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. � ��/ � TOWN OF YARMOUTH
SEWAGE PLAN REVIEW CHECKLIST �
! Location: A.M.�� Lot__�� Zone of Contribution: In Out `�' Acreage
Comtnercial: Residential: �- f
Street: i
Village: 4 Floor Plan: #Bedrooms: '� _
Owner: Installer: ;
Address: Phone: J�
Phone:
Builder: Engineer: .
Address: Phone: ' � / � '
Phone: � � �S
,..--��•�' �"� ,
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N/A YES NO
1.Re uired#of copies received
2.Date of soils e�ca.m and ercolation test not older than 2 years
3.4-5 ft of na.turall occurrin ervious material, above water ta.ble �
4.Foundation 2 ft above hi oint of road H�.: Fnd: Var.: ':
5.Water line 10 ft from s tic com onents Var.: �
6.Benchmark indicated and shown-NGVD if near wetlands r
7. S tic tank minimum 10 ft from founda.tion, deck Var.: �
8.Leachin minimum 20 ft full, 15 ft crawl, 10 ft slab Var.: ;,:_.-�' "
9.L,eachin minimum 100 ft from wetlands Var.: '
10.Leachin minimum 150 ft from drinkin welU25 ft irri ation well Var.:
11.Tank/leachin minimum 10 ft from ro erty line Var.: �,,.� '
12. S stem rneets all other setback r uirements Var.: �,./
13.Uses ad'ustment for maximum hi oundwater � .: �/
14.Leaching set 4-5 ft above adj.water or bottom of t le Var.: L/
15.System not in to or subsoil(A,B horizons)or removal ,�
16.Pro osed contours are suitable u�--� I
17. S stem meets slo e r irements-min. 1/8", '/4" eferred '�--�
18. S stem meets breakout re uirements PVC liner: Wall: ✓
19. S ec�ed tee sizes are ro er, s ba.ffle on outlet tee �
20. Sewa e is under 10,000 gpd for arcel i,._/ j
21.No bage dis osal I
22. S stem ad uatel sized for its intended use ;
f 23.Minimum 6"stone or com acted below tank and dbox �
24.Manhole covers within 6"of ade, um chamber cover to ade f
25.Ins ection ort on lastic cha.mbers/leach field �
26.Electrical ermit for chamber/S arate meter for du lexes �
27.Pum system-2"line,weep hole,check valve,tee in dboaL, um size ;
28. S tic tank/ um chamber to be factory wat roofed u'"
29.Vent rovided if leachin below 3 feet,under driveway/ arkin '
30.Buo ancy ca.lculations for tank/pump chamber ,
31.E ' eer to ins ect and c ' soils: wall: commercial: �'' -, i
32.En ' eer/Re 'stered Sanitaria.n and Land Surve or stam s/si ature ` �
33.H-20 loading is subject to vehicular tra.ffc, oundwater �..�-�'
34.Title V A lication and ermit fee,installer si ture "�----''
35.Foundation footin min. 2 feet above ad'usted ound water for new house �
36.Deed Restriction r uired max. #bedrooms: max.flow: -� �
37.Check azea lots for oundwater/Label oundwater in Assessor's Ma
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Plan reviewed by: �,o3�os ;
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