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� � � >/ TOWN OF YARMOUTH �
SEWAGE PLAN REVIEW CHECKLIST � '
� �C�l,l�: '� ��:.���;��%'
' � Location: A.M.� I,ot� Zone of Contribution: In�Ci Out Acreage -�0?�
� � Commercial: Residential:
Sh�eet:
Village: Floor Plan: �/ #Bedrooms: �
Owner: !� Installer: �
Address: Phone: �
Phone:
Builder: Engineer: ' ,
Address: Phone: 0 ' - 3 '
Phone: � y f, ��',� � �
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N/A YES NO
1.R ' ed#of co ies received
2.Date of soiLs e�ssam and �colation test not older than 2 years L/
3.4-5 ft of natura occurrin �vious material,above water table �/
4.Foundation 2 ft abwe hi int of road H.P.: Fnd: Vaz.:
5. Water line 10 ft from s tic com onerns Var.:
6.Bencl�mark indicated and shown-NGVD if near weUands
7. S 'c tank minimum 10 ft from foundation, deck Var.:
8. L,eachin minimum 20 ft fiil1, 15 ft crawl, 10 ft slab Var.:
9.Leachin min;mum 100 ft&om wetlands Vaz.: -- -
10.Leachin m;n;mum 150 ft from drinkin well/25 ft uri 'on well Var.: �
1 I.Tank/leachin minimum 10 ft from r erry line Vaz.: ��
12. S stem mcets all other setback uirements Vaz.:
13.Uses ad' tment for ma�mum hi oundwater Vaz.:
14.Leaclun set 451t abwe ad'.water or bottom of test hole Var.:
15. S stem not in or subsoil(A,B horizons) or 5'r�oval
16. sed contours aze suitable
17. S stem meets slo e ' ements-min. 1/8", '/<" eferred ��
18. S stem mcets breakout r irements PVC lina: Wall: �r
19. S ified tee sizes are r ex�, gas baffie on outlex tee
20.Se e is unda 10,000 d fot cel
21.No e dis osal ��
. 22. S stem ad uatel sized for its intended use
23.Minimum 6"stone or com acted below tank and dbox
24.Manhole covers witliin 6"of gade, um chamber cover to ade
° 25. ion on lastic chambers/leach field ��
26.Electrical ermit for um chambedS meter for du lexes -
27•Pum stem-2"line,wee hole,check valve,tee in dboat, size
28.S 'c tank/ chamb�to be f w roofed
29.Vent wided if leachin below 3 feet, unda drivewa / azldn _�
30.Bu c calculations for tank/ chamber �-
31.E ' e�to ins and soils: wall: comm�cial:
32.En ' eer/R ' e�ed Sanitarian and Land Surv or s/si ture
33.H-201oadin is sub'ect to vehicular traffic, dwate,r
34.Title V lication and ermit fee, installer s' ture
35.Foundation footm min. 2 fcet above ad'usted ound wat�for new house �
36:Deeci Rest�iction ired max. #bedrooms: max. flow:
37.Check area lots for oundwater/L,aUel oundwatea�in Assessor's Ma
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Plan reviewed by: �' ��