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- TOWN OF YARMOUTH
SEWAGE PLAN REVIEW CHECKLIST
' Location: A.M.� Lot_�'�. Zone af Contribution: In Out �'A eagef�
,/ � / Commercial: Residential:
Street: �'� `% d F�`
Village: Floor Plan: C� #Bedrooms: �
Owner: �C�L GfQ C�'".2�C��,� Installer: /I�/'j��Gl��
Address: Phone:
Phone:
Builder: Engineer:
Address: Phone: - � 6
Phone: � �'�e�>��„-`, % ,�� �;�� .t���f' �7 r
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N/A YES / NO',: �'lJ.,ry�:,;(
l.R uired#of copies received �
2. Date of soils exam and ercolation test not older than 2 ears �/
3. 4-5 ft of naturall occurrin ervious material,above water ta.ble �^
4.Foundation 2 ft above high point of road H.P.: Fnd: Var.: �-
5. Water line 10 ft from s tic com onents Var.: v'
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.: L-''
9.Leachin minimum 100 ft from wetlands Var.: i �
10.Leaching minimum 150 ft from drinking welU25 ft irrigation well Var.: ��
11.Tank/leachin minimum 10 ft from ro e line Var.: ��',�` ' �.-
12. S stem meets all other setback r uirements Var.: ��'
13.Uses adjustment for maximum hi oundwater Var.: L'.-�- � c� " i
14.L,eachin set 4-5 ft above adj.water or bottom s Var.: �
15. System not in to or subsoil(A,B horizons) 5' remo ' '�' �
16.Pro osed contours are suitable
17. S stem meets sla e re uirements-min. 1/8", '/a" referred t��-"
18. S stem meets breakout r uirements PVC liner: �' ,;� Wall: v�
19. S ecified tee sizes are ro er, as baffle on outlet tee
20. Sewage is under 10,000 d for arcel -
- 21.No arbage 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 grade, ump chamber cover to ade
25.Ins ection ort on plastic chambers/leach field
26.Electrical erxnit for um chamber/S arate meter for du lexes �---�-
27.Pump system-2" line,wee hole,check valve,tee in dbox, um size
28. Septic tank/ ump chamber to be factory wat roofed
29.Vent rovided if leaching below 3 feet,under drivewa / arkin
30.Buoyancy calculations for tank/ ump chamber L..�-
31.En ' eer to ins ect and cert' soils: --=wall: �-�commerciaL•
32.En ' eer/Registered Sanitarian and Land Surveyor s s/si ature
33.H-201oadin is subject to vehicular traffic, groundwater `.�
34.Title V A lication and permit fee, installer si ature �
35.Foundation footing min.2 feet above adjusted ground water for new house .i-
36.Deed Restriction r uired max. #bedrooms: max. flow: d
37.Check area lots for groundwater/Label groundwater in Assessor's Ma `��
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Plan reviewed by: �.�-� NO3/03