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7� �' /� TOWN OF YARMOUTH �li�L�C . � /''�`<���J%�n
SEWAGE PLAN REVIEW CHECKLIST�
, Location: A.M. /o Lot �6� Zone of Contribufion: In_ Out Acreage�_���
� '/ Commercial: Residential:�
Street: O f�/�%4L/ / 3
Village: Floor Pian: �/ #Bedrooms:
Owner: �- ��K/�� Installer: � � �
Addcess: Phone:�� �,7�- D'/� �
Phone:
Builder: Engineer: G+ LL ��0�'/
Address: Phone: �
Phone: ��`'� '- � lr✓:��vt�7�Gi
N/A YES NO
l.R uired#of ies received �/
2.Date of soils exam and ercolation test not older�an 2 ears L�
3.45 ft of natural occurrin ervious material, above water table L�
4.Foundation 2 ft above hi im of road HP.: Fnd: Vaz.:
5.Water]ine 10 ft&om s tic com onents Var.:
6.Benchmark indicated and shown-NGVD if neaz wetlands
7. S 'c tank minimum 10 ft from foundarion, deck Var.: �/
8. I.eachin minimum 20 ft fiill, 15 ft crawl, 10 ft slab Var.: �/
9. Leachin min'vnum 100 ft from wetlands Vaz.:
10.Ixachin minimum 150 ft from drinkin welU25 ft irri tion well Var.:
1 I.Tank/leachin minimum 10 ft from ro line Vaz.:
12. S stem meets all other s�back ' ements Vaz.:
13.Uses ad' eirt for maximum hi oundwater Vaz.:
14.Leachin sd 4-5 1t above ad'.water or bottom of test hole Var.:
15. S stem not in t or subsoil(A,B horizons)or 5'removal
16.Pro sed contours aze suitable ✓
17. S stem meets slo r irements-min. 1/8", '/." eferred
18. S meets breakout r uirements PVC liner: Wall:
19. S ecified tee sizes aze ro , baffle on outlet tee `�
20. Sewa e is under 10,000 for arcel (�
' 21.No 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 within 6"of e, cl�amber cover to e
25. ection rt on lastic chambeds/leach field
26.Electrical esmit for um chamb�/S ate meter for du lexes �-
27. stem-2" line,wee hole,check valve,tee in dbox, um size �
28. S tic tank/ chamb�to be wa roofed /
29.Vent rovided if leachin below 3 feet,undea drivewa / azkin �
30.Buo c calculations for tank/ u chamber
31.En ' eer to ins ect and c ' soils: wall: commercial:
32.En ' eer/Re ' ered Sanitarian and L.aud Surv or stam s/si ture
33.H-201oadin is sub'ect to velucular traffic, oundwater
34.Title V lication and ermit fee, installer si e
35.Foundation footin min. 2 feet above ad'usted ound water for new house �
36.Deed Restriction uired max. #bedrooms: max. flow: d
37.Check area lots for oundwat�/Label oundwata in Assessor's M
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Plan reviewed by: 2�' uavm