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J TOWN OF YARMOUTH
I SEWAGE PLAN REVIEW CHECKLIST
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Location: A.M.� Lot �� Zone of Contribution: In Out �A reage
Commercial: Residential: ��j
' Street: /
� Village: � Floor Plan: ✓ #Bedrooms:_��
Owner: �f/�� Installer: �
Address: Phone: ��/�
G�Rsf�EL' -�' ��I��'c'�.-
Phone: .��`�%�-' • ����/• ,7 ' '
' Builder: Engineer: ��
Address: Phone: '`� �'
Phone: � r lL��`�'� ,
, � � � C��
N/A YES NO
1.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 u"
4.Foundation 2 ft above high point 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 ft from wetlands Var.:
10. Leaching minimum 150 ft from drinking we1U25 ft irrigation well Var.:
11. Tank/leachin minimum 10 ft from roperty line Var.: �'
12. S stem meets all other setback r uirements Var.:
13.Uses adjustment for maximum hi oundwater Var.: E...�
14.Leaching set 4-5 ft above ad'.water or bottom of test hole Var.: 'j
15. System not in to or subsoil(A,B horizons)or 5'removal -..../
16.Proposed contours are suitable �---�
17. S stem meets slo e r uirements-min. 1/8", '/4" referred
18. System meets breakout re uirements PVC liner: Wall: �---�
19. Specified tee sizes are ro er, gas baffle on outlet tee `.��'
20. Sewa e 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 compacted below tanlc and dbox .
24.Manhole covers within 6"of ade, um chamber cover to ade
25.Ins ection ort on plastic 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 dbo� ump size
28. S tic tank/pum chamber to be factory waterproofed
29.Vent rovided if leaching below 3 feet, under driveway/ arkin
30. Buoyancy calculations for tank/pum chamber
31.En ' eer to ins ect and cert' soils: wall: commercial:
32.En ' eer/Registered Sanitarian and Land Surveyor stam s/si ature ���
33.H-201oadin is subject to vehicular traffic, oundwater '
34.Title V A lication and ermit fee, installer si ature
35.Foundation footin min. 2 feet above adjusted ound 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: [+�, wo3�o3