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TOWN OF YARMOUTH
_ SEWAGE PLAN REVIEW CHECKLIST
�' Location: A.M. �✓3 Lot � � Zone of Contribution: In Out Acreage
� �' /� Commercial: Residential: �
; Street: �� /
� Village: Floor Plan: �-� #Bedrooms: �
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� Owner: ��Q Installer: ��`�'2P
Address: Phone: , - -- �
Phone:
� ��1�� ' ' '��Z� `
Builder: Engineer:
Address: Phone: 7
Phone: -�/,
�-� �� Z. G�Y�v���G�'�l�'
�,��j� ��,
N/A YES O
l.R uired#of copies received
2. Date of soils exam and ercolation test not older than 2 ears
3.4-5 ft of natural occurrin ervious material, above water ta.ble
4.Founda.tion 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.:
8. Leachin minimum 20 ft full, 15 ft crawl, 10 ft slab Var.: -
9.Leachin minimum 100 ft from wetlands Var.: - .
10.Leaching minimum 150 ft from drinkin welU25 ft irri tion well Vaz.:�
11. Tank/leachin minimum 10 ft from ro line Var.: � ; �-�
12. S stem meets all other setback r uirements Var.:
13.Uses ad'ustment for maximum hi oundwater Var.:
14. Leaching 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 sed contours are suitable �-
17. S stem meets slo e r irements-min. 1/8", '/a" eferred �,,,�-�'
18. S stem meets brea.kout r uirements PVC liner: Wall: ��
19. S ecified tee sizes are ro er, gas baffle on outlet tee
20. Sewa e is under 10,000 for arcel
21.No arba 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 grade, um cha.mber cover to ade
25.Inspection ort on lastic chambers/leach field
i 26.Electrical ermit for um chamber/S arate meter for du lexes
27.Pum system-2"line,w hole,check valve,tee in dbox, um size -
28. S tic tank/pum chamber to be fact wa roofed
29.Vent rovided if leachin below 3 feet,under driveway/ arkin
30.Buo anc calculations for tank/ um cha.mber
31.En ' eer to ins ect and cert' soils: wall: commercial: �
32.En ' eer/Registered Sanitarian and Land Surv or stam s/si ature �
33.H-201oading is sub'ect to vehicular tra�c, oundwater
34. Title V A lication and ermit fee, installer si ature ���
35.Foundation footin min.2 feet above ad'usted ound water for new house f
36.Deed Restriction r ired max. #bedrooms: maxc, flow: d
37.Check area lots for oundwater/Label oundwater in Assessor's M
Plan reviewed by: ^ � 6/03/03
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