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TOWN OF YARMOUTH
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SEWAGE PLAN REVIEW CHECKLIST
Location: A.M. �-/" (/ Lot Z7 Zone of Contribution: In Out/ Acreage
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; Commercial: Residential: �/
� Street: � `
� Village: Floor Plan: � #Bedrooms: -�
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; Owner: Installer: l
' Address: � Phone: -
i Phone: r
3 �Builder: Engineer:
Address: Phone: �-
Phone: ✓ G� � „� �, ��,`c,
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N/A S NO
l.Required#of copies received
2. Date of soils exam and percolation test not older than 2 years L./
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 septic components Var.: �
6. Benchmark indicated and shown-NGVD if neax wetlands `�
7. Se 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.Leaching minimum 150 ft from drinking welU25 ft irri ation well Var.: _--'"
11. Tank/leachin minimum 10 ft from roperty line Var.:
12. S stem meets all other setback r uirements Var.:
13.Uses ad'ustment for maximum high groundwater Var.: ���
14. Leaching set 4-5 ft above adj.water or bottom of test hole Var.: �
15. System not in top or subsoil(A,B horizons)or 5'removal
16.Pro osed contours are suitable
17. S stem meets slo e re uirements-min. 1/8", 1/4" referted
18. System meets breakout requirements PVC liner: Wall: �,�
19. Specified tee sizes are roper, gas baffle on outlet tee L/
20. Sewage is under 10,000 d for arcel
21.No garba e disposal ,_,_�
' 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 grade, um chamber cover to ade
25.Inspection port on lastic chambers/leach field
26.Electrical ermit for um chamber/S arate meter for du lexes
27.Pum system-2" line,wee hole,check valve,tee in dbo� ump size
28. Septic tank/pump chamber to be factory wat roofed
29.Vent rovided if leaching below 3 feet,under driveway/ arking
30.Buoyancy calculations for tank/pum chamber
31.En ' eer to ins ect and cert' soils: wall: commercial:
32.Engineer/Registered Sanitarian and Land Surve or stam s/si ture
33.H-201oadin is subject to vehicular tr�c, 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: max. flow: d --�
37.Check area lots for groundwater/Label oundwater in Assessor's
Plan reviewed by: �03�03