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TOWN OF YARMOUTH
SEWAGE PLAN REVIEW CHECKLIST
Location: A.M.� Lot ��� Zone of Contribution: In Out �ea.ge
. � L�� � Commercial: Residential: �----�
Street:
Village: �`v- Floor Plan: #Bedrooms: � '
Owner:_y��uf���CG�,�v-,r���° Installer: �
Address: Phone: � -" Z
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Phone: ���°�'�L��A 'GG1��
Builder: Engineer: ��l -�'�%���
Address: Phone: � �,�_ �"'
Phone: -- / V�� ��'�G
.�1,�,/�'�y ��`/
N/A YES NO
1.Required#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
4.Foundation 2 ft above hi 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.: Cx./
9.Leaching minimum 100 ft from wetlands Var.: `----
10.Leaching minimum 150 ft from drinking welU25 ft irri tion well Var.:
11.Tank/leachin minimum 10 ft from rop line Var.:
12. S stem meets all other setback r uirements Var.:
13.Uses adjustment for maximum hi groundwater Var.:
14.Leachin set 4-5 ft above adj.water ar bottom �st�$`o�a Var.:
15. System not in to or subsoil(A,B horizons) 5'remov ' r
16.Pro osed contours are suitable �--�'''
17. S stem meets slo e r uirements-min. 1/8", '/4" referred ...._..�•�••''
18. System meets breakout re uirements PVC liner: Wa1L• r..-
19. S ecified tee sizes are pro er, gas ba.ffle on outlet tee
20. Sewage is under 10,000 gpd for arcel �.._.--�
. 21.No garba e dis osal
22. S stem ad uatel sized for its intended use
23.Minimum 6"stone or com acted below tank and dbox
' 24.Manhole covers within 6"of ade,pum chamber cover to grade �...,..-✓
i 25.Inspection ort on plastic chambers/leach field
� 26.Electrical ermit for um chamber/Se arate meter for du lexes
27.Pump s stem-2" line,wee hole,check valve,tee in dbox, ump size
28. Septic tank/pum chamber to be factory wat roofed
29.Vent rovided if leachin below 3 feet,under driveway/parking "
30. Buoyancy calculations for tank/pump chamber
31.En � eer to ins ect and cert' soils: wall: commercial:
� 32.Engineer/Registered Sanitarian and Land Surve or stam s/si ature =�---�
1
; 33.H-20 loading is subject to vehicular trai�ic, groundwater
� 34.Title V Application and ermit fee; installer signature �...---'
35.Foundation footing min. 2 feet above adjusted ground water for new house
36.Deed Restriction re uired ma.x. #bedrooms: m�. flow: d
37. Check area lots for groundwater/Label groundwater in Assessor's Map �
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i Plan reviewed by: �o3io3
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