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TOWN OF YARMOUTHA ,SEWAGE PLAN REVIEW CHECKLIST / xG• f , /
Location: A.M. 2 Lot2-1 Zone of Contribution: In - 6ut_ Acreage -2-a."
(&.(r/zy----47-
Commercial: Residential: '
Street: ‘5.--- �
z
Village: KjV
Floor Plan: �. #Bedrooms: ,3
Owner: �� 7/1 Installer: T7
Address: Phone:
Phone: /n
Builder: Engineer: E-A-9//Ulb! (®'\Gl-
Address: Phone: 9-6 / 7--5,,/3
Phone: �,�GJ�C /. S�? li��, S
N/A YES NO
1.Required#of copies received L✓
2.Date of soils exam and percolation test not older than 2 years L,.---
3.4-5 ft of naturally occurring pervious material,above water table (--`
_ 4.Foundation 2 ft above high point of road H.P.: Fnd: Var.: C.....---C.....----'.
5.Water line 10 ft from septic components Var.: CLQ
6.Benchmark indicated and shown-NGVD if near wetlands (---
7. Septic tank minimum 10 ft from foundation, deck Var.:
8.Leaching minimum 20 ft full, 15 ft crawl, 10 ft slab Var.: 3 c�-
9.Leaching minimum 100 ft from wetlands Var.: -�
10.Leaching minimum 150 ft from drinking well/25 ft irrigation well Var.: c_.----
11.Tank/leaching minimum 10 ft from property line Var.: �--*
12. System meets all other setback requirements Var.: +7i'./p eli4 ,d c.----
13.
13.Uses adjustment for maximum high groundwater Var.: `�
14.Leaching set 4-5 ft above adj.water or bottom of test hole Var.: �®
15. System not in top or subsoil(A,B horizons)or 5'removal U-----
16.
_f16.Proposed contours are suitable i,i--
17. System meets slope requirements-min. 1/8", '/4"preferred (...-----
18.
.,.-r18. System meets breakout requirements PVC liner: Wall: c._.----
19. Specified tee sizes are proper, gas baffle on outlet tee C-----
20. Sewage is under 10,000 gpd for parcel (---.
21.No garbage disposal l_...---
22. System adequately sized for its intended use c....--"
23.Minimum 6"stone or compacted below tank and dbox L----'
24.Manhole covers within 6"of grade,pump chamber cover to grade l-'
25.Inspection port on plastic chambers/leach field C.--
26.
„r26.Electrical permit for pump chamber/Separate meter for duplexes .....---
27.Pump system-2" line,weep hole,check valve,tee in dbox,pump size ......---
28. Septic tank/pump chamber to be factory waterproofed k.._._-
29.
_29.Vent provided if leaching below 3 feet,under driveway/parking
30.Buoyancy calculations for tank/pump chamber `---•
31.Engineer to inspect and certify soils: wall: commercial: t._.----
32.Engineer/Registered Sanitarian and Land Surveyor stamps/signature �._-�
33.H-20 loading is subject to vehicular traffic, groundwater ...------O
34.Title V Application and permit fee, installer signature
35.Foundation footing min.2 feet above adjusted ground water for new house _
36.Deed Restriction required max. #bedrooms: max. flow: gpd
37. Check area lots for groundwater/Label groundwater in Assessor's Map ' -
Plan reviewed by: 6/03/03