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Gt, n TOWN OF YARMOUTH
CA'rea SEWAGE PLAN REVIEW CHECKLIST
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Loca •on: A.M. Lot Zone of Contribution: In Out / Acreage
Commercia Residential: Y----
Street: -rat_ L-1,._
Village: Floor Plaeraim„Pill" #Bedrooms: 3
9 -R 6 wA --
Owner: Installer:
Address: Phone:
Phone: II
Builder: Engineer: V C
Address: Phone: ��
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 V
4. Foundation 2 ft above high point of road H.P.: Fnd: Var.: ✓
® ater line 10 ft from septic components Var.: K
6. Benchmark indicated and shown—NGVD if near wetlands ✓
Septic tank minimum 10 ft from foundation, deck Var.: �CtS41/ 4)
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Leaching minimum 20 ft full, 15 ft crawl, 10 ft slab Var.: x
9 Leaching minimum 100 ft from wetlands Var.: X
1 . Leaching minimum 150 ft from drinking well/25 ft irrigation well Var.: %/
Tank/leaching minimum 10 ft from property line Var.: d/VSystem meets all other setback requirements Var.:
X.
Uses adjustment for maximum high groundwater Var.: V14 eaching set 4-5 ft above adj. water or bottom of test hole Var.:
System not in top or subsoil(A,B horizons)or 5' removal r�N,r� �/AiVI etkeL X_
Proposed contours are suitable
17. System meets slope requirements—min. 1/8", '''4"preferred ,/
18. System meets breakout requirements PVC liner: X Wall:
19. Specified tee sizes are proper, gas baffle on outlet tee
20. Sewage is under 10,000 gpd for parcel ✓
21.No garbage disposal t/'
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
5. Inspection port on plastic chambers/leach field
Electrical permit for pump chamber/Separate meter for duplexes V
27. Pump system-2"line,weep hole,check valve, tee in dbox,pump size t/
28. Septic tank/pump chamber to be factory waterproofed V-
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 ✓
34. Title V Application and permit fee, installer signature
35. Foundation footing min. 2 feet above adjusted ground water for new house i/. -
36. Deed Restriction required max. #bedrooms: max. flow: gpd V-
37.
/
37. Check area lots for groundwater/Label grou el a er ' Assessor's Map ✓
Plan reviewed by:
6,03 03