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TOWN OF YARMOUTH
SEWAGE PLAN REVIEW CHECKLIST
Location: A.M.� Lot ��� Zone of Contribution: In Out �Acre.age
� `� Commercial: Residential'��
Street:
Village: Floor Plan: l.� #Bedrooms: �
� Owner: ljV�����X,�l� Installer: �
� Address: Phone: � �Z� "� �� �-�G.
Phone: , l��'�?G'� "/
Builder: Engineer: �`'� � -`�IilS
Address: Phone: - �' -'
Phone: �� / ����� �i
/�; �, �/�.�� '�°�.�/
N/A YES N0
l.Required#of copies received
2.Date of soils exam and ercolation test not older than 2 ears
3.4-5 ft of naturall occurrin ervious material, above water ta.ble
4.Foundation 2 ft above hi oint of road H�.: 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.Leaching minimum 100 ft from wetlands Va,r.: - -
10.Leaching minimum 150 ft from drinkin welU25 ft irri tion well Var.:
11.Tank/leachin minixnum 10 ft from ro line Var.: r..----'
12.S stem meets all other setback r uirements Var.:
13.Uses adjustment for maximum hi oundwater Var.: ; �._---
14.Leachin set 4-5 ft above ad'.water or bottom es�ho Var.:
15. System not in to or subsoil(A,B horizons)or 'remov '
16.Pro osed contours are suitable
17. S stem meets slo e r uirements-min. 1/8", '/a" referred ��'
18. S stem meets breakout r uirements PVC liner: Wall: Z-.--'
- 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
R 22. S stem ad uatel sized for its intended use
23.Minimum 6"stone or com acted below ta.nk and dbox �y,�-
24.Manhole covers within 6"of grade, um cha.mber cover to ade �i
25.Ins ection ort on lastic chambers/leach field �.�-�
26.Electrical ermit for um chamber/S arate meter for du lexes �� z
27.Pum s stem-2"line,w hole,check valve,tee in dbo� um size �
28. S tic tanklpum chamber to be factory wat roofed
29.Vent rovided if leachin below 3 feet,under driveway/ arkin �/ :
30.Buoyancy calculations for ta.nk/ um chamber /
31.En ' eer to ins ect and cert' soils: wall: commercial:
32.En ' eer/Re 'stered Sanitarian and Land Surveyor stam s/si ature '
33.H-201oading is sub'ect to vehicular traf�c, groundwater
34.Title V A lica.tion and ermit fee, insta.11er si ture
35.Founda.tion footin min. 2 feet above ad'usted ound water for new house
36.Deed Restriction r uired max. #bedrooms: ma�c. flow: d --�''�� '
37.Check area lots for groundwater/Label oundwater in Assessor's ;
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Plan reviewed by: � � �o3io3