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TOWN OF YARMOUTH ��� �!�
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• SEWAGE PLAN RE�IEW CHECKLIST ��� � o
Location: A.M. o l� Lot � Zone of Contribution: In� Out Acreage � � .
y Commercial: Residential:�_
Street: �� / ,� `�
Village: Floor Plan: #Bedrooms:
Owner: �� �f// Installer: / // �,� Gr�v ��
Address: Phone: - S
Phone:
Builder: Engineer: �
Address: Phone: 2- Z�
Phone: ✓2 ,,n��
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N/A YES NO
1.R uired#of co ies received
2.Date of soils exam and colation test not older than 2 years L.�
3.4-5 ft of natural occurrin ious material,above water table ��
4.Foundation 2 ft above hi int 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 l��' i
7. S tic tank minimum 10 ft from foundation, deck Var.: �l '
8.Leaching minimum 20 ft full, 15 ft erawl, 10 ft slab Var.: ��
9.Leachin minimum 100 ft from wetlands Var.: '
10.Leachin minimum 150 ft from drinkin we1U25 ft irri tion well Var.: ��
11.Tank/leaching minimum 10 ft from r line Var.: y • �--"
12. S stem meets all other setback r uirements Var.:
13. Uses ad'ustment for maximum hi oundwater Var.: '
14.I.eachin set 4-5 ft above ad'.water or bottom of test hole Var.: ✓ '
15. S stem 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", 1/4" �ferred ��'
18. System meets breakout r uirements PVC liner: Wall: ��'
19. S �ed tee sizes are ro er,gas baffle an outlet tee �� ;
20. Sewa e is under 10,000 for arcel �.�
. 21.No e dis osal
22. S stem ad uatel sized for its intended use ��
23.Minimum 6"stone or com acted below tanlc and dbox L�
24.Manhole covers within 6"of ade, um chamber cover to ade �_-_
25.Ins tion ort on lastic chambers/leach field L�
26.Electrical ermit for um chamber/S arate meter for du lexes
27.Pum system-2" line,wee hole,check valve,tee in dbo� um size �---
28. S tic tank/ um chamber to be factory wat roofed �
29.Vent rovided if leachin below 3 feet, under driveway/parkin `�
30. Buoyanc calculations for tank/ um chamber -�
31.En ' eer to ins �t and cert' soils: wall: commercial:
32.Engineex/Re 'stered Sanitarian and Land Surveyor stam s/signature �
33. H-201oading is subject to vehicular traffic, oundwater �--_
34.Title V A lication and ermit fee, installer signature -
35.Foundation footing min. 2 feet above adjusted ound water for new house
36.Deed Restriction r uired maa�. #bedrooms: ma�c. flow: d
37.Check area lots for oundwater/Label oundwater in Assessor's M
Plan reviewed by: � wo3�os