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TOWN OF YARMOUTH ���,��,5. �j�l�
' SEWAGE PLAN REVIEW CHECKLIST i�''�"�� ��'�
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Location: A.M.� Lot_�_ Zone of Contribution: In ��Acreage ��� d-'j ��?�
� � Commercial: Residential: ��
Street: (�i`� � �7 . / -'��`�x - ;� ��'✓2JY�'l
Village: ° Floor Plan: ✓ #Bedrooms:-�!--
Owner: L��17�����r Insta ller:
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Address: Phone: '" � �
Phone: , w�� l �l"G '� i' ,�(�r'' ���'��
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Builder: Engineer: �
Address: Phone: F- '" ` ,p
Phone: � . �'�J� �t�°l dv� � �w� ����/
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N/A YES NO
1.Required#of copies received
2.Date of soils exam and percolation test not older than 2 ears
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 septic components 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.Leaching minimum 150 ft from drinking welU25 ft irrigation well Var.:
11.Tank/leaching minimum 10 ft from roperty line Var.:
12. S stem meets all other setback re uirements Var.: `,.,._.--
13.Uses adjustment for maximum hi groundwater Var.: �...,.....-
14.Leaching set 4-5 ft above ad'.water or bottom of test hole Var.: P
15.System not in top or subsoil(A,B horizons)or 5'removal (��'
16.Pro osed contours are suitable �....i`
17. S stem meets slo e re uirements-min. 1/8", '/4" referred �/"'
18. System meets breakout r uirements PVC liner: Wall:
19. S ecified tee sizes are pro er, gas baffle on outlet tee �y-�'
20. Sewage is under 10,000 d for arcel r---''
21.No garbage dis osal
22. S stem ade uatel sized for its intended use z---�
23.Minimum 6"stone or compacted below tank and dbox ��'
� 24.Manhole covers within 6"of ade, ump chamber cover to ade �..�--
25.Inspection ort on plastic chambers/leach field �....--�`
26.Electrica.l ermit for uxn chamber/S arate meter for du lexes �- `
27.Pump system-2" line,wee hole,check valve,tee in dbo� ump size
28. S tic tank/ ump chamber to be factory wa roofed
29.Vent provided if leaching below 3 feet,under driveway/parking
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 loading is subje�t to vehicular tr�c, groundwater
34.Title V Application and permit fee,installer si ture �
35.Foundation footing min. 2 feet above adjusted ground water for new house
36.Deed Resiriction re uired max. #bedrooms: max. flow: d
37.Check area lots for oundwater/Label groundwater in Assessor's Ma
Plan reviewed by: L'� 6/03/03