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TOWN OF YARMOUTH
' SEWAGE PLAN REVIEW CHECKLLST
� Location: A.M.� I,ot (U� Zone of Contribution: In_ Out� Acreage
� Commercial: Residential:��
str�: /���/� �1�i �. /
Village: �- /�v� Floor Plan: ✓ #Bedrooms:���
Owner: �/i� �!�(�i`i.�'k� Installer:_ �G��G� S
Address: r Phone:
Phone:
Builder: Engineer: �dt� /
�i ( �2P � ' /'/ Y�
Address: Phone: C-� -�� - /
Phone: - �t"i'A' c� �'GztC? ��G`�
N/A YES NO
l. ' ed#of ies received
2. Date of soIls e�cam and ercolation test not older than 2 ears �i
i� 3. 4-5 ft of natun occurrin ervious ma
terial, abwe water table `�.
4.Foundation 2 ft above lu i�of road H.P.: Fnd: Vaz.:
5. Wat�line 10 ft from s 'c com onems Var.:
6.Benchmark indicated and shown-NGVD if near wetlands
7. S tic tank minimum 10 ft from foundation, deck Vaz.:
8. Leachin minimum 20 ft full, 15 ft crawl, 10 ft slab Vaz.:
9.Leachin minimum 100 ft from wetlands Var.: �---
10.Leaching minimum 150 ft from drinkin well/25 ft ' ' 'on well Vaz.:
11.Tank/leachin mininium 10 ft from line Var.:
12. S stem meets all other setback ' ements Var.: ��
13.Uses ad' ent for ma�cimum high oundwater Vaz.:
14. Leachin set 4-5 ft above ad'. water or bottom of test hole Vaz.: `/
15. S stem not in or subsoil(A,B horizons)or 5'removal
16.Pro sed co�o�ss are suitable .��/
17. S stem meets sl e irements-min. 1/8", '/<" erred
18. System meets breakout r uirements PVC liner: VJall: `/
19. S ified tee sizes are ro er, baffie on oufld tee ��
20. Sewa e is unda 10,000 d for azcel
21.No ba e ' osal
22. S stem ad uatel sized for its mtended use
23.Minimum 6"stone or com acted below tank and dbox
24.Manhole covers within 6"of e, c}�amber cover to e �.
� 25. 'on on lastic cLamb�s/leach field
26.Electrical ermit for chamba/S meter for du le�ces �
27•P system-2"line,w hole,check valve,tee in dbox, size
28. S 'c tank/ chambea to be factory wa oofed
29.Vent rovided if leachin below 3 feet,under drivewa / azkin
30.Buoyancy calculations for tank/ chamber
31.En ' eer to ins ect and c ' soils: wall: commercial: �
32. ' cer/Re ' aed Sanitarian and Land Surv or s/si ture
33.H-201oadin is sub'ect to vehicular haffic, oundwater �
34. Title V lication and ennit fee, installer s' ture
35.Foundation footin min. 2 f�t above ad'usted ound water for new house f
36.Deed Restriction r ired max. #bedrooms: mazc. flow:
37. Check azea lots for oundwates/Label oundwater in Assessor's Ma
Plan reviewed by: _ � ��