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TOWN OF YARMOUTH � I
SEWAGE PLAN REVIEW CHECKLIST
Location: A.M.�_ Lot�_ Zone of Contribution: In Out_�Acreage ' '
Commercial: Residential. �
Street: :
Village: Floor Plan: #Bedrooms:
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Owner: P���%1���/���Installer:
Address: Phone: - "'
Phone:
Builder: Engineer: � �
Address: Phone: ""
Phone: ��'.-�'.� � s��� ;?_ ��'z'�%`/����
N/A YES NO
1.Re uired#of co ies 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 ✓
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 founda.tion, deck Var.:
S.Leachin minimum 20 ft full, 15 ft crawl, 10 ft slab Var.: ` i �-�'
9.Leaching minimum 100 ft from wetlands Var.: �-
' 10.Leachin minimum 150 ft from drinking welU25 ft irrigation well Var.:
11.Tank/lea.ching minimum 10 ft from ro erty line Var.: •�%
12. S stem meets all other setback r uirements Var.: .�-
13.Uses adjustment for maxirnum high goundwater Var.: �
14.Leaching set 4-5 ft above ad'.water or bottom of test hole Var.: �„�.� '
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 irements-min. 1/8", 1/4" referred `sc��-
18. S stem meets breakout r uirements PVC liner: Wall: '
19. S ecified tee sizes are ro er, gas baffle on outlet tee
20. Sewa e 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 compacted below tank and dbox
24.Manhole covers within 6"of ade, um cha.mber cover to grade L� . �
25.Ins ection port 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 dbo�pump size !
28. S tic tank/ ump chamber to be factory waterproofed ��� ;
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.En ' eer/Re 'stered Sanitarian and Land Surveyor stam s/si ature �
33.H-201oading is subject to vehicular ttaffic, oundwater ��/
34.Title V A plication and ermit fee, insta.11er si ature
35.Foundation footing min. 2 feet above ad'usted 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
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Plan reviewed bY� ����, wo3�o3