Review Checklist ,
� �!�� TOWN OF YARMOUTH
SEWAGE PLAN REVIEW CHECKLIST
: Location: A.M. V v Lot �� Zone of Contribution: In� Acreage
Commercial: Residential: �.-�-
Street:
Village: F1oorPlan: i_� #Bedrooms:�
Owner: �7�E���G� Installer:
Address: Phone: - � �
Phone: '
Builder: Engineer: � � ����
Address: Phone: - �- i
Phone: �� '� �
N/A YES NO
1.Required#of co ies received
2.Date of soils exam and ercolation test not older than 2 years �.-� ;
3.4-5 ft of natural occunin ervious material,above water ta.ble
4.Foundation 2 ft above hi int of road H.P.: Fnd: Var.: l
, 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 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.Leachin minimum 150 ft from drinking we1U25 ft irrigation well Var.:
11.Tank/leachin minimum 10 ft from roperty line Var.:
12.S stem meets all other setback r irements Var.: '
13.Uses adjustment for maximum high groundwater Var.: �
14.Leaching set 4-5 ft above adj.wate,r or bottom of test hole Var.: �-- '
15. System not in to or subsoil(A,B horizons)or 5'removal �� 4
16.Pro osed contours are suitable �
17. S stem meets slo e r irements-min. 1/8", '/a" eferred 1�.._..�' ;
18. S stem meets breakout r irements PVC liner: Wall: �,,,,�' '
19. Specified tee sizes are ro , as ba.ffle on outlet tee �,/
20. Sewa e is under 10,000 for arcel j
21.No garbage dis osal `
22. S stem ade ua.tel sized for its intended use ;
23.Minimum 6"stone or com acted below tank and dbox
24.Manhole covers within 6"of ade, um cha.mber cover to ade �
� 25.Ins ection rt on lastic chambers/leach field �,�.�
26.Electrical ermit for um chamber/S arate meter for du lexes '
27.Pum system-2"line,wee hole,check valve,tee in dbox, ump size
28. S tic tank/ um chamber to be facto wa 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 cert' soils: wall: commercial: �,..� '
32.En ' eer/Registered Sanitarian and Land Surveyor sta.m s/si ture �,�.
33.H-201oadin is subject to vehicular traffic, oundwater ��
34.Title V A lication and ermit fee,installer signature ';
35.Foundation footin min. 2 feet above ad'usted ound water for new house '
36.Deed Restriction r uired max. #bedrooms: max. flow: d '
37.Check azea lots for oundwater/Label oundwater in Assessor's Ma �
� j
Plan reviewed by: wo3io3 ;