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` TOWN OF YARMOUTH
SEWAGE PLAN REVIEW CHECHI.LST
� Location: A.M.�� Lot�_ Zone of Contribution: In Out� Acreage
Commercial: Residenrial�/�
s�c: 2 ��
Village: Floor Plan: � #Bedrooms:�
Owner: S ��� Installer: �
Address: Phone: '
Phone:
B,�ua�: ���: S �
Address: Phone: ' - / .
� Phone: - p� �g��? t c/<�/' W�� f/
�f�9r-�- %�-�i'�bC S t��.a�'rt�', ✓GS��'�
N/A YES NO
1.R uired#of ies received
2. Date of soils e�cam and olation test not older than 2 years `�
3.45 ft of na occurrin ervious material,above water table `i
4.Foundation 2 ft above hi oi�of road H.P.: Fnd: Var.:
5. Water line 10 ft from s tic com onerts Vaz.: `/
6.Benchmark indicated and shown-NGVD if near wetlands ��
7. S ' tank minimum 10 ft from foundation,deck Vaz.; �
8.Leachin minimum 20 ft full, 15 ft crawl, 10 ft slab Var.:
9.Leachin minimum 100 ft from wedands Vaz.:
10.Leachin minimum 150 ft from drinkin welU25 ft irri tion well Var.:
11.Tank/leachin minimum 10 ft&om r erry line Var.:
12. S stem meets all other s�back ' ements Vaz.:
13.Uses ad'us�ent for maximum hi aundwater Vaz.:
14.I.eachin set 45 ft above ad'.water ar bottom of test hole Vaz.: �
15. S em not in to or subsoil(A,B horizons)or 5'removal
16.Pr ed contours aze suitable
17. S meets slo e irements-mia 1/8", Y<" erred
18. System meetc breakout uirements PVC liner: Wall:
19. S ified tee sizes aze ro �, baffle on outl�tee
20. Sewa e is unda 10,000 d for arcel �
21.No ba e ' osal
22.S ad 1 sized for its 'vrtended use
23.Minimum 6"stone or com acted below tank and dbox
• 24.Manhole covers within 6"of ade, chamb�cover to e
25.Ins 'on ort on lastic chambers/leach field
26.Electrical �mit for um chamber/S e m�er for du le.ces
27. em-2"line,w hole,check valve,tee in dbo�t, um size
28. S tic tank/ cbamber to be facto wa roofed
29.Vern rovided if leaclrin below 3 feet,under drivewa / azldn
30.Buoyanc calculations for tank/ chambea
31. ' eer to ins ect and c ' soils: wall: commercial:
32.E ' eerB ' ered Sanitarian and I,and Surv or s/si e
33.H-201oadin is sub�ect to vehicular traffic, oundwater
34.Title V lication and ermit fee,installer si ture
35.Foundation footin min. 2 feet above adjusted ound water for new house
36.Deed Restriction ired max. #bedrooms: max. flow: d
37.Check azea lots for undwater/Label oundwater m Assessor's Ma
Plan reviewed by: �