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• TOWN OF YARMOUTH ,�,� , ,/�
SEWAGE PLAN REVIEW CHECKLIST '" 9/J � ��`t� ���`-�
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� Location: A.M.� Lot �� � Zone of Contribution: In '�Out Acreage
/� Commercial: Residential: �
Street: �' Z�/f �
Village: Floor Plan: � #Bedrooms:
Owner: � Installer:
Address: Phone: -
Phone:
Builder: Engineer:
Address: Phone: -�" �--� -
Phone: - ��7'� �" �,,.� � �: '�
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N/A YES NO
1.Required#of co ies received
2.Date of soils exam and percolation test not older than 2 years �.�
3.4-5 ft of naturall occurrin ervious material, above water table -�
4.Foundation 2 ft above hi oint of road H.P.: Fnd: Var.:
5. Water line 10 ft from septic com onents Var.: �-
6.Benchmark indicated and shown-NGVD if near wetlands
7. Se 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 Var.:
10.Leachin minimum 150 ft from drinking 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 ad'ustment for maximum hi groundwater Var.: �
14.Leaching set 4-5 ft above adj.water or bottom of test hole Var.:
15. System not in to 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", '/a" referred �_--
18. System meets breakout r uirements PVC liner: Wall:
19. Spec�ed tee sizes are pro er, gas baffle on outlet tee
20. Sewage 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 com acted below tank and dbox
24.Manhole covers within 6"of ade, um chamber cover to ade �
25.Ins ection port on plastic chambers/leach field
26.Electrical ermit for um chamber/S arate meter for du lexes _.�
27.Pum system-2" line,weep hole,check valve,tee in dbo�pump size
28.S tic tank/pump chamber to be factory waterproofed
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.En 'neer/Registered Sanitarian and Land Surveyor stam s/si ature
33.H-201oading is subject to vehicular trafFic, groundwater ;.�/
34.Title V Application and ermit fee, insta.11er signature �---�
35.Foundation footing min.2 feet above adjusted ound water for new house /
36.Deed Restriction r uired max. #bedrooms: max. flow: d
37.Check area lots for groundwater/Label groundwater in Assessor's Map
Plan reviewed by: �� �o3io3