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• TOWN OF YARMOUTH '
SEWAGE PLAN REVIEW CHECKLIST
j Location: A.M. �� Lot� Zone of Contribution: In Out� Acreage
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Commercial: Residential:�
Strcet:
Village: Floor Plan: t� # Bedrooms: �
Owner: �//>��� Install�: ����
Address: Phone:
Phone:
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Builder: Engine�:
Address: Phone: �
Phone:
N/A YES NO
1.R uired#of co ies received
2. Date of soils eacam and colation test not older than 2 ears
3.4-5 ft of natural occurrin ervious material,above water table
4.Foundation 2 ft above hi int of road H.P.: Fnd: Var.:
5. Water line 10 ft from s tic com onents Var.: +►----!
6.Benchmark indicated and shown-NGVD if near wetlands
7. S tic tank minimum IO ft from foundation, dack Vaz.:
8. Leachin minimum 20 ft full, 15 ft ctawl, 10 ft slab Var.: ✓/
9.Leachin minimum 100 ft from wetlands Var.: ``�
10. Le�achin minimum 150 ft from drinkin welU25 ft irri tion well Var.: ��
11.Tank/leachin minimum 10 ft from line Var.: ✓
12. S stem meets all other setback uirements Var.:
13.Uses ad'ustment for maximum hi oundwater Var.: ✓
14.Leachin set 45 4�above ad'.water or bottom of test hole Var.: �-�
15. S stem not in to or subsoil A,B horizons or 5' removal �._-�
16.Pr s�contours are suitable
17. S stem meets slo e r uirements-min. 1/8", `/a" efened �.-�'
18. S stem meets breakout uirements PVC liner: Wall: ��
19. S ified tee sizes are ro , baffle on outlet tee ��
20. Sewa e is under 10,000 for arcel
21.No rba e dis osal
22. S stem ad uate! siz�for its intended use �--�'
23.Minimum 6"stone or com acted below tank and dbox
24.Manhole covers within 6"of ade, um chamber cover to e
25.Ins ion on lastic chambers/leach fieid �-�"
26.Electrical ermit for um chambedS arate meter for du lexes �
27.Pum stem-2" line,w hole,check valve,tee in dbox, size -�^
� 28. S ic tank/ u chamtr�to be fact wa roofed
29.Vetrt rovided if leachin below 3 feet, under drivewa /
30. Buo anc calculations for tank/ um chamber f
3 l. En 'neer to ins ect and certi soils: wall: commercial: f
32.En 'ncer/Re 'stered Sanitarian aad Land Surv or stam s/si ature
� 33. H-201oadin is sub'ect to vehicular traffic, oundwate,r
� 34.Title V A lication and it fee, installer si ture
� 35.Foundation footin min.2 feet above ad'usted ound water for new house
36.I7eed Restriction r uire� max. #becfrooms: max. flow:
' 37.Check azea lots for oundwatedLabel oundwater in Assessor's Ma
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� Plan reviewed by: