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TOWN OF YARMOUTH
SEWAGE PLAN REVIEW CHECKLIST
Location: A.M.� Lot� Zone of Contribution: In Out� Acreage �
' Commercial: Residential:-�
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Village: � Floor Plan: #Bedrooms:
Owner: G11 � �staller:
Address: /� Phone:
Phone:
Builder: Engineer: ��
Address: Phone: �
Phone: �--- ��,y���t 1�1 �/'t'Z����'��
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N/A YES NO
1.Re uired#of ies received
2. Date of soils exam and ercolation test not older than 2 years r'`J
3.4-5 ft of na.tural occurrin ervious material,above water ta.ble -�"
4.Foundaxion 2 ft above hi int of road H.P.: Fnd: Var.: , /�
5.Water line 10 ft from s tic com oneuts 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.: ✓
9.Leaching minimum 100 ft from wetlands Var.: ��
10.Leaching minimum 150 ft from drinkin welU25 ft irrigation well Var.: �
11.Tank/leachin minimum 10 ft from ro line Var.:
12. S stem meets all other setback r irements Var.:
13.Uses adjustment for maximum hi groundwater Var.:
14.Leachin set 4-5 ft above ad'.water or bottom of test hole Vaz.: �./ ✓
15.S stem not in to or subsoil(A,B horizons)or 5'removal t-.-.-� -
16.Pro osed contours are suitable '�-�''' ��
17. S stem meets slo e r irements-min. 1/8", '/4" referred �_ ...i'
18. S stem meets breakout re irements PVC liner: Wall: �
19. S ecified tee sizes are roper, as baffle on outlet tee �
, 20. Sewa e is under 10,000 d for arcel C./" �
; 21.No ba e dis osal t----"
22. S stem ade uatel sized for its intended use t.,/ ��
23.Minimum 6"stone or com acted below ta.nk and dbox --� P
24.Manhole covers within 6"of ade, um chamber cover to ade �'"
25.Ins ection ort on lastic chambers/leach field l�
26.Electrical erxnit for um chamber/S arate meter for du lexes
27.Pum stem-2"line,w hole,check valve,tee in dboa�, um size L.�'
28. S tic tank/ um chamber to be factory wat roofed ��
29.Vent rovided if leachin below 3 feet,under drivewa / arkin
i 30.Buoyancy calculations for tank/pum chamber
31.E ' eer to ins ect and cert' soils: wall: commercial:
I 32.Engineer/Registered Sanitarian and Land Surveyor stam s/si ture L----''
� 33.H-20 loa.din is subject to vehicular traffic, groundwater
34.Title V Ap lication and ermit fee,insta.11er si ture ._--%'
35.Foundation footing min.2 feet above adjusted ound water for new house
36.Deed Restriction r uired max. #bedrooms: max.flow: d �.,
37.Check azea lots for groundwater/L,abel oundwater in Assessor's Ma
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Plan reviewed by: � �; 6/03/03
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