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�j� � � T WN OF YARMOUTH
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- SEWAGE PLAN REVIEW CHECKLIST /
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_ Location: A.M. ��� Lot� Zone of Contribution: In Out_ Acreage�`
/ Commercial: Residential:
s��: l � // � � �
Village: Floor rlan: � �Eedrooms:
Owner: �'�d'���/f'�� Installer: fi
Address: Phone: � "<f�3 --� D �� ,
Phone: '
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Builder: Engineer: � ' � 4
Address: Phone: � --� '
Phone:
N/A YES NO
1.Required#of copies received
2.Date of soils exam and ercolation test not older than 2 ears L_._,�
3.4-5 ft of natural occurrin ervious 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 - -
7. S tic tank minimum 10 ft from founda.tion, deck Var.: �...--
8.Leaching minimum 20 ft full, 15 ft crawl, 10 ft slab Var.:
9.I,eachin minimum 100 ft from wetlands Var.:
10.Lea.ching minimum 150 ft from drinking welU25 ft irrigation well Var.: �-----
11.Tank/leaching minimum 10 ft from r erty line Var.: �---- '
12. S stem meets all other setback r uirements Var.: i
13.Uses ad'ustment for maximum high oundwater Var.: `------� � '
14.Leaching set 4-5 ft above adj.water or bottom of test hole Var.: c._.--
15.System not in to or subsoil(A,B horizons)or 5'removal
16.Pro sed contours are suitable ✓
17.S stem meets slo e r uirements-min. 1/8", '/4" eferred �-..--'`
18. System meets breakout r irements PVC liner: Wall: �.._.�
19. Spec�ed tee sizes are ro er, as baffle on outlet tee
20. Sewa e is under 10,000 d for arcel C=�-- ,
21.No ba e 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 grade, um cha.mber cover to ade
^ 25.Ins tion ort on lastic chambers/leach field
26.Electrical ermit for um chamber/S arate meter for du lexes
27.P system-2" line,w hole,check valve,tee in dbox, um size ,
28. S tic tank/ um chamber to be factory wa roofed -�'''�
29.Vent rovided if leachin below 3 feet,under drivewa / arkin ''"�
30.Buo ancy calculations for tank/pum chamber ��
31.En ' eer to ins ect and cert' soils: wall: commercial:
32.En ' eer/Re ' tered Sanitarian and Land Surveyor stam s/si ature
33.H-201oadin is subject to vehicular traffic, oundwater
34.Title V A lication and ermit fee, installer si ture
35.Foundation footin min. 2 feet above ad'usted ound water for new house
36.Deed Restriction r ired ma.x. #bedrooms: maac. flow: d
37.Check area lots for oundwater/Label oundwater in Assessor's Ma
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Plan reviewed by: �"� �03�03