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TOWN OF YARMOUTH
SEWAGE PLAN REVIEW CHECKLIST '
- Location: A.M.� Lot �S� Zone af Contribution: In Out�Acreage�
Commercial: R�sidential: �f
Street: - .�"� �
Village: .�ll� � Floor Plan: Bedrooms: '
Owner:,J�t1�����'�li" [�Y ��� Insta ller: � j
Address: Phone:
Phone: �
Builder: Engineer: ��
Address: Phone: -"0 a -- Z
Phone: ! !�`Gt�� > ,
i y � > ��y �' i
N/A YES NO `
1.Required#of copies received
2.Date of soils exam and ercolation test not older than 2 years ;
3.4-5 ft of naturall occurrin ervious material, above water table '
4.Foundation 2 ft above high oint of road H.P.: Fnd: Var.: '
5.Water line 10 ft from s tic com onents Var.: '
6.Benchmark indica.ted and shown-NGVD if near wetlands ' '!
7. Se tic tank minimum 10 ft from foundation, deck Var.: � ��---- ;
8.Leaching 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.:
1 L Tank/leaching minimum 10 ft from ro erry line Var.:
x
12. S stem meets all other setback r uirements Var.: �
13.Uses adjustment for ma�mum high groundwater Var.: �f �
14.Leachin set 4-5 ft above adj.water or bottom of test hole Var.: L,� �
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 brealcout re uirements PVC liner: Wall: �
19. Specified tee sizes are ro er, gas baffle on outlet tee ;
, 20. Sewa e is under 10,000 gpd for arcel '
21.No ba e disposal
22. S stem ade ua.tel sized for its intended use '
• 23.Minimum 6"stone or com acted below tank and dbox (
24.Manhole covers within 6"of grade,pum chamber cover to ade �-�"� ;
25.Inspection ort on plastic chambers/leach field - j
26.Electrical ermit for um cha.mber/S arate meter for du lexes �
27.Pum s stem-2" line,weep hole,check valve,tee in dbo� um size !
28. Septic ta.nk/pum chamber to be factory wat roofed �`
29.Vent rovided if leaching below 3 feet,under driveway/parkin `
30.Buo anc calculations for tank/ um chamber
31.En ' eer to ins ect and c ' soils: wall: commercial:
32.Engineer/Re ' tered Sanitarian and Land Surveyor stam s/si ture '
33. H-201oadin is sub'ect to vehicular traffic, groundwater
34.Title V A lication and ermit fee, installer si ture
35.Foundaxion 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 groundwater in Assessor's Ma
4
Plan reviewed by: c�o3�o3 '