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TOWN OF YARMOUTH ��, �
� � SEWAGE PLAN REVIEW CHECKLIST ��t�'/��X�. `"� �����'���vt��
, ` Location: A.M.� Lot� Zone of Contribution: In�Otif�_ Acreage �� ���
` � � Commercial: Residential: �
Street: � /�%/
Village: Floor Plan: , � #Bedrooms: �
Owner: ?� ��j"c.1 Insta.11er: � � �
Address: Phone: � "' (�
Phone:
Builder: Engineer:
Address: Phone: 7 ^
Phone: •� X- � ���,,`'`
�.. �
N/A YES NO
l.Required#of copies received �/' ;
2.Date of soils exam and percolation test not older than 2 years ✓� '
3.4-5 ft of naturall occurrin ervious material,above water table ,
4.Founda.tion 2 ft above high 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. Se tic tank minimum 10 ft from foundation, d�k Var.: i`..�'
8.Leaching minimum 20 ft full, 15 ft crawl, 10 ft slab Var.:
9.Leachin minimum 100 ft from wetlands Var.: -w�-
10.Leaching minimum 150 ft from drinking we1U25 ft irrigation well Var.: �,.�--"�"
11.Tank/leachin minnnum 10 ft from property line Var.: �
12. S stem meets all other setback r uirements Var.: '
13.Uses adjustment for ma�mum high groundwater Var.:
14.Leaching 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" referred �,.,_.--� '
18. S stem meets brealcout r uirements PVC liner: Wall: �....----,
19. S ec�ed tee sizes are roper, as ba.ffle on outlet tee `„_...--
20. Sewa e is under 10,000 d for arcel �..r.-�
21.No garba e dis osal '
" 22. S stem ad uatel sized for its intended use �-
23.Minimum 6"stone or compacted below tank and dbox
.
24.Manhole covers within 6"of ade,pum chamber cover to grade �
25.Ins ection ort on plastic chambers/leach field �,Y,......_- '
26.Electrical ermit for um chamber/Se arate meter for du lexes --W`�" ;
27.Pum stem-2" line,wee hole,check valve,tee in dbo� um size �'�"
28. S tic tank/pump chamber to be factory waterproofed �,,..--�-�� �
29.Vent provided 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.Engineer/Registered Sanitarian and Land Surveyor stam s/signature �
33.H-20 loadin is subject to vehicular traffic, groundwater
34.Title V Ap lication and ermit fee, installer si ature �_� �
35.Foundation footin min. 2 feet above ad'usted ound water for new house _✓-
36.Deed Restriction re uired ma.x. #bedrooms: max. flow: d �.:=---
37.Check area lots for groundwater/Label oundwater in Assessor's Ma
Plan reviewed by:_ � eio3ios �