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_ � � TOV�tN OF YARMOUTH
SEWAGE PLAN REVIEW CHECKLIST
•Location: A.M.�_ Lot� Zone of Contribution: In Out Acreage
i Commercial: Residential: �/
Street: /
Village: Floor Plan: � #Bedrooms:��
Owner: �j(�C1,2�/ ll��� � Insta ller: ��irQ� f
� Address: Phone: -�./
Phone:
Builder: Engineer: ��' `
� Address: Fhone: - ,�"=
Phone:
� N/A YES NO
i l.R uired#of copies received
� 2.Date of soils e�m and ercolation test not older than 2 years
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3.4-5 ft of naxurall occurrin ervious material, above water table L,r
4.Founda.tion 2 ft above hi oint of road H.P.: Fnd: Var.:
� 5. Water line 10 ft from s tic com onents Vaz.:
6.Benchmark indicated a.nd shown-NGVD if near wetlands ��
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.Leaching minimum 150 ft from drinking welU25 ft irri tion well Var.:
11. Tank/leachin minimum 10 ft from r erty line Vaz.: C�
12. S stem meets all other setback r uirements Var.:
13. Uses ad'ustment for maximum high 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 osed contours are suitable
� 17. S stem meets slo e r uirements-min. 1/8", '/a" referred ,�_.
� 18. S stem meets brea.kout r irements PVC liner: Wall:
19. S ified tee sizes aze ro er, ba.ffle on outlet tee v..-
� 20. Sewa e is under 10,000 d for arcel ��.�
: ' 21.No ba. e 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 e, ump chamber cover to grade
25. Inspection ort on lastic chambers/leach field
26.Electrical 't for um chamber/S arate meter for du lexes
27.P system-2"line,wee hole,check valve,tee in dbox, ump size
28. S tic ta.nk/ um chamber to be facto wat roofed �
29.Vent rovided if leachin below 3 feet,under driveway/ arkin
30. Buo anc calculations for tank/pum chamber �
31.En ' eer to ins ect and cert' soils: wall: commercial: .
32.En ' eer/Re ' tered Sanitarian and Land Surve or stam s/signature ,
33.H-201oadin is sub'ect to vehiculax tra.ffic, oundwater
34. Title V A lication and ermit fee, insta.11er si ture ��-
35.Foundation footin min. 2 feet above ad'usted ound water for new house
36.Deed Restriction r uired max. #bedrooms: max. flow: d
37.Check area lats for gronndwater/Label oundwater in Assessor's Ma
Plan reviewed by: �� ' _,.� �os�o3
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