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TOWN OF YARMOUTH
' SEWAGE PLAN REVIEW CHECKLIST
Location: A.M. � Lot_�� Zone of Contribution: In Out ''A ge J'�'y
Commercial: ResidentiaL•
Street:
Village: � Lf�/ Floor Plan: �� #Bedrooms:�_
Owner: Insta ller: ��j�
Address: Phone: ' �
Phone:
Builder: Engineer: ��
Address: Phone: �16� _�
Phone: '- ����'�- �jG c� �� �„ ��J�
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/A YES NO
1.R uired#of co ies received
2.Date of soils exaxn and ercolation test not older than 2 years C�
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.: E/'
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.Leachin minimum 100 ft from wetlands Var.: h----
10.Leachin minimum 150 ft from drinking welU25 ft irri tion 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.: C7 S
14.Lea.ching set 4-5 ft above adj.water or bottom of le Var.: "�'
15. S stem 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", '/4" eferred
18. S stem meets breakout re uirements PVC liner: Wall: c..�-�
• 19.S ecified tee sizes are ro er, gas baffle on outlet tee
20. Sewa e is under 10,000 gpd for arcel
21.No garba e dis osal t��
: 22.S stem ad uatel sized for its intended use
23.Minimum 6"stone or com acted below tank and dbox -L�
24.Manhole covers within 6"of grade, um chamber cover to ade
25.Ins ection ort on plastic chambers/leach field t/
26.Electrical ermit for um chamber/S arate meter for du lexes �-
27.Pum stem-2" line,weep hole,check valve,tee in dbo� ump size
28. S tic tank/pum chamber to be facto waterproofed
29.Vent provided if leachin below 3 feet,under driveway/ arkin ----r`
30.Buoyanc calculations for tank/ um chamber
31.En ' eer to ins ect and c ' soils: wall: commercial:
32.En ' eer/Registered Sanitarian and Land Surveyor stam s/si ature ��
33.H-201oading is subject to vehicular traffic, groundwater
34.Title V A lication and ermit fee,installer signature `/ '
35.Foundation footin 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 groundwater/Label groundwater in Assessor's Ma
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Plan reviewed by: ��' wo3io3