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TOWN OF YARMOUTH
SEWAGE PLAN REVIEW CHECKLIST
;Location: A.M.� Lot � Zone of Contribution: In Out A reage
/ Commercial: Residential: "
Street: �(� /
Village: !1 , Floor Plan: �� #Bedrooms:�
Owner:��� ����t%(.G�� Installer:
Address. rhone: Lq� --' �_�
Phone: '
Builder: Engineer: (.L���
Address: Phone: '" �`
Phone: �' �
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/A YES NO
1.R uired#of copies received �-•-
2.Date of soils exam and percolation test not older than 2 years
3.4-5 ft of naturall occurrin ervious material,above water table e.---
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 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 drinking we1U25 ft irri ation well Var.:
11.Tank/leaching minunum 10 ft from properry line Var.: o...-�` �
12. S stem meets all other setback re uirements Var.: ',
13.Uses ad'ustment for ma�mum hi groundwater Var.: '
14.Leachin set 4-5 ft above ad'.water or bottom of test hole Vax.: :,.r.-� �
15. System not in to or subsoil(A,B horizons)or 5'removal �.�....� ;
16.Pro osed contours are suitable '
17. S stem meets slo e r uirements-min. 1/8", '/4" referred c_.,......- �
18. System meets breakout r uirements PVC liner: Wall: - - `
19. Specified tee sizes are ro er, as baffle on outlet tee �..._.-�-�'
20. Sewage is under 10,000 gpd for arcel ;
21.No garba e dis osal � E
22. S stem ade uatel sized for its intended use ;
23.Minimum 6"stone or compacted 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 le�ces !-""" -
27.Pump system-2" line,weep hole,check valve,tee in dbo�pump size -�'''y'�-� '
28. S tic tank/pump chamber to be faetory waterproofed .,.-v'"""� ',
29.Vent rovided if leaching below 3 feet,under driveway/parking �--�
30.Buoyancy calculations for tank/ um chamber
31.En ' eer to ins ect and cert' soils: wall: commerciaL• �
32.Engineer/Re 'stered Sanitarian and Land Surveyor stamps/signature �
33.H-201oading is subject to vehicular traffic, oundwater ..,�.- !
34.Title V A lication and ermit fee, installer si ature -
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 groundwater/Label oundwater in Assessor's ' ,
Plan reviewed by: (�'� �o3io3