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�'<y- TOWN OF YARMOUTH
SEWAGE PLAN REVIEW CHECKLIST
I,ocation: A.M. �� Lot�� Zone of Contribution: In_ Out (�Acreage �
d /' Commercial: ResidentiaL c�
Street: /6 l Gtl� .GQ.yC�
Village:� Floor Plan: #Bedrooms:
Owner: Ci r � C� Installer: �
Address: ! �6��� �' �/�Dy�hone:
' Phone: T
Builder: ? Engineer: /7 � (�7.�z�� _
Address: Phone: �i7� -7 �'- /9
� Phone: �.,.�GG��� LE'�.u� � �-Fry,�
N/A YES NO
1.R uired#of co ies received t/
2. Date of soils e�m and ercolarion test not older than 2 years
3. 45 ft of naturall occurrin ervious material,above water table �•
� 4.Foundation 2 ft above hi oint of road H.P.: Fnd: Vaz.:
5. Water line 10 ft from s tic com onents Vaz.:
6.Benchmazk indicated and shown-NGVD if near wetlands � �yt � c:�
7. S tic tank minimum 10 ft from foundation, deck Vaz.: i f
8. Leachin minimum 20 ft full, 15 ft crawl, 10 ft slab Var.:
9. I,eachin minimum 100 ft from w�lands Vaz.:
10. Leaching minimum 150 ft from drinkin welU25 ft irrigation well Var.:
11. Tank/leachin minimum 10 ft from ro erty line Vaz.:
12. S stem meets all other setback r uements Vaz.:
i 13.Uses ad�ustment for maximum hi oundwater Vaz.:
' 14. Leaching set 4-5 ft above ad'.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 irements-min. I/S", '/<" eferred �/
18. System meets breakout r uirements PVC liner: Wall: ii
19. Spec�ed tee sizes aze ro er, baffle on outlet tee � .
20. Sewa e is under 10,000 d for arcel �/
21.No ba e dis osal �.�
22. S stem ad uatel sized for its intended use `i '
23. Minimum 6"stone or com acted below tank and dbox �
24.Manhole covers witUin 6"of ade, um chamber cover to e
25. Inspection on plastic chambers/leach field `�
26.Electrical ermit for um chamb�/S azate meter for du lexes
27.Pum stem-2" line,wee hole,check valve,tee in dboic, ump size f
28. Septic tank/ ump chamber to be facto waterproofed
29. Vent rovided if leachin below 3 feet,under drivewa /pazking
30. Buoyancy calculations for tank/ ump chamber
31. En ' eer to ins ect and cert' soils: wall: commercial:
32. En 'neer/Registered Sanitarian and Land Surve or stam s/si ture
33. H-201oadin is subject to vehicular traftic, oundwater �-
34.Title V A lication and permit fee, installer si ture
35.Foundation footin min. 2 feet above adjusted ound water for new house `�
36.Deed Resh�iction r uired ma�c. #bedrooms: max. flow: _�
37.Check azea lots for oundwater/Label oundwater in Assessor's Ma
Plan reviewed by: /� �mPo3
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