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TOWN OF YARMOUTH
. SEWAGE PLAN REVIEW CHECKLIST
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Location: A.M. �� Lot �� Zone of Contribution: In Out Acreage
• , Commercial: ResidentiaL•
Street: �
Village: Floor Plan: � #Bedrooms:
Owner: ��G�/1� �1��/� L7�'t..�/ Installer: � '
Address: Phone: f
Phone: '
Builder: Engineer: GC� �'� �
Address: Phone: - -
Phone: � vy�� � , ���
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- ��'`�- �`� �, � ���
/A YES NO
l.R uired#of copies received
2.Date of soils exam and percolation test not older than 2 years
3.4-5 ft of naturall occurrin ervious material, above water table ��'
4.Foundation 2 ft above hi oint of road H.P.: Fnd: Var.:
5.Water line 10 ft from septic components 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 Vax.:
9.Leaching minimum 100 ft from wetlands Var.: L�
10.Leaching minimum 150 ft from drinking we1U25 ft irri ation well Var.:
11.Tank/leaching minimum 10 ft from ro erty line Var.:
12. S stem meets all other setback r uirements Var.: .
13.Uses adjustment for ma�mum high oundwater Var.: . '
14.Leachin set 4-5 ft above adj.water or botto
15. System not in to or subsoil(A,B horizo s)or 5' al
16.Pro osed contours are suitable �
17.S stem meets slo e re uirements-min. 1/8", '/4" eferre �''�
18. S stem meets breakout re uirements PV liner: ��;�-�Vall:
19. S ecified tee sizes are ro er, gas baffle on outlet tee �`
20.Sewa e is under 10,000 d for arcel ��
21.No garba e dis osal •}-�'
- 22. S stem ade uatel sized for its intended use �Y-�
23.Minimum 6"stone or com acted below tank and dbox ��
24.Manhole covers within 6"of grade, um chamber cover to grade � �
' 25.Inspection port on lastic chambers/leach field �-�
26.Electrical ermit for um cha.mber/Se arate meter for du lexes
27.Pum system-2" line,weep hole,check valve,tee in dbo� um size
28.S tic tank/purti �chainber to be facto wat roofed ` �'(,�� ` �
29.Vent rovided if leaching below 3 feet,under driveway/ arkin
30.Buoyancy calculations for tank/pum chamber ��
31.En ' eer to ins ect and cert soils: wall: commercial:
32.Engineer/Re ' tered Sanitarian and Land Surv or stam s/si ture
33.H-201oadin is sub'ect to vehicutar traffic, groundwater
34.Title V A lication and ermit fee, installer si ture �
35.Foundation footin min. 2 feet above adjusted ground water for new house
36.Deed Restriction r uired max. #bedrooms: max. flow: d
37.Check area lots for oundwater/Label oundwater in Assessor's Ma
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Plan reviewed by: �osio3