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`�� TOWN OF YARMOUTH
a ' SEWAGE PLAN REV�W CHECKLIST
Location: A.M. ��� Lot �� � Zone of Contribution: In Out t/Acreag�
- Commercial: Residential.
Street: � -C
Village: Floor Plan: z/'`� #Bedrooms: �
Owner: �Q`,� ��lr/�%'�� Installer: � d�
Address: Phone: �-
Phone: �- - "' �
Builder: `����"j"C� Engineer: -
Address: Phone: �
Phone:
N/A YES NO
l.Re uired#of co ies received
2. Date of soils exam and ercolation test not older than 2 years
3. 4-5 ft of naturall occurrin ervious material, above water table �..,.�
4.Foundation 2 ft above high oint of road H.P.: Fnd: Var.: �--''
5. Water line 10 ft from septic components Var.: (.�._.
6.Benchmark indicated and shown-NGVD if near wetlands �f
7. Se tic tank minimum 10 ft from foundation, deck Var.:
8.Leaching 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 irrigation well Var.: --'"�""
11. Tank/leaching minimum 10 ft from properly 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 r uirements-min. 1/8", '/4" referted .�,_r
18. System meets breakout re uirements PVC liner: Wa1L• �.___--
19. Spec�ed tee sizes are pro er, gas baffle on outlet tee �.,_..
20. Sewage is under 10,000 d for arcel �..._,..----
21.No garbage dis osal
^ 22.S stem ade uatel sized for its intended use
23.Minimum 6"stone or com acted below tank and dbox �_/
, 24.Manhole covers within 6"of grade,puxnp chamber cover to grade ----�
25. Inspection ort on lastic chambers/leach field ✓
26. Electrical ermit for um chamber/Se arate meter for du lexes
27.Pump system-2" line,weep hole,check valve,tee in dbo� um size
28. Se tic tank/pump chamber to be factory waterproofed -
29.Vent provided if leaching below 3 feet, under driveway/parking �-
30.Buoyancy calculations for tank/pump chamber _.--�
31.En ' eer to ins ect and cert' soils: wall: commerciaL• ��
32.Engineer/Registered Sanitarian and Land Surveyor stamps/signature ----�
33.H-201oadin is subject to vehicular traffic, oundwater
34.Title V A lication and permit fee, installer signature ,,V!
35.Foundation footing min. 2 feet above ad'usted ground water for new house �
36.Deed Restriction r uired max. #bedrooms: max. flow: d -�'
37.Check area lots for groundwater/Label groundwater in Assessor's Map `
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Plan reviewed by: �L!�-�% �oaio3