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TOWN OF YARMOUTH '* --1-71".1
SEWAGE PLAN REVIEW CHECKLIST ! / - ZN��! .
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Location: A.M. 7c Lot Z_ Zone of Contribution: In Out Acreage
Commercial: Residential: .
j ' Street: t5 V(1,ee- 'S /4,1
Village: G(/ fl r% Floor Plan: #Bedrooms: 1
I Owner: "a {,F -i� l/
Installer:
Address: Phone: - 74-- .01'11-
Phone:
Builder: Engineer: Ziy2 _
Address: ....'7 Phone: �► VJ - (P(32
Phone:
N/A YES NO
1.Required#of copies received
2.Date of soils exam and percolation test not older than 2 years
i.------
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.: if----"'
5.Water line 10 ft from septic components Var.: 1-....--
6.
��6. Benchmark indicated and shown-NGVD if near wetlands
7. Septic tank minimum 10 ft from foundation,deck Var.: t.-----
8.
./
8. Leaching minimum 20 ft full, 15 ft crawl, 10 ft slab Var.: `,----
9.Leaching minimum 100 ft from wetlands Var.: �J
10.Leaching minimum 150 ft from drinking well/25 ft irrigation well Var.: ------
11.Tank/leaching minimum 10 ft from property line Var.: 1.....-•
12. System meets all other setback requirements Var.: L.----
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 L
16.Proposed contours are suitable
17. System meets slope requirements-min. 1/8", '/4"preferred c_...------
18.
_�18. System meets breakout requirements PVC liner: Wall:
19. Specified tee sizes are proper, gas baffle on outlet tee l__.----
20. Sewage is under 10,000 gpd for parcel L.------
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 L___-
26.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 _-----
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:
32.Engineer/Registered Sanitarian and Land Surveyor stamps/signature y/---
33.H-20 loading is subject to vehicular traffic, groundwater L.--------
34. Title V Application and permit fee, installer signature ..____----
.------
35.
___----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:
06/03iO3