'��/J !�
Village: Floor Plan: #Bedrooms. � � � ,
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o��-: ,��� �����-� �s�n�: � ���.� - � /����� '�
Address: Phone: % ��"(��`' � � '
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Phone• � L�"� ,�''` C�'� ;
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Builder: Engineer: � �' � � � � �� >���� I
dre : " Phone: - &��� .�i'���'�"' �
Ad ss 3-7� � � �' ,� I
Phone: , -�i��Yy ��-�i�°'���r.� � �% �S i
,,��r-� / ����i� , G����� �_ �'�"�
N/A YES NO
1.Re uired#of co ies received
2.Date of soils exam and ercolation test not older than 2 years -
3.4-5 ft of natura.11 occurrin ervious material, above water table �/�
4.Founda.tion 2 ft above hi oint 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 t�--
7. S tic tank minimum 10 ft from foundation, de�k Var.: t�
8.Leaching minimum 20 ft full, 15 ft crawl, 10 ft slab Var.: '
9.Leaching minimum 100 ft from wetlands Var.: �ii` t---�'�
10.Leachin minimum 150 ft from drinking welU25 ft irriga.tion well Var.:
11.Tank/leachin minimum 10 ft from ro erry line Var.: ! �
12. S stem meets all other setback re uirements Var.:
13.Uses adjustment for maxi.mum hi groundwater Var.: �---�"
14.Leaching set 4-5 ft above adj.water or bott of tes`� e Uar.:
15.System not in to or subsoil(A,B horizons or 5'removal '
16.Proposed contours are suita.ble '
17.S stem meets slo e r uirements-min. 1/8", '/4" referred '
18. System meets breakout r irements PVC liner: alL•
19. Specified tee sizes are roper, gas ba$le on outlet tee t---�'" f
20. Sewa e is under 10,000 d for arcel �� �
21.No arbage disposal ;
22. S stem ad ua.tel sized for its intended use '
23.Minimum 6"stone or com acted below tank and dbox ;
24.Ma.nhole covers within 6"of ade,pum chamber cover to grade �,� �
25.Ins ection ort on lastic chambers/leach field �./'
26.Electrical ermit for um cha.mber/S arate meter for du lexes ✓
27.Pump system-2" line,weep hole,check valve,tee in dbo� um size �'
28. S tic tank/pum cha.mber to be factory wat roofed .
29.Vent rovided if leachin below 3 feet, under driveway/ arkin
30. Buoyancy calculations for tank/ ump chamber �,.�
31.En ' eer to ins ect and c ' soils: /wall• commercial:
32.Engineer/Registered Sanitarian and Land Surveyor s s/si ture
33.H-20 loading is subject to vehicular traiiic, groundwater ���
34.Title V A plication and ermit fee, insta.11er signature '
35.Foundation footing min. 2 feet above ad'usted ound water for new house
36.Deed Restriction re uired max. #bedrooms: . flow: -�-- d
37.Check area lots for oundwater/Label groundwater in Assessor's Ma �
Plan reviewed by: wo3io3