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' TOWN OF YARMOUTH �
SEWAGE PLAN REVIEW CHECKLIST
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� � Location: A.M.� Lot �3� Zone of Contribution: In Out`� Acreage
/ Commercial: Residential:� '
Street: / O •
Village: V Floor Plan: � # Bedrooms:�
�
Owner: �i�//G�d•v1'! �t�u'1/4'l�G�l�- Installer: � S
Address: Phone: � -- �
. .� -
Q� � � �
Phone: S��� ?7�� - �/9 G��� -�''` �,/("'1Yfi'l /v �-e�' �
Builder: Engineer: �-�t ,
Address: Phone: � 7 Z3 -
Phone: .� dr����'t�_G� ���� ��'�
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N/A NO
1.R uired#of co ies received
2. Date of soils exam and colation test not older than 2 ears
3.4-5 ft of natural occurrin ervious material,above water table L�
4.Foundation 2 ft above hi int of road H.P.: Fnd: Var.:
5. Water line 10 ft from s tic com onents Var.: E/
6. Benchmark indicated and shown-NGVD if near wetlands i/
7. S tic tank minimum 10 ft from foundation, deck Var.: `1/
8. Leachin minimum 20 ft full, 15 ft crawl, 10 ft slab Var.:
9. Leachin minimum 100 ft from wetlands Var.:
10. Leachin minimum 150 ft from drinkin welU25 ft irri tion well Var.: �
11.Tank/leachin minimum 10 ft from ro line Var.: � �
12. S stem meets all other setback r uirements Var.: --
13. Uses ad'ustment for maximum hi oundwater Var.: , �
14.Leachin 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 -� S ` .
16.Pro sed contours are suitable �l
17. S stem meets slo e r uirements-min. 1!8", '/." referred ✓
18. S stem meets breakout r uirements PVC liner: i, Wall:
19. S ecified tee sizes are ro , bai�le on outlet tee �.�
� � '20. Sewa e is under 10,000 for arcel ✓�
21.No ba e dis osal +�-�
22. S stem ad 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 ade
25. Ins tion rt on lastic chambers/leach field
26. Electrical ermit for um chamber/S arate meter for du lexes
27.Pum s stem-2" line,wee hole,check valve,tee in dboar, um size
I� 28. S tic tank/ um chamber to be facto wat roofed
29. Vent rovided if leachin below 3 feet, under drivewa / arkin
30. Buo anc calculations for tank/ um chamber
31. En ineer to ins ect and certi soils: wall: commercial:
i 32.En 'neer/Re 'stered Sanitarian and Land Surve or stam s/si ature
33. H-20 loadin is sub'ect to vehicular traffic, oundwater
34.Title V A lication and ermit fee, installer si ature
35. Foundation footin min. 2 feet above ad'usted ound water for new house
36. Deed Restriction r uired max. #bedrooms: malc. flow:
37.Check area lots for oundwater/Label oundwater in Assessor's Ma
P(an reviewed by: �os�o3