Review Checklist'; _ �`�`� � L��-�f
T WN � �r
O OF YARMOUTH
SEWAGE PLAN REVIEW CHECKLIST ��k, �? � `� �� ��'!I
+ Location: A.M.L-t-�� Lot /� Zone of Contribution: In L-6Qf�� Acreage ��=7 /7��/�'..�
Commercial: ResidentiaL• •�''
Street: �
Village: Floor Plan: c./"" #Bedrooms: �
Owner: Insta.11er: /%�
Address: Phone: '-�
Phone:
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Builder: Engineer: ' n��� /�
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Address: Phone: - O ^ ����G%
Phone: _/7��� �� G�
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N/A YES NO
1.R uired#of c ies received
2.Date of soils exam and ercolation test not older than 2 years
3.4-5 ft of naturall occunin ervious material, above water ta.ble
4.Foundation 2 ft above hi oint of road H.P.: Fnd: Var.:
5. Water line 10 ft from s tic com onents Vaz.: �,./
6.Benchmark indicated and shown-NGVD if near wetlands
7. S tic tank minimum 10 ft from foundaxion, deck Var.:
S.Leachin minimum 20 ft full, 15 ft crawl, 10 ft slab Var.: �,_----
9.Leaching minimum 100 ft from wetlands Var.:
10.Leachin minimum 150 ft from drinkin we1U25 ft irrigation well Var.:
11.Tank/leaching minimum 10 ft from ro erty line Var.: �;/
12. S stem meets all other setback r uirements Var.:
13.Uses adjustment for maximum high groundwater Var.:
14.Leachin 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 uirements-min. 1/8", '/4" referred (�-''
18. System meets breakout r irements PVC liner: Wall:
19. Specified tee sizes are ro er, as ba.ffle on outlet tee
20. Sewa e is under 10,000 d for parcel ��...-
' 21.No ba e dis osal �/
22. S stem ad ua.tel sized for its intended use
: 23.Minimum 6"stone or compacted below tank and dbox
24.Manhole covers within 6"of ade, um chamber cover to ade r---�''"
25.Ins tion ort on lastic chambers/leach field �-�
26.Electrical ermit for um cha.mber/S arate meter for du lexes ._..._-
27.Pum system-2"line,wee hole,check valve,tee in dbox, um size .�.,�-
28. S tic tank/pum cha.mber to be factory wat roofed ._----'
29.Vent rovided if leaching below 3 feet,under driveway/ arkin -
30.Buoyanc calculations for tank/ um cha.mber
31.En ' eer to ins ect and cert' soils: wall: commerciaL• �,--^
32.En ' eer/Re 'stered Sanitarian and Land Surveyor stam s/si ture �-j
33.H-20 loadin 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 ired max. #bedrooms: � . flow: ' d �
37.Check area lots for oundwater/Label groundwater in Assessor's Ma
Plan reviewed bY: �l / �o3ro3 '