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� TOWN OF YARMOUTH
' SEWAGE PLAN REVIEW CHECKLIST
' � � �
Location: A.M. � Lot /�j 3 Zone of Contribution: In Out `� Acreage
� Commercial: Residential: �
� Street: �
i Village: �G Floor Plan: #Bedrooms:�_
Owner: ��°d �2%(��'-�'� Installer: �����
Address: r Phone: -' Z
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Phone: �-��� %� �C���� �� �� �. .
I Builder: ' Engineer: � ���
Address: Phone: � � �
Phone: „_.,f��'�%�/l� f' ��'��� ��'!�'�1�`�
� - �. - � �� �n ��r:�� ,�s
I N/A YES NO
' 1.R uired#of co ies received <-�'
2.Date of soils�am and ercolation test not older than 2 years C.�-
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 com onents Var.:
6.Benchmark indicated and shown-NGVD if near wetlands
7. S 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.Leachin minimum 150 ft from drinking welU25 ft irri ation well Var.:
11.Tank/leaching minimum 10 ft from pro line Var.: a,_.-��
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 ad'.water or bottom of t Var.: �--�-�'
15.System not in to or subsoil(A,B horizons) 're
16.Pro osed contours are suita.ble �,�
17. S stem meets slo e r uirements-min. 1/8", '/4" eferr - --�--- ��''
18. System meets breakout re uirements VC liner: all: �
19. Spec�ed tee sizes are roper, gas baffle on outlet tee
20. Sewage is under 10,000 d for arcel
21.No garba e dis osal L�'
' 22. S stem ad uatel sized for its intended use cr�
23.Minimum 6"stone or com acted below tanlc and dbox ���'
, 24.Manhole covers within 6"of grade, um chamber cover to grade
25.Ins tion ort on la.stic chambers/leach field ��
26.Electrical ermit for um chamber/S arate meter for du lexes
27.Pum stem-2" line,wee hole,check valve,tee in dboar, ump size
28. S tic tank/ um chamber to be factory waterproofed --
29.Vent rovided if leachin below 3 feet,under driveway/ arkin --'`�
30.Buo ancy calculations for tank/ ump chamber
31.En ' eex to ins ect and cert' soils: wall: commerci :-
32.En ' eer/Registered Sanitarian and Land Surve or stam s/si ature
33.H-201oadin is subject to vehicular traffic, groundwater
34.Title V A lication and ermit fee, installer signature
35.Foundation footing min. 2 feet above adjusted ground water for new house
36.Deed Restriction r uired max. #bedrooms: max. flow: d
37.Check area lots for oundwater/Label groundwater in Assessor's Ma
Plan reviewed by: � �03�03