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s 7 �/
�� / / TOWN OF YARMOUTH "/`��� ���
SEWAGE PLAN REV�W CHECKLIST ..�C�1�"' ����'�� ��
� Location: A.M. � � Lot� Zone of Contribution: In�t_ Acreage�,����
�� n _ � Commercial: ResidentiaL• ��
Street: (,O
Village: i Floor Plan: �� #Bedrooms: .� '.
Owner: / Insta.11er: �)
Address: Phone: -
Phone: '.
Builder: Engineer: /2� � �i�
Address: Phone: (r - �--
Phone: _���y'� � -G �
N/A YES NO
l.R uired#of co ies received
2.Date of soils exam and colation test not older than 2 ears L,.�-�'� '
3.4-5 ft of natura occurrin ervious material,above water table
4.Founda.tion 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.: � �.i
9.Leachin minimum 100 ft from wetlands Var.:
10.Leachin minimum 150 ft from drinking we1U25 ft irrigation well Var.:
1 from r
line Var.:
c.---�
11.Tank/leachin minixnum 0 ft operly ���
12. S stem meets all other setback r uirements Var.:
13.Uses adjustment for maximum hi oundwater Var.:
14.Lea.chin 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 uirements-min. 1/8", '/4" eferred
18. System meets breakout r irements PVC liner: Wall: �_�---
19. S ecified tee sizes are ro , gas ba,ffle on outlet tee
20. Sewa e is under 10,000 d 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 cha.mber cover to ade
` 25.Ins tion ort 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 dbo� um size -�"�-
28. S tic tank/ um chamber to be facto wat roofed
29.Vent rovided if leachin below 3 feet,under drivewa / arking
34.Buoyancy calcula.tions for tank/ um cha.mber
3 l.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-20 loadin is subject to vehicular traffic, oundwater
34.Title V A lica.tion and ermit fee, installer si ature
35.Founda.tion footin min. 2 feet above ad'usted ound water for new house
36.Deed Restriction r ired max. #bedrooms: max. flow: d ___..-� '
37.Check area lots for oundwater/Label oundwater in Assessor's Ma -'""�
Plan reviewed by: �osios