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r TOWN OF YARMOUTH
SEWAGE PLAN REVIEW CHECKLIST
' Location: A.M. �� Lot �� Zone of Contribution: In Out creage �,
Commercial: Residential: �-
Street:
Village: Floor Plan: #Bedrooms:�
Owner: ��Q GI � d'i Insta ller: '�����-� ���
Address: Phone:
Phone:
a�'
Builder: Engineer:
Address: Phone: r
Phone: '`_ b >�Y. � ���,��
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 naturall occurrin ervious material,above water ta.ble �..--
4.Foundation 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 C--' '
7. S tic tank minimum 10 ft from foundation,deck Var.: `-� �
8.Leachin minimum 20 ft full, 15 ft crawl, 10 ft slab Var.:
9.Leaclung minimum 100 ft from wetlands Var.: �� �
10.Leachin minimum 150 ft from drinkin welU25 ft irrigation well Var.: �--''����
11.Tank/leaching minimum 10 ft from pro erty line Var.: �--�''�
12. S stem meets all other setback r uirements Var.:
13.Uses ad'ustment for maximum high groundwater 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 C�
16.Pro osed contours are suita.ble �-----�
17. S stem meets slo e re irements-min. 1/8", '/a" referred
18. System meets breakout r uirements PVC liner: WaIL ��-=
19.S ecified tee sizes are pro er, as baffle an outlet tee �--�
20. Sewa e is under 10,000 d for arcel L_--�
� 21.No ba e dis osal L�
22. S stem ad uatel sized for its intended use �-r-'�
23.Minimum 6"stone or com acted below tank and dbox �---�''
' 24.Manhole covers within 6"of grade, um chamber cover to ade
25.Ins ection ort on lastic chambers/leach field �---�"'
26.Electrical ermit for um chamber/S arate meter for du lexes ---�
27.Pump system-2" line,wee hole,check valve,tee in dbox, ump size ✓"�
28. S tic tank/pum chamber to be facto wa roofed
29.Vent rovided if leachin below 3 feet,under driveway/ arkin
30.Buoyancy calculations for tank/pump chamber
31.En ' eer to ins ect and c ' soils: wall: commercial:
32.Engineer/Re 'stered Sanitarian and Land Surveyor stam s/si ture "--�''
33.H-201oadin is subject to vehicular traffic, oundwater
34.Title V Ap lication and ermit fee, installer si ture '
35.Foundation footin min.2 feet above ad'usted ound water for new house
36.Deed Restricdon r uired max. #bedrooms: m�. flow: d �
37.Check area lots for groundwater/Label groundwater in Assessor's Ma �
Plan reviewed by: C'�� 6/03/03