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� _'� � """ TOWN OF YARMOUTH � /
- SEWAGE PLAN REVIEW CHECKLIST ` _ ��- �l
_[ ti� �Out Acreage ��Uv�/ ` �"
I,ocation: A.M. Lot �o � Zone of Contribution: In_
, '. Commercial: Residential:�
��- - �
Street: � �. �Q/A "� �"s�. �
Village: Floor Pi�� #Bedrooms:
Owner: �7JvhL� Installer: C7�.-'�d� ��1�2L-� _ �
Address: Phone: 77/ - �
Phone: �
Builder: Engineer: ���//l UYl(�
Address: Phone: �j
Phone:
N/A YES NO
1.Re uired#of ies received
: 2. Date of soils esam and reolafion test not older than 2 ears
3. 4-5 ft of natural occurrin ervious material, above water table
4.Foundation 2 ft above hi im of road H.P.: Fnd: Vaz.:
5. Water line 10 ft from s tia com onents Vaz.: ^�
6. Bencl�wark indicated and shown-NGVD if near wetlands
7. S tic tank minimum 10 ft from foundarion, deck Vaz.:
8.I,eachin minimwn 20 ft full, 15 ft crawl, 10 ft siab Var.: •
9. Leachin minimum 100 ft from wetlands Vaz.:
10. Leachin minimum I50 ft from drinkin welU25 ft irri tion well Vaz.:
11. Tank/leachin minimum 10 ft from r erty line Var.: � ��
12. S stem meets all other setback ' ements Vaz.:
13. Uses ad'ustment for inaximum hi groundwater Vaz.:
14. I,eaching set 45 ft above ad'.water or bottom of test hole Vaz.:
15. S stem not in to or subsoil(A,B horizons)or 5' r�noval
16.Pro osed contours aze suitable
17. S stem meets slo e r uirements-min. 1/8", Yd' eferred
18. S stem meets breakout r irements PVC liner: Wall: �,�
19. S ified tee sizes aze r er, baffle on outlet tee L�
20. Sewa e is under 10,000 for el
21.No ba e dis osal ,�
�22. S stem ad uatel sized for its i�ended use
23. Minimum 6"stone or com acted below tank and dbox
24.Manhole covers within 6"of ade, chamber cover to de
25. Ins ion ort on lasdc chambers/l�ch field
26. Electrical ermit for um chamber/S ate meter for du lexes L/
27.Pum s stem-2" line,w hole,check valve,tee in dbou, um size
28. Septic tank/ um chamber to be facto wat roofed �
29.Vent rovided if leachin below 3 feet,under driveway! arkin
30.Buo ancy calculations for tank/pum chamber
31.En ' eer to ins ect and cert' soils: wall: commercial:
32. Engineer/Registered Sanitarian and Land Surv or stam s/si ture
33. H-20 loading is subject to vehiculaz trafHc, oundwater
34. Title V A lication and �mit fee, installer si ture _i
35.Foundarion footin min. 2 feet above ad'usted ground water for new house
36.Deed Restriction uired ma�c. #bedrooms: max. flow: d `-�
37. Check azea lots for oundwater/Label oundwater in Assessor's Ma
Plan reviewed by: �� dmio3