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TOWN OF YARMOUTH �" `l�� "-�'
- SEWAGE PLAN REVIEV`V CHECKLIST
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Location: A.M. Lo Zone of Contribution: In Out Acreage �-
' c � Commercial: Residential: �-�
Street: D
Village: Floor Plan: #Bedrooms: �
Owner: �' ^ Installer: `�����`��i ,�
Address: Phone:
Phone: ' ' �,�G�'- � �� -.�
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Builder: Engineer:
Address: Phone: � `
Phone: _`" . �tx "'��.��, ' �
N/A YES NO
1.Re uired#of co ies received
2.Date of soils eaLam and ercolation test not older than 2 years v..�''
3.4-5 ft of naxurall occurrin ervious material, above water table C,...--�'
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.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 we1U25 ft irri ation well Var.:
11.Tank/leachin minimum 10 ft from rop line Var.:
12. S stem meets all other setback r uirements Var.:
13.Uses ad'ustment for maximum high groundwater Var.:
14.Leachin set 4-5 ft above adj.water or bottom of test hole Var.:
15.S stem not in to or subsoil(A,B horizons)or 5'removal �.�.�--
16.Pro osed contours are suitable
17. S stem meets slo e r uirements-min. 1/8", '/4" eferred t..�-''
18. System meets breakout r uirements PVC liner: Wall: �----
19.Specified 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
22. S stem ad uatel sized for its intended use �----y
23.Minimum 6"stone or compacted below tank and dbox �✓'
' 24.Manhole covers within 6"of ade, um chamber cover to ade ��
25.Ins ion ort on lastic chambers/leach field �----'
26.Electrical ermit for um chamber/S arate meter for du lexes
27.P stem-2"line,wee hole,check valve,tee in dbox, um size ----
28.S tic ta.nk/ um chamber to be facto wa roofed �-
29.Vent rovided if leachin below 3 feet,under driveway/ arkin �_,,_-
30.Buoyancy calculations for tank/pum cha.mber
31.En ' eer to ins ect and cert' soils: wall: comm i�l:
32.Engineer/Registered Sanitarian and Land Surv or stam s/si ture
33.H-201oa.ding is subject to vehicular traffic, oundwater
34.Title V A lication and ermit fee, installer si ture �.___.-�
35.Foundation footin min. 2 feet above ad'usted ound water for new house
36.Deed Restriction r uired max. #bedrooms: maaL. flow: d
37.Check area lots for oundwater/Label oundwater in Assessor's Ma �---"'
Plan reviewed by: ( �G� 6/03/03