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_ TOWN OF YARMOUTH '
SEWAGE PLAN REVIEW CHECKLIST ;
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' Location: A.M. / � Lot�_ Zone of Contribution: In Out_ Acreage
Commercial: Residential:�-
S�e�: �
Village: � Floor Plan: �,/ #Bedrooms: �
Owner: ��Sc�e'L-/.-C Installer: ��'-
Address: Phone: --
Phone:
Builder: Engineer: � f
Address: Phone: �- '�
Phone: �j�� f Cti�;�,��;Y�Gy�
N/A YES NO
1.R uired#of copies received i
2.Date of soils exa.m and percolation test not older than 2 ears ,
3.4-5 ft of natural occunin ervious material, above water ta.ble
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 indicated and shown-NGVD if near wetlands
7.S tic tank minimum 10 ft from foundation, deck Var.: i
8.Leachin minimum 20 ft full, 15 ft erawl, 10 ft slab Var.: �
9.Leaching minimum 100 ft from wetlands Var.: �.--- ;
10.Leachin minimum 150 ft from drinkin we1U25 ft irri tion well Var.: `--�" j
11.Tank/leaching minimum 10 ft from ro line Var.: �--� �
12. S stem meets all other setback r irements Var.: C=---" I
13.Uses ad'ustment for maximum hi groundwater Var.: __. . - '
14.Leaching 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 breakout re irements PVC liner: Wall: `._.,-�` '
19.S ecified tee sizes are pro er, s baffle on outlet tee
20. Sewage is under 10,000 d for arcel ,
21.No garba 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 de, um chamber cover to ade �-----
25.Ins ection ort on lastic chambers/leach field
26.Elecirical ernut for um chamber/S azate meter for du lexes `----�'"'"
27,pum system-2" li.ne,weep hole,check valve,tee in dbox, um size
28.S tic tank/ um chamber to be facto wa roofed a''�^ ,,
29.Vent rovided if leachin below 3 feet,under driveway/ arking -/��
30.Buoyancy calculations for tank/pu chamber
31.En ' eer to ins ect and cert' soils: wall: commercial:
32.En ' eer/Re 'stered Sanitarian and Land Surveyor stam s/si ture
33.H-20 loading is subject to vehicular traffic, oundwater �-�''
34.Title V A lication and ermit fee, installer si ture �"'''
35.Founda.tion footin 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
Plan reviewe�by: �03�03