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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 ��
T- - -
' � Commercial: ResidentiaL•
Street: �
Village: Floor Plan: �� #Bedrooms:
Owner: �oj1��,� � Installer: ��-
Address: Phone: G -7 - D
Phone:
Builder: Engine,er:
Address: Phone: - -
Phone: � � � � �
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N/ YES NO
1.Re uired#of co ies received
2.Date of soils exaxn and reolation test not older than 2 years �---
3.4-5 ft of naturall occurrin ervious material,above water ta.ble '�---�
4.Foundation 2 ft above hi oint of road H.P.: Fnd: Var.:
5.Water line 10 ft from septic com onents Var.:
6.Benchmark indicated and shown-NGVD if near wetlands
7. S tic tank minimum 10 ft from foundation, deck Var.:
8.Lea.ching minimum 20 ft full, 15 ft crawl, 10 ft slab Var.: c_,��
9.Leachin minimum 100 ft from wetlands Var.:
10.Leachin minimum 150 ft from drinkin welU25 ft irri ation well Var.:
11.Tank/leaching minixnum 10 ft from ro erty line Var.:
12. S stem meets all other setback r uirements Var.: -�-��
13.Uses adjustment for maximum high groundwater 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", '/4" eferred
18. System meets breakout re uirements PVC liner: Wall:
19. S ecified tee sizes are ro er, gas baffle on outlet tee �°'`
20. Sewa e is under 10,000 d for parcel
, 21.No garba e dis osal
22.S stem ad ua.tel sized for its intended use
23.Minimum 6"stone or compacted below tank and dbox �1
• 24.Manhole covers within 6"of ade, um chamber cover to ade c_�
25.Ins ection ort on lastic chambers/leach field ��
26.Electrical ermit for um chamber/S arate meter for du lexes �---�--
27.Pum system-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 leaching below 3 feet, under driveway/ arking
30.Buo ancy calculations for tank/ um cha.mber
31.En ' eer to ins ect and cert' soils: wall: commercial:
32.En ' eer/Re ' tered Sanitarian and Land Surveyor stam s/signature
33.H-201oadin is sub'ect to vehicular traffic, groundwater
34.Title V A lication and ermit fee, installer 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 lots for oundwater/Label groundwater in Assessor's Ma
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Plan reviewed by: C�U 6/03/03