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TOWN OF YARMOUTH
SEWAGE PLAN REVIEW CHECKLIST
` y Location: A.M. 4 Lot 7 7 Zone of Contribution: In Out Acreage -�-
Street: �'(
%2/ � Commercial: Residential: -��
-0'
Village: A(140 , Floor Plan: C -__. #Bedrooms:
Owner: /C Q s'h Installer: 001/4 f ILI
Address: Phone:
Phone:
Builder: Engineer: , ./
g `
Address: Phone: _ /- 4I 41
� /
Phone: _ fY / di
N/A YES NO
1.Required#of copies received
2. Date of soils exam and percolation test not older than 2 years C1
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.: ,_---
5. Water line 10 ft from septic components Var.:
6. Benchmark indicated and shown-NGVD if near wetlands �------
7. Septic tank minimum 10 ft from foundation, deck Var.: j
8. Leaching minimum 20 ft full, 15 ft crawl, 10 ft slab Var.: `7 � ----
9. Leaching minimum 100 ft from wetlands Var.:
10. Leaching minimum 150 ft from drinking well/25 ft irrigation well Var.: ✓
11. Tank/leaching minimum 10 ft from property line Var.: S k_
12. System meets all other setback requirements Var.: T '` <H /
13. Uses adjustment for maximum high groundwater Var.: I
14. Leaching set 4-5 ft above adj.water or botto of test ho ,
15. System not in top or subsoil'(A,B horizons) 5' removal
16.Proposed contours are suitable �__-
17. System meets slope requirements-min. 1/8", 1/4"preferred \ 1
18. System meets breakout requirements PVC liner: illou,Wall: L�
19. Specified tee sizes are proper, gas baffle on outlet tee Lf
20. Sewage is under 10,000 gpd for parcel `..,----
21.No garbage disposal (._1
22.System adequately sized for its intended use L1
23.Minimum 6"stone or compacted below tank and dbox t._f
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 �---'
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
33. H-20 loading is subject to vehicular traffic, groundwater
34.Title V Application and permit fee, installer signature (-------7,
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: g'J 6/03/03