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� , TOWN OF YARMOUTH � ��L��/"�
SEWAGE PLAN REV�W CHECKLIST ���I �'
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Location: A.M.� Lot ��� Zone af Contribution: In Out Acreage1'i�J�s �
� Commercial: Residential: �--------�-
� Street: �� !� ��
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j Village: - • Floor Plan: (_ #Bedrooms:
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Owner: � C G(� Installer:
� Address: Phone: � -G �
� Phone: �
Builder: Engineer: S
Address: Phone: � �'-- " � '-
Phone: _ �}�� �' �,�,,,� ��.
� ��� / 7 ��� �-
N/A YES
1.Re uired#of co ies received
2. Date of soils e�ca.m and ercolation test not older than 2 years
3. 4-5 ft of naturall occurrin ervious material, above water table �.i
4.Foundation 2 ft above high oint of road H.P.: Fnd: Var.:
5. Water line 10 ft from septic com onents Var.:
6.Benchmark indica.ted 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.: r-----
10.Lea.chin minimum 150 ft from drinkin welU25 ft irri tion well Var.:
11.Tank/leaching minimum 10 ft from roperty line Var.: ;.._,�
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 re uirements-min. 1/8", '/a" eferred
18. System meets breakout r uirements PVC liner: Wall: `
19. Spec�ed tee sizes are ro er, as baffle on outlet tee ��
20. Sewage is under 10,000 d for arcel �---
� 21.No ba e dis osal
22. S stem ad uatel sized for its intended use
'i � 23.Mmimum 6"stone or com acted below tank and dbox �,.i
24.Manhole covers within 6"of de, um chamber cover to grade
25.Ins ection ort on lastic chambers/leach field �_....
26.Electrical ermit for um chaxnber/S arate meter for du lexes
27.Pum s stem-2"line,wee hole,check valve,tee in dbox, um size -
28. S tic tank/ um chamber to be factory wa roofed ��-
29.Vent rovided if leachin below 3 feet,under driveway/ arking
30. Buo ancy calculations far tank/pum chamber
31.En ' eer to ins ect and cert' soils: wall: commercial:
32.En ' eer/Re 'stered Sanitarian and Land Surveyor stam s/si ature
` 33.H-20 loadin is subject to vehicular trai�c, groundwater f_.�-
34.Title V A lica.tion and ermit fee, installer si ature `____--
35.Foundation footin min. 2 feet above adjusted ground water for new house ✓
i 36.Deed Restriction r uired max. #bedrooms: max. flow: d - -
j37. Check area lots for groundwater/Label groundwater in Assessor's Map
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Plan reviewed by: ` il �03�03
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