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TOWN OF YARMOUTH
SEWAGE PLAN REVIEW CHECKLIST
Location: A.M. 'X Lot /e..5Zone of Contribution: In Out_ Acreage
Commercial: Residential:
F Street: /-� -, �E-5 ,5(3,-- ---- .
Village: Sl, - Y (7, Floor Plan: #Bedrooms:
iOwner `5‘c.2-5,----t----/ /-c - Installer: /'e c�cam(
Address: Phone: .$t0- e, 4.6 -
Phone: -/3 - 3,91/_:S'37
Builder Engineer: /7/1e ei 5-,Z S `=yv 6-
Address: / Phone: • � Sejp-33 f',"
Phone:
N/A YES NO
1.Required#of copies received
2.Date of soils exam and percolation test not older than 2 years V
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.: V/
5.Water line 10 ft from septic components Var.: 7/
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.: /
9.Leaching minimum 100 ft from wetlands Var.: /I/
10.Leaching minimum 150 ft from drinking well/25 ft irrigation well Var.: V
11.Tank/leaching minimum 10 ft from property line Var.: /
12. System meets all other setback requirements Var.:
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
16.Proposed contours are suitable I
17. System meets slope requirements-min. 1/8", 'A"preferred •
17/
18. System meets breakout requirements PVC liner: Wall: V
19. Specified tee sizes are proper, gas baffle on outlet tee
20. Sewage is under 10,000 gpd for parcel V
21.No garbage disposal
22. System adequately sized for its intended use V/
23.Minimum 6"stone or compacted below tank and dbox
24.Manhole covers within 6"of grade,pump chamber cover to grade
25.Inspection port on plastic chambers/leach field
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 4,,
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 V
33.H-20 loading is subject to vehicular traffic,groundwater V
34.Title V Application and permit fee, installer signature >/
35.Foundation footing min.2 feet above adjusted ground water for new house v/
36.Deed Restriction required max. #bedrooms: max. flow: gpd ;,/
37.Check area lots for groundwater/Label groundwater in Assessor's Map IV
Plan reviewed by: pl,,,Q i J I 1/111
�""fv� 6/03/03