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� TOWN OF YARMOUTH .
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SEWAGE PLAN REVIEW CHECKLIST
Location: A.M. �� Lot � Zone of Contribution: In Out "�eage
' C��- Commercial: Residential: �
Street: � // ' ,�/
Village: Floor Plan: � #Bedrooms: i�
Owner: ����� �f�1��" S Installer: ��
Address: Phone: - -•
Phone: ���'� � j�,�� '
,0,�9,
Builder: Engineer:
Address: Phone: � -
Phone: � �_ �'�,�;� .��� �
" � 4
N/A NO
1.Required#of copies received
2. Date of soils e�m and percolation test not older than 2 eaxs ��
3. 4-5 ft of naturall occurrin ervious material, above water table ��
4.Foundation 2 ft above hi int 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.Leaching minimum 20 ft full, 15 ft crawl, 10 ft slab Var.: �._._._,.-
9.Leaching minimum 100 ft from wetlands Var.: --�"
10.Leaching minimum 150 ft from drinkin welU25 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.Leaching set 4-5 ft above adj.water or botto s o Var.: �-
1 S. System not in to or subsoil(A,B horizons) 5'remov
16,Pro osed contours are suitable ��
17. S stem meets slo e r uirements-min. 1/8", '/4" referred
18. System meets breakout re uirements PVC liner: Wall:
19. Specified tee sizes are roper, gas baffle on outlet tee �-
20. Sewa e is under 10,000 gpd for arcel
21.No garba e dis osal <</ ,
22. S stem ade uatel sized for its intended use („/^
23.Minimum 6"stone or compacted below tank and dbox
• 24.Manhole covers within 6"of grade,pump chamber cover to grade •
25.Inspection ort on lastic chambers/leach field ��'
26.Electrical ermit for um chamber/S arate meter for du lexes �---"
27.Pump system-2" line,wee hole,check valve,tee in dbox,pum size --�'
28. S tic tank/ ump chamber to be factory waterproofed �
29.Vent provided if leaching below 3 feet,under driveway/parking
30.Buoyancy calculations for tank/pum chamber ��
31.En ' eer to ins ect and cert' soils: wall: commercial:
32.Engineer/Registered Sanitarian and Land Surveyor stamps/si ature �-
33.H-201oading is subject to vehicular traffic, groundwater �'
34.Title V A plication and permit fee, installer signature ��'
35.Foundation footing min. 2 feet above ad'usted ground water for new house
36.Deed Restriction r uired maX. #bedrooms: max. flow: d -^�
37.Check area lots for oundwater/Label groundwater in Assessor's Ma
Plan reviewed by: eiosio3