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TOWN OF YARMOUTH �`�°jyL( .�
��'� �' SEWAGE PLAN REVIEW CAECKLIST ��� , � �
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Location: A.M. �o � Lot � �� Zone of Contribution: In�Out Acreage��`} �
;� Commercial: Residential:�
S�eet: � /
Village: Cf�/ Floor Plan: c./ #Bedrooms: �
- Owner: Insta ller: ��G�-c%G��
j Address: Phone:
� Phone:
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i Builder: �
Engineer:
1. Address: Phone: -
Phone: `
N/A YES NO
l.Re uired#of co ies received `
2.Date of soils e�m and ercolation test not older than 2 ears
i 3. 4-5 ft of natura.11 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 s tia com onents Var.:
6. Benchtnark indicated and shown-NGVD if near wetlansis
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. Leaching minimum 100 ft from wetlands Var.: ✓
10.Leachin minimum 150 ft from drinkin welU25 ft irri ation well Var.: ✓
11. Tank/leachin minimum 10$from ro line Var.: �/
12. S stem meets all other setback r uirements Var.: ��
13. Uses ad'ustment for ma�mum hi groundwater Var.:
14.Leachin s�t 4-5 ft above ad'.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", '/a" referrEd
18. S stem meets breakout r uirements PVC liner: Wall:
, 19. S ec�ed tee sizes are ro er,gas baf�le an outlet tee `/
20. Sewa e is under 10,000 d for arcel ��
21.No garba e dis osal L/
t 22. S stem ade uatel sized for its intended use
23.Minimum 6"stone or com acted below tank and dbox
24.Manhole covers within 6"of ade, um chamber cover to grade
25.Ins ection ort on lastic chambers/leach field
26. Electrical ermit for um chamberlS arate meter for du lexes ��
27.Pu s stem-2" line,wee hole,check valve,tee in dbo�pum size
28. Septic tank/ um chamber to be facto wat roofed �/
29.Vent rovided if leachin below 3 feet, under driveway/parkin ,/
30. Buo ancy calculations for tank/ ump chamber
31.En ' eer to ins ect and cert' soils: wall: commercial:
32.En 'neer/Re 'stered Sanitarian and Land Surveyor stam s/si ture
33.H-201oadin is sub'ect to vehicular traffic, groundwater L,/ �
34. Title V A lication and ermit fee, installer signature
35.Foundation footing min. 2 feet above adjusted ound water for new house
36. Deed Restriction r uired max. #bedrooms: max. flow: d
37. Check area lots for groundwater/Label oundwater in Assessor's Map
Plan reviewed by: �os�o3