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; TOWN OF YARMOUTH ���� /
� SEWAGE PLAN REVIEW CHECKLIST /��x'- ��UK����'�'>
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� Location: A.M.� Lot_��� Zone of Contribution: In ✓Out_ Acreage �� � �/�
�-, � Commercial: Residential:�9
Street: �
' Village: Floor Plan: C� #Bedrooms:�
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Owner: /� Installer: ,�
Address: Phone: � "' --
Phone:
Builder: Engineer: �� l�l�l6fi
Address: Phone: -� -
Phone: ._. >, �i�j'i�/• � � 1�'tit�°(. {-t�'y�
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N/A YES NO
1.Re uired# of co ies received i,,.,.,.�
2.Date of sails 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 hi oint 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 Vax.:
9.Leachin minimum 100 ft from wetlands Var.:
10.Leaching minimum 150 ft from drinkin welU25 ft irri ation well Var.:
11.Tank/leaching minimum 10 ft from ro erry line Var.:
12. S stem meets all other setback r uirements Var.: �?�Gs�c ��...
13. Uses ad'ustment for maximum high goundwater 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 re uirements-min. 1/8", '/4" eferred
18. S stem meets brea.kout r uirements PVC liner: Wall: �-
19. S ecified tee sizes are roper, as baffle on outlet tee ��,
20. Sewa e is under 10,000 d for parcel
21.No arba e dis osal L�
- 22. S stem ade ua.tel sized for its intended use ��
23.Minimum 6"stone or com acted below tank and dbox L,,,�-
' 24.Manhole covers within 6"of ade,pum chamber cover to ade �....---'
25.Inspection ort on lastic chambers/leach field �,,,1
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/ um chamber to be factory waterproofed �
29.Vent rovided if leachin below 3 feet, under driveway/ arking �
30.Buoyancy calculations for tank/ ump chamber �""
31.En ' eer to ins ect and cert' soils: wall: commercial:
32.En ' eer/Registered Sanitarian and Land Surve or stam s/signature ��- t
33.H-201oadin is sub'ect to vehicular traffic, groundwater j
34.Title V A plication and ermit fee, installer signature �/ f
35.Foundation footing min. 2 feet above ad'usted ound water for new house �
36.Deed Restriction r uired max. #bedrooms: maa�. flow: d �
37.Check area lots for groundwater/Label groundwater in Assessor's Ma �
Plan reviewed by: � ,✓'%,�% � wos�o3
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