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� TOWN OF YARMOUTH • '
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SEWAGE PLAN REVIEW CHECKLIST '
Location: A.M. Lot� Zone of Contribution: In Out_�Acreage ' '
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Commercial: ResidentiaL•
Street: �-7 � .
Village: Floor Plan: #Bedrooms:
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Owner:-�!;�'��`��' �� ���'� Installer: � i
Address: Phone: ^ ,�.,,
Phone: �j'�l� ��� :a,� �'lI�/`��
✓� _ �GG,�� 9J� /
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Builder: Engineer: �` ��
Address: Phone: ¢/� � '
Phone: - �' ``�k'- � ` '�Li� ��� _�
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N/A NO
l.Required#of co ies received � :
2.Date of soils exam and ercolation test not older than 2 years
3.4-5 ft of naturall occurrin ervious material, above water table
4.Foundation 2 ft above hi oint of road H.P.: Fnd: Var.:
5.Water line 10 ft from s tic com onents Var.: '
6.Benchmark indicated and shown-NGVD if neax 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.: C`�' ' �'
9.Leaching minimum 100 8 from wetlands Var.: `� �---'
10.Leachin minimum 150 ft from drinking welU25 ft irrigation well Var.:
11.Tank/leaching minimum 10 ft from ro line Var.: t.r...�
12. S stem meets all other setback r uirements Var.:
13.Uses ad'ustment for maximum hi oundwater Var.:
14.Leaching set 4-5 ft above adj.water or bottom-af test.�hole Var.:
15. System not in to or subsoil(A,B horizo �or 5'remo �
16.Pro osed contours are suitable
17. S stem meets slo e re uirements-min. 1/8", '/4" referred
18. S stem meets brealcout re uirements PVC liner: , Wall: i/ �.�''
19. S ecified tee sizes are proper, as baffle on outlet tee �
20. Sewage is under 10,000 d for arcel
21.No garbage 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 grade, um chamber cover to grade ��
25.Ins ection ort on lastic chambers/leach field ✓
26.Electrical ermit for um chamber/S arate meter for du lexes
27.Pum system-2" line,weep hole,check valve,tee in dbo�pum size - � f � � - ;
28. S tic tank/ um chamber to be factory wa roofed •�>
29.Vent rovided if leaching below 3 feet, under driveway/ arkin
30.Buoyancy calculations for tank/pum chamber
31.En ' eer to ins ect and cert' soils: wall: commercial:
32.Engineer/Registered Sanitarian and Land Surveyor staxn s/signature
33.H-201oadin is sub'ect to vehicular tr�c, oundwater ',
34.Title V A lication and permit fee, insta.11er signalure '
35.Foundation footin min. 2 feet above adjusted ound water for new house _----" ';
36.Deed Restriction r uired max. #bedrooms: max. flow: d
37.Check area lots for oundwater/Label oundwater in Assessor's Ma
Plan reviewed by: G�r �,os�os
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