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TOWN OF YARMOUTH
' SEWAGE PLAN REV�W CHECKLIST
. �P � Lot / / (� Zone of Contribution: In Out�A reage
Location: A.M.
��-- - -
��¢ Commercial: Residentia`t---'�
Street: � 7f/ ` ,
Village: Floor Plan: � #Bedrooms: '� '
Owner: ����t%G/. %< Installer:
Address: / hone: r
Phone: � "' � t�iy'� � �
Builder: Engineer: s '
Address: Phone: '- -
Phone:
N/A YES NO
l.Required#of co ies received
2.Date of soils e�.m and ercolation test not older than 2 ears
' 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 septic components Vaz.: z�,�-�'
6.Benchmark indicated and shown-NGVD if near wetlands
7. Se tic tank minimum 10 ft from founda.tion, deck Var.:
8.Leachin minimum 20 ft full, 15 ft crawl, 10 ft slab Var.:
9.Leachi.ng minimum 100 ft from wetlands Var.: -�--
10.Leaching minimum 150 ft from drinking welU25 ft irri tion well Var.: �-�"� ;
1 l.Tank/leachin minimum 10 ft from ro erty line Var.: �'
12. S stem meets all other setback r uirements Var.: c.:._,...-�
13.Uses adjustment for maximum hi groundwater Var.: ;
14.Leaching set 4-5 ft above adj.water or bottom of test hole Var.: Lr/
15. System not in to or subsoil(A,B horizons)or 5'removal
16.Pro sed contours are suitable L.,.1
17. S stem meets slo e r uirements-min. 1l8", '/4" eferred �/
18. System meets breakout r irements PVC liner: WaIL• � -->
19. S ec�ed tee sizes are ro er, as baf�le on outlet tee v'
20. Sewage is under 10,000 gpd 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 ection ort on lastic chambers/leach field L.....-
26. Electrical ermit for um chamber/S arate meter for du lexes ��
27.Pum system-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 leaching below 3 feet,under driveway/ arking ':
30.Buo ancy calculations for tank/ um chamber
31.En ' eer to ins ect and cert' soils: wall: commercial: �
32.Engineer/Re ' tered Sanitarian and Land Surve or stam s/si ature !
33.H-20 loadin is sub'ect to vehicular traffic, groundwater
34.Title V A lication and ermit fee, installer si ture '
35.Foundation footing 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 groundwater in Assessor's Ma
Plan reviewed by: "� wo3io3