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`��"��- ��� TOWN OF YARMOUTH , ������ �
. SEWAGE PLAN REV�W CHECKLIST `'���
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Location: A.M.� Lot�_ Zone of Contribution: In ut_ AcreagaJ ��
Commercial: Residential:
Street:
Village: Floor Plan: #Bedrooms: .�
Owner: �/p�C� Insta.11er:
Address: Phone: � �7
Phone:
Builder: Engineer:
Address: Phone: -
Phone: _ , � �" --{%�zE>`T '�1 �
N/A YES O
1.Required#of co ies received
2.Date of soils exam and ercolation test not older than 2 ears 1.---�
3.4-5 ft of naturall occurrin 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 founda.tion, deck Var.: �
8.Leaching minimum 20 ft full, 15 ft crawl, 10 ft slab Var.:
9.Leachin minimum 100 ft from wetlands Var.: ��� ,
10.Lea.ching minimum 150 ft from drinking welU25 ft irri tion well Var.:
11.Tank/leachin minimum 10 ft from ro erty line Vaz.: (.,,�� ,
12.S stem meets all other setback r uirements Var.: t`.r-� '
13.Uses adjustment for ma�mum 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 t..�-''
16.Pro sed contours are suitable �.,.��"
17. S stem meets slo e r irements-min. 1/8", '/4" referred
18. System meets breakout r irements PVC liner: Wall:
19.S ecified tee sizes are ro er, gas ba.ffle on outlet tee
20. Sewa e is under 10,000 d for arcel �'
21.No garbage dis osal
� 22. S stem ade uatel sized for its intended use
23.Minimum 6"stone or com acted below tank and dbox
: 24.Manhole covers within 6"of de, ump chamber cover to ade
25.Ins ion ort on lastic chambers/leach field
26.Electrical ermit for um chamber/S arate meter for du lexes
27.Pum system-2"line,w hole,check valve,tee in dbo� um size �..�'-""
28. S tic tank/ chamber to be facto waterproofed .����
29.Vent rovided if leachin below 3 feet,under drivewa / arking /�
30.Buoyancy calculations for tank/ u chamber �'`�
31.En ' eer to ins ect and c ' soils: wall: commercial:
32.En ' eer/Registered Sanitarian and Land Surveyor stam s/si ture -
33.H-201oa.din is subject to vehicular tra.ffic, oundwater �„r� '
34.Title V A lication and ermit fee,insta.11er si Lure �`
35.Foundation footin min. 2 feet above adjusted ound water for new house ----�''
36.Deed Restriction r ired m�. #bedrooms: max.flow: d =-�""` '
37.Check area lots for oundwater/Label oundwater in Assessor's
Plan reviewed by: �f� �o3ros