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TOWN OF YARMOUTH
T SEWAGE PLAN REVIEW CHECKLIST
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: Location: A.M.� Lot� Zone of Contribution: In Out�Acreage
f� /' Commercial: Residential:
Street: y�r!i'"Y L� �
' Village: Floor Plan: #Bedrooms: �
I s�
Owner: ��!/(�G�� Installer: �
� Address: Phone: ��
Phone:
Builder: Engineer: �>a�Gl
Address: Phone: �'� --
� Phone: lC.
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N A S NO
l.Required#of co ies received
2.Date of soils exam and ercolation test not older than 2 years �-�-
3.4-5 ft of naturall occunin ervious material, above water table
4.Foundation 2 ft above high 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. Se 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 irri ation well Var.:
11.Tank/leachin minimum 10 ft from roperty line Var.: �'` "
12. S stem meets all other setback r uirements Var.:
13.Uses adjustment for maximum high oundwater 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", '/a" referred + -
18. System meets breakout re uirements PVC liner: Wall: �
19. S ecified tee sizes are proper, gas baffle on outlet tee
20. Sewa e is under 10,000 d for parcel
• 21:No arbage dis osal
22. S stem ade uatel sized for its intended use �____�
23.Minimum 6"stone or com acted below tank and dbox
24.Manhole covers within 6"of ade, um chamber cover to grade
25.Inspection port on lastic chambers/leach field
26.Electrical ermit for um chaxnber/S arate meter for du lexes
27.Pum system-2" line,weep hole,check valve,tee in dbox, ump size .,�,..�
28.S tic tank/ ump chamber to be factory wat roofed
29.Vent rovided if leaching below 3 feet,under driveway/ arking -
30.Buoyancy calculations for tank/ um chamber
31.En ' eer to ins ect and c ' soils: wall: commercial:
32.Engineer/Registered Sanitarian and Land Surveyor stam s/si ature �-- '
33.H-201oadin is subject to vehicular traffic, oundwater
34.Title V A plication and ermit fee, installer si ture `,Y�
35.Foundation footing min. 2 feet above ad'usted ound water for new house �-'''�� ,
36.Deed Restriction r uired max. #bedrooms: max. flow: d �--�" �
37.Check area lots for groundwater/Label groundwater in Assessor's Ma !
Plan reviewed by: 1 ( tj wo3io3