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TOWN OF YARMOUTH � +
' SEWAGE PLAN REVIEW CHECKLIST ' ,��,�. �����
. Location: A.M. � / Lot� Zone of Contribution: In� Out Acreage� �
/� J � /� � � Commercial: Residential: �e
Street: .Z�-/„ �p�p /l�l'i'C�' �� /
Village: ,�, / //G, Floor Plan: r/ #Bedrooms:�_
Owuer. f'�it U ��-QA�L� Installer: �
Address: Phone:
Phone:
Builder: Engineer: S S
Address: Phone:� - ( Z
Phone:
N/A YES NO
l.R ired#of co ies received
2.Date of soils exam and ercolation test not older than 2 ears
3.4-5 ft of natural occurrin ervious material, above water table
4.Foundation 2 ft above hi int of road H.P.: Fnd: Vaz.:
5. Water]ine 10 ft from s tic components Vaz.:
6.BencUwark indicated and shown-NGVD if near wetlands
7. S tic tank minimum 10 ft from foundarion, deck Var.:
8.Leachin minimwn 20 ft full, 15 ft crawl, 10 ft slab Vaz.: �f
9. Leachin minimum 100 ft from wetlands Var.:
10. Leachin minimum 150 ft from drinkiu welU25 ft irri tion well Var.:
11.Tank/leachin miuimum 10 ft from ro line Vaz.: �'
12. S stem meets all other setback r ' ements Vaz.:
13.Uses ad'ustment for maximum high goundwater Vu.:
14.Leaching set 4-5 it above adj.water or bottom of test hole Vaz.: `/
15.System not in to or subsoil(A,B horizons)or 5'removal ��
16.Pro osed contours aze suitable
17. S stem meets slo e r uuements-min. 1/8", '/<" eferted ��
18. S stem meets breakout r uements PVC liner: Wall: `�
19. Spec�ed tee sizes aze ro er, gas baffle on outle,t tee
20. Sewage is under 10,000 for azcel
21.No garba e dis osal ��
22. S stem ad uatel sized for its intended use
� 23.Minimum 6"stone or compacted below tanlc and dbox
24.Mauhole covers within 6"of ade, ump chamber cover to ade ��
25.Inspection port on lastic chambers/leach field
26.Electrical ermit for um chamber/S arate meter for du lexes
27.Pum system-2" line,weep hole,check valve,tee in dbox, ump size
28. Septic tauk/pum chamber to be factory waterproofed
29.Vent rovided if leachin below 3 feet, under drivewa / azkin
30. Buo ancy calculations for tank/pum chamber
31. En ' eer to ins ect and c soils: wall: commercial:
32.Engineer/Registered Sanitarian and Land Surveyor stamps/si ture
33.H-201oading is subject to vehicular traffic, oundwater
34.Title V A lication and permit fee, installer si ature �
35.Foundation footin min. 2 feet above adjusted ound water for new house --
36. Deed Restriction r uired max. #bedrooms: ma7c, flow: d -
37.Check azea lots for groundwater/Label oundwater in Assessor's Ma
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Plan reviewed by: 1 /( ,� sro3ro3