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TOWN OF YARMOUTH
SEWAGE PLAN REVIEW CHECKLIST � ��l� • � /���
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Location: A.M. / / Lot�� Zone of Contribution: In t/ Out Acreage L/_ �7��j�'
` Commercial: ResidentiaL• �% :
Street: G-
Village: �' Floor Plan: t� #Bedrooms:�_�
�..`' �,ti1/�iG�"� � f��/Iy)
Owner: f d(Q� ���� Installer:
a
Address: Phone:
Phone:
Builder: Engineer: �
Address: Phone:
Phone: �- � '�! `i `��� ' C(�-�r��
N/A YES NO
l.Required#of copies received
2.Date of soils e�m and colation test not older than 2 ears •�-
3.4-5 ft of natural occurrin ervious material,above water table
4.Founda.tion 2 ft above high 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 �-
7. S tic tank minimum 10 ft from foundation,deck Var.: �-�
8.Leaching minimum 20 ft full, 15 ft crawl, 10 ft slab Var.: -
9.Leaching 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 property line Var.: c�
12. S stem meets all other setback r uirements Var.: :�''
13.Uses adjustment for maximum hi oundwater Var.: -
14.Leachin 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.Pro osed contours are suitable
17. S stem meets slo e r uirements-min. 1/8", '/<" referred
18. S stem meets breakout requirements PVC liner: Wall:
19.S ecified tee sizes are ro er, as baffle on outlet tee �--
20. Sewage is under 10,000 d for parcel
21.No arbage 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 grade, um cha.mber cover to grade �.-- ,
25.Ins ection ort on la.stic chambers/leach field '
26.Electrical ermit for um chaxnber/S arate meter for du lexes
27.Pum system-2" line,wee hole,check valve,tee in dbox,pump size ��
28. S tic tank/ um chamber to be factory wat roofed
29.Vent rovided if leaching below 3 feet,under driveway/ arkin
30.Buoyancy calculations for ta.nk/pum cha.mber
31.En ' eer to ins ect and cert' soils: wall: commercial:
32.En ' eer/Registered Sanitarian and Land Surveyor stam slsi ature
33.H-201oadin is sub'ect to vehicular traffic, groundwater �
34.Title V A lica.tion and ermit fee, installer si ture �
35.Foundation footing min. 2 feet above ad'usted ound water for new house
36.Deed Restriction r uired max. #bedrooms: max.flow:
37.Check area lots for oundwater/Label oundwater in Assessor's
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Plan reviewed by: � s`'� �o3�os