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� • TOWN OF YARMOUTH ����� -
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SEWAGE PLAN REVIEW CHECKLIST ����r � ���%��
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' Location: A.M.� Lot � Z.- Zone of Contribution: In�t Acreage� �`
3 � Commercial: ResidentiaL• a-----�'��
Street: J
Village: � Floor Plan: � #Bedrooms: �
Owner: ��� ����"/y� Installer: �
Address: � Phone:
Phone:
Builder: Engineer:
S � ,�� .
Address: Phone: �7 --� � --�
Phone:
N/A YES NO
1.Required#of co ies received
2.Date of soils exam and percolation test not older than 2 years v
3.4-5 ft of natural occunin ervious material, above water table s..
4.Foundation 2 ft above hi oint of road H.P.: Fnd: Var.:
5. Water line 10 ft from s tic components Var.: �,f
6.Benchmark indicated and shown-NGVD if near wetlands
7. Se tic tank minimum 10 ft from founda.tion, deck Var.:
8.Leaching minimum 20 ft full, 15 ft crawl, 10 ft slab Var.:
9.Lea.ching minimum 100 ft from wetlands Vax.: ��. .
10.Leaching minimum 150 ft from drinkin welU25 ft irri ation well Var.:
11. Tank/leaching minnnum 10 ft from ro erty line Var.:
12. S stem meets all other setback r uirements Var.: c_.,._..-
13.Uses adjustment for maximum high groundwater Var.:
14. Leachin set 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 suita.ble -�o
17. S stem meets slo e r uirements-min. 1/8", 1/4" eferred
18. S stem meets breakout r uirements PVC liner: Wall:
19. Spec�ed tee sizes are roper, as baffle on outlet tee
20. Sewa e is under 10,000 gpd 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 ta.nk and dbox
' 24.Manhole covers within 6"of ade,pum chamber cover to grade �,/
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. Septic tank/ um chamber to be factory wat roofed ��
29.Vent rovided if leaching below 3 feet,under driveway/ arkin �-
30.Buoyanc calculations for tank/ um chamber
31.En ' eer to ins ect and c ' soils: wall: commercial:
32.Engineer/Registered Sanitarian and Land Surve or stam s/signature �
33.H-201oadin is subject to vehicular traffic, groundwater
34.Title V A lication and permit fee, installer signature
35.Foundation footing min. 2 feet above adjusted ground water for new house
36.Deed Restriction re uired max. #bedrooms: ma�c. flow: d -
37.Check area lots for groundwater/Label oundwater in Assessor's Ma -r
Plan reviewed by: / (/� 6/03/03 j
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