Review Checklist . �- z� -iG
, TOWN OF YARMOUTH
' SEWAGE PLAN REVIEW CHECKLIST
> Location: A.M. Z Z-- Lot��. Zone af Contribution: In Out_`�creage
� Commercial: Residential: �
� Street: c �2�
�
, d �u.v S �
Village: ��j�� Floor Plan: C� #Bedrooms:� _-
Owner: Installer: �li
Address: Phone: � - � v
Phone:
Builder: Engineer:
Address: Phone: -- -
Phone: --v2�' � / ���r'� 'w' y-
.-_ �--= �9
N/A YES NO
1.Re uired#of co ies received c�-�'
2.Date of soils exam and percolation test not older than 2 ears v
3.4-5 ft of naturall occurrin ervious material,above water ta.ble �.-
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.: c/
6.Benchmark indica.ted and shown-NGVD if near wetlands
7. S tic tank minimum 10 ft from foundation, d�k Var.:
8.Leaching minimum 20 ft full, 15 ft crawl, 10 ft slab Var.: Li
9.Leachin minimum 100 ft from wetlands Var.:
10.Leaching minimum 150 ft from drinking 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 hi oundwater Var.: „
14.Leachin set 4-5 ft above ad'.water or bottom of test hole Var.:
15. S stem not in to or subsoil(A,B horizons)or 5'removal �/
16.Pro sed contours are suitable
17. S stem meets slo e r uirements-min. 1/8", '/a" referred
18. S stem meets breakout r uirements PVC liner: Wall:
19. S ecified tee sizes are roper, as baffle on outlet tee
20. Sewage is under 10,000 d for arcel
� 21.No ba e disposal
22. S stem ad uatel sized for its intended use L,�.-
�
23.Minimum 6"stone or com acted below tank and dbox �,.��
24.Manhole covers within 6"of ade, um cha.mber cover to ade c,_./
25.Ins ection port on plastic chambers/leach field ��
26.Electrical ermit for um chamber/S arate meter for du lexes �_�
27.Pum system-2" line,weep hole,check valve,tee in dbo�pump size _���
28. Septic tank/pump cha.mber to be facto wat roofed
29.Vent rovided if leachin below 3 feet,under driveway/ arkin .� _
30.Buoyanc calculations for tank/ u chamber
31.En ' eer to ins ect and cert' soils: wall: commerciaL•
32.Engineer/Re ' tered Sanitarian and Land Surveyor sta.m s/signahue
33.H-201oading is sub'ect to vehicular traffic, oundwater
34.Title V A lication and ermit fee, installer si ture `,�-�
35.Foundation footin min. 2 feet above adjusted ground water far new house �---
36.Deed Restriction r uired max. #bedrooms: maac. flow: d
37.Check area lots for groundwater/Label groundwater in Assessor's Ma /-
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Plan reviewed by: �� �osio3