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X Y�� TOWN OF YARMOUTH
' ��� �`°�~ '� SE�VAGE PLA�T REVIEW CHECKLIST
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i l Location: A.M. � �� Lot� Zone of Contribution: In Out �eage
� • ,_,,,{ Commercial: Residential:
Street: �� ��Z/�CL �-"
Village: F�oor Plan: #Bedrooms:�
Owner: Installer: �
Address: Phone: �
Phone:
Builder: Engineer: c��ti��''�/ yC Y
Address: Phone: �.��'�����
Phone: L{- �'r�-� � /lf���"I �� f � G'�Yl/Y�/
N/A YES O �'��
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1.R uired#of co ies received �
2.Date of soils exam and colation test not older than 2 ears
3. 4-5 ft of natural occunin 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 10 ft from foundation, deck Var.:
8.Leachin minimum 20 ft full, 15 ft crawl, 10 ft slab Var.:
9.Leachin minimum 100$from wetlands Vaz.:
10.Leachin minimum 150 ft from drinkin welU25 ft irri tion well Var.:
11. Tank/leachin minimum 10 ft from ro line Var.:
12. S stem meets all other setback r uirements Var.:
13.Uses ad'ustment for maximum hi oundwa�er-- -_Yar.:
14.Leachin set 4-5 ft above ad'.water or bott of test ho `�
15. S stem not in to or subsoil(A,B horizons) 5'removal
16.Pro osed contours are suitable ---
17. S stem meets slo e r uirements-min. 1/8", '/4" eferred
18. S stem meets breakout r uirements PVC liner: Wall: �,i
19. S ecified tee sizes aze ro ,gas baffle on outlet tee
20. Sewa e is under 10,400 for arcel �
21.No rba e dis osal �_/
22. S stem ade uatel sized for its intended use ,�/
?3.Minitnum 6"stone or com acted below tank and dbox `��
24.Manhole covers within 6"of de, um chamber cover to ade �
25.Ins ion ort on lastic chambers/leach field ��
26. Electrical ermit for um chamber/5 arate meter for du lexes
27.Pum stem-2"line,w hole,check valve,tee in dboaz, um size
28. S tic tank/ um chamber to be facto wat roofed _.�
29.Vent rovided if leachin below 3 feet,under drivewa / arkin .�
30.Buoyanc calculations for tank/ um chamber <---�''
31.En ' eer to ins ect and cert' soils: wall: commerciaL•
32.En 'neer/Re ' tered Sanitarian and Land Surveyor staxn s/si ature -
33. H-201oadin is sub'ect to vehicular traffic, oundwater
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: ma�c. flow: d
37. Check area lots for oundwater/Label oundwater in Assessor's Ma
Plan reviewed by: . '� �o3ros •