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�� �/�� TOWN OF YARMOUTH ��� '��
i 4 SEWAGE PLAN REVIEW CHECKLIST ���'. � /���'�
Location: A.M. r6 Lot�_ Zone of Contribution: In � Acreage /���/� ��"�
' � Commercial: Residential: �--�
Street:
Village: !� Floor Plan: c�J #Bedrooms:�"�
Owner:�G �r.��Z�('��_ Insta.11er: �
Address: Phone:
Phone:
Builder: Engineer: ��
Address: Phone: �-
� Phone: - ���� ��Ci z`T�,e�,,�'�,�
N/A YES NO
1.Required#of copies received �.�
2. Date of soils exam and ercolation test not older than 2 ears --�"�
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 com onents Var.: �,
6.Benchmark indicated and shown-NGVD if near wetlands ti----�'
7. Se tic tank minimum 10 ft from foundation, deck Var.: �..�
8.Leaching minimum 20 ft full, 15 ft crawl, 10 ft slab Var.: ;ii
9.Leaching minimum 100 ft from wetlands Var.: �---- .
10.Leachin minimum 150 ft from drinking welU25 ft irrigation well Var.:
11. Tank/leaching minimum 10 ft from pro erty line Var.: .�-'°
12. S stem meets all other setback r uirements Var.: �_,.��
13.Uses ad'ustment for maximum high groundwater Var.: "
14.Leachin set 4-5 ft above adj.water or bottom of test hole Var.: j____,....
15. S stem not in to or subsoil(A.,B horizons)or 5'removal
16.Pro osed contours are suitable �y=
17. S stem meets slo e r uirements-min. 1/8", '/4" eferred
18. S stem meets breakout requirements PVC liner: a1L•
19. S ec�ed tee sizes are ro er, as ba.ffle on outlet tee L..r--
20. Sewage is under 10,000 gpd for parcel
. 21.No garba e dis osal
22.S stem ad uatel sized for its intended use
23.Mmimum 6"stone or compacted below tank and dbox �,y.
i 24.Manhole covers within 6"of grade, um cha.mber cover to grade �w
25.Inspection port 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 dbo�pum size -
28. Septic tank/pump chamber to be factory wat roofed
29.Vent rovided if leaching below3 feet,under driveway/ arkin
30.Buoyancy calculations for tank/pum cha.mber -�'
31.En ' eer to ins ect and cert' soils: wall: commerciaL
32.Engineer/Registered Sanitarian and Land Surveyor stam s/signature
33.H-201oading is subject to vehicular traffic, oundwater '
34.Title V A plication and ermit fee, insta.11er si ture
35.Foundation footing min. 2 feet above ad'usted ground water for new house -�
36.Deed Restriction r uired max. #bedrooms: maac. flow: d
37. Check area lots for groundwater/Label oundwater in Assessor's M
Plan reviewed by: � �io3io3