32 Septic Checklists 2015 PROJECT NO.: 2 X1.5 -
CITY/TOWN: ok= •aF.Prp,.i
APPLICANT: c3g..&5 'c tcot
ADDRESS: War Fa∎R,
DESIGN FLOW:
REVIEWED BY:
443
C�A4JNrJ
gpd
DATE: yL4/7O75!
OK
f t
Legal boundaries denoted [310 CMR 15.220(4)(a)]
Street, Lot,tax parcel number and lot number noted on plan [310
CMR I5.220(4)(u)]
Locus Provided [310 CMR 15.2204(t)]
/
x
Plan proper scale?(1"=40' for plot plans, 1"=20' or fewer for
components) [310 CMR 15.220(4)]
/- -. 3a'
Asav-tcA
Easements shown [310 CMR 15.220(4)(b)]
eve,->c.---
System located totally on lot served [310 CMR 15.405(1)(a) for
upgrades]- if not, a variance is required [310 CMR 15.412(4)]
Location of impervious surfaces (driveways,parking areas etc.)
[310 CMR 15.220(4)(d)]
✓
Location all buildings existing and proposed 310 CMR
15.220(4)(c)]
✓
Location and dimensions of system components and reserve
areas. [310 CMR 15.220(4)(e)]
7"
fAtiLg
System Calculations [310 CMR 15.220(4)(f)]
daily flow
✓
septic tank capacity(required and provided)
✓
soil absorption system(required and provided)
,C
whether system designed for garbage grinder
✓
North arrow [310 CMR 15.220(4)(g)]
Existing and proposed contours [310 CMR 15.220(4)(g)]
,'
Location and log of deep observation holes (existing grade el. on
each test) [310 CMR 15.220(4)(h)]
Names of soil evaluator and BOH representative [310 CMR
15.220(4)(h)and (i)]
✓
Location and date of percolation tests (performed at proper
elevation?) [310 CMR 15.220(4)0)]
7
Percolation test results match loading rate? [310 CMR 15.242]
Certification statement by Soil Evaluator [310 CMR 15.220(4)(j)]
erg--
Observed and Adjusted groundwater(method for adjustment
given or indicated) [310 CMR 15.103(3)and 310 CMR
15.220(4)(n)]
7,
Address
5 q5
Aop ✓
ADD /
tars,`fr.v ex
tihcfO
Ciwamrf��s?
Sheet 1 of 13
Address
WkTEC UNE,
r.1ur 5Keu-tl
Sheet 2 of 13
ovation of every water supply,public and private, [310 CMR
5.220(4)(k)]
f surface water supplies and gravel packed public water supply
ells
within 250 feet of the proposed system location in the case
f tubular public water supply wells
✓
/
within 150 feet of the proposed system location in the case
f private water supply wells
✓
ovation of all surface waters and wetlands located up to 100 ft.
eyond setbacks listed in 310 CMR 15.211 and any catch basins
>cated within 50 ft. [310 CMR 15.220(4)(1)]
Vater lines and other subsurface utilities located [310 CMR
5.220(4)(m)] (if water line cross see 310 CMR 15.211(1)[1])
✓
Profile of system showing invert elevations of all system
omponents and the bottom of the SAS [310 CMR15.220(4)(o)]
✓'
!tamp of designer [310 CMR 15.220(1) and 310 CMR 15.220(2)]
damp of Registered Land Surveyor(required if construction
ctivities within 5 ft. of lot line) [310 CMR 15.220(3)]
'est Holes adequate (two in each of the primary and reserve
finless trenches as permitted in 310 CMR 15.102(2)or as
tpproved for an upgrade under LUA at 310 CMR I5.405(1)(k)]
✓
fest hole adequate to demonstrate four feet of suitable material?
310 CMR 15.103(4)]
✓
fest Holes adequate to confirm adequate groundwater separation?
310 CMR 15.103(3)]
7
3enchmark within 50-75'of system [310 CMR 15.220(4)(q)]
Materials specifications noted? [various sections of 310 CMR
15.000]
System components not>36" deep (unless Local Upgrade
Approval or LUA requested) [310 CMR 15.405(1(b)]
All system components marked with magnetic tape 15.221(12)
Address
WkTEC UNE,
r.1ur 5Keu-tl
Sheet 2 of 13
e OK? [310 CMR 15.2230)]
et tee located ten inches below flow line [310 CMR 15.227(6)]
diet tee 14" or 14" +5" per foot for increase ft depth [310 CMR
.227(6)]
ttlet tee with gas baffle or approve
rte regarding installation on stable compacted base [310 CMR
.228(1)]
paration between inlet and outlet tees (no less than liquid
pth) [310 CMR 15.227(2)]
let/Outlet elevations at least 12" above high groundwater
xcept as described 310 CMR 15.227(5))or permitted for
grades under LUA [310 CMR I5.405(1)(k)]
inimum cover 9" (Tanks buried more than 9" must have risers
all openings and on the d-box) [310 CMR 15.22280) and 310
MR 15.232(3)(f)]
-tree access covers (inlet and outlet must be 20" or greater)-
iddle access at least 8" (by 7/07) [310 CMR 15.228(2)]
ccess to within 6 " of grade - one port for systems<1000gpd,
vo for systems>1000 gpd [310 CMR 15.228(2)]
11 at-grade covers secured to unauthorized access? [310 CMR
5.228(2)]
10 ft from building foundation [310 CMR 15.211(1)]
uoyancy calculation Required/Done [310 CMR 15.221(8)]
[-20 Where appropriate? [310 CMR 15.226(3)]
etbacks from resources [310 CMR 15.211]
t ter 310 CMR 15.227(4)]
✓
V
V
I
required when other than single-family dwelling or flow>1000
pd [310 CMR 15.223(0(b)]
irst compartment 200%daily flow; Second compartment 100%
Laity flow [310 CMR 15.224(2)and(3)]
U" pipe through or over baffle,outlet of each compartment with
as baffle or approved filter[310 CMR 15.224(4)]
t/
Address
Sheet 3 of 13
table compacted base [310 CMR 15.221(2) and 310 CMR
5.232(2)(a)]
plash plate or baffle tee required on inlet/provided? (when
ressure sewer to d-box or steep pitch of gravity sewer) [310
:MR 15.323(3)(a)]
riser if deeper than 9" [310 CMR 15.232(3)(f)]
)side minimum dimension 12" [310 CMR 15.232(2)(6)]
Minimum sump 6" [310 CMR15.232(3)(e)]
Vatertight cover if<2000gpd); waterproof manhole if>2000gpd
310 CMR 15.232(3)(d)]
Japacity(emergency storage above working design flow)? [310
:MR 231(2)]
?roper setbacks [310 CMR 15.211 (same as septic tanks)]
Watertight 20-in minium access manhole at least 20" MUST BE
ro GRADE [310 CMR 15.231(5)]
Service components accessible(not too deep with piping,
disconnects accessible)
Alarm floats- alarm on circuit separate from pumps specified?
Exceeds two units must have two pumps operating in lead-lag
mode. [310 CMR 15.231(6)and(8)]
Address
Sheet 4 of 13
rated at least ten feet from any water line? [310 CMR
222(2)]
,y,/\
sposal piping at least 18" below water line(when water and
ver cross, see 310 CMR 15.211(1)[1])
required/provided? [310 CMR 15.222(8)]
✓
.tanouts
rust blocks specified in force mains?310 CMR I5.221(6)(c)]
vi
Jpe of sewer line not less than 0.01 (1/8"/fr) 0.02 preferable
10 CMR 15.222(6)]
oper pitch on all runs? (.005 within gravity-distributed trenches
d beds) [310 CMR 15.251(9)and 310 CMR 15.252(2)(c)]
✓
phon problem/(leachfield below pump chamber)
/
idcaps or vent manifold specified?
N/
ze and orientation of discharge holes specified? (not smaller
an 3/8" not larger than 5/8") [310 CMR 15.251(8)and 310
MR 15.252(2)(h)]
✓
l
[aterials specified (310 CMR 15.251(5) specifies various pipe
nes allowed)
�/
table compacted base [310 CMR 15.221(2) and 310 CMR
5.232(2)(a)]
plash plate or baffle tee required on inlet/provided? (when
ressure sewer to d-box or steep pitch of gravity sewer) [310
:MR 15.323(3)(a)]
riser if deeper than 9" [310 CMR 15.232(3)(f)]
)side minimum dimension 12" [310 CMR 15.232(2)(6)]
Minimum sump 6" [310 CMR15.232(3)(e)]
Vatertight cover if<2000gpd); waterproof manhole if>2000gpd
310 CMR 15.232(3)(d)]
Japacity(emergency storage above working design flow)? [310
:MR 231(2)]
?roper setbacks [310 CMR 15.211 (same as septic tanks)]
Watertight 20-in minium access manhole at least 20" MUST BE
ro GRADE [310 CMR 15.231(5)]
Service components accessible(not too deep with piping,
disconnects accessible)
Alarm floats- alarm on circuit separate from pumps specified?
Exceeds two units must have two pumps operating in lead-lag
mode. [310 CMR 15.231(6)and(8)]
Address
Sheet 4 of 13
kddress
Sheet 5 of 13
We Compacted Base[310 CMR 15.221(2)]
oyancy calculations needed?Provided? [310 CMR 15.221(8)]
sing chamber capacity(required and provided),pump curves
1 specifications,number of dosing cycles and depth per cycle?
0 CMR 15.220(4)(r)]
I
luent tee filter provided? [310 CMR 15.231(10)]
kddress
Sheet 5 of 13
lculations correct?
eet of naturally occurring material demonstrated? [310 CMR
.240(1)]
quired separation to groundwater? [310 CMR 15.212)]
;gregate specified as double washed [310 CMR 15.247(2)]
stem Venting required/provided? (system under driveway or
6" deep) [310 CMR 15.241]
;pection ports specified and within 3"final grade? [310 CMR
.240(13)]
eakout requirements met? (No violation of breakout elevation
thin 15 ft of SAS unless barrier) [310 CMR 15.211(1)[4] and
ridance Document]
iambers and Gal. in trench configuration supplied with inle
try 20 ft. [310 CMR 15.253(6)]
ich structure with one inspection manhole (if>2000 gpd must
to grade) [310 CMR 15.253(2)]
ggregate 1' minimum-4'maximum. [310 CMR 15.253(1)(b)]
sidewall credit maximum [310 CMR 15.253(1)(a)]
i bed configuration, inlet every 40 sq. ft. [310 CMR 15.253(6)]
Tidth 2'minimum 3' maximum [310 CMR 15.251(1)(6)]
DO feet-maximum length [310 CMR 15.251(1)(a)]
linimum separation 2x effective depth or width whichever t
mate• -serve between trenches) [310 CMR 251(1)(d)] 9
ituated a ong contours [310 CMR 15.251(2)]
ireakout OK? [310 CMR 15.211(1)[4] and Guidance Document]
Minimum 2 distribution lines [310 CMR 15.252(2)(a)]
ilaximum separation between lines 6' [310 CM R15.252(2)(d)]
ataximum separation between lines and outside of bed 4' [310
:MR 15.252(2)(e)]
kggregate depth below discharge pipes 6" minimum, 12"
naximum. [310 CMR 15.252(2)(g)]
separation between beds 10'minimum. [310 CMR 15.252(2)(0]
3ottom area used in calculations only [310 CMR 15.252(2)0)]
Sheet 6 of 13
Address
assure Dosed System ? Provided pump and piping
zulations as required [310 CMR 15.220(4)(r)]
,undwater Separation Per 310 CMR 15.240(12) does the
undwater separation take into account mounding.
ssure dosing required on all systems>2000gpd or alternative
tems under remedial approval [310 CMR 15.254(2) and 1/A
medial Use Approvals]
rsed in gravelless system-make sure jet is directed as not to
mr soil interface[Guidance Document]
once per year(systems<2000 gpd)or quarterly
?000gpd)good to note on plan [310 CMR 15.254(2)(d)]
?nstruction in fill - Did the plan specify that the fill shall meet
specification of 310 CMR 15255(3)?
fl i.L FWLr15
ri 772—
pervious barrier and/or retaining wall ? [Guidance Document]
Impervious barrier installation must be supervised by
signer [310 CMR 15.255(2)(b)]
Retaining wall must be designed by Registered Professional
igineer [310 CMR 15.255(2)(a)]
Side slope not exceed 3:1 ? [310 CMR 15.255(2)]
Breakout requirements met? [310 CMR 15.252(2)and
uidance Document]
At least 5 ft. from impervious barrier to edge of SAS (10 ft.
commended) [310 CMR 15.255 (2)(e)]
Check DEP Approval letters for credits and design conditions
If used with pressure dosing do not allow pressure discharge
• scour soil interface
Was DEP Approval Letter provided and/or have you
;viewed the letter for conditions?
Is the technology being properly applied and does it meet all
/EP Approval Conditions?
Is there a note on the plan regarding the requirement for
perpetual maintenance agreement?
Any alarms involved on separate circuits
Did the applicant submit an operation and maintenance
manual?
agreement?
Are the variances listed on the plan? [310 CMR 15.220
4)(p)]
kddress
• Sheet 7 of 13
Wdress
Sheet 8 of 13
RLS Stamp necessary on plan if a component is within five
t of property line [310 CMR 15.412(4)]
New construction or increased flow proposed- [Refer to 310
1R 15.4141
Wdress
Sheet 8 of 13
he system in a Designated Nitrogen Sensitive Area(Zone II for
ublic supply well)? [310 CMR 15.214, 310 CMR 15.215 and
CMR 15.216 - also refer to Policy regarding upgrades of such
sting systems]
he system proposed on the same lot as served by private well ?
0 CMR 15.214(2)]
the nitrogen loads proposed in compliance? [310 CMR
216(1)]
mping to septic tank? [ 310 CMR 15.229]
ared System [310 CMR 15.290]
address
Sheet 9 of 13
Commonwealth of Massachusetts
City/Town of
Septic System Installation Checklist
B. Application Checklist(cont.)
2 Construction Inspection
a) Building Sewer(310 CMR 15.222)
All waste pipes bed into building sewer
Schedule 40 PVC 4'cc cast iron
Minimum slope of 0.01-0.02
Pipe laid in contiron"c straight Me
Pipe ltd on compact, firm base
Cleanouts precede all changes in
alignment/grade
Cleanout provided every 100 ft
Baddill material dean
b) Septic Tank (310 CMR 15223)
Tank is set lval with 6'stone under
(15 228)
Tank is required size/loading per plan
Inlet and outlet we at proper location
(15.227)
Tank is water tight(15.226)
Outlet tees extend 6'above flow ire
Approved filter device placed at outlet
Gas bawl installed at outlet tea
Inlet and outlet tees on wrier lira
Approved
Basement check
Verify by reading pipe .l>d
Visual L_i"
Visual rL__N///
Visual L"
Verify by visuavtape
Verify by visual/tape
Visual LS
Check wth level
Verify with plan
Verify with plan
Test
Verify by
DEP list
Visual
Visual
Tank is badMNed with axeptab1e material Visuall
'emu g
N/A
U
❑
❑
Problem
❑
❑
❑
Approved N/A Problem
LLJ,"/ ❑ ❑
L� ❑ ❑
Cr ❑ ❑
❑ ❑
suautape CY ❑ ❑
Er ❑ ❑
Ritt L✓ ❑ ❑
❑ ❑
d ❑ ❑
e System InbMeon Cheops't t.oe.aec•St.
Form Norm•Per 2 of 6
Commonwealth of Massachusetts
City/Town of
Septic System Installation Checklist
B.Application Checklist(cont)
c) Distribution Box(310 CMR 15.232) Approved N/A Problem
AP outlet pipes at same elevation Check by adding water E9 ['. ❑
Number of outlets Pwn Number of laterals
Inlet tee ma r over outlet Visual and whape
D box set on level base Visual
Top of D box 37 max depth Visual and w/tape
D box is water-tight Add water
D box has a minimum of Y thick wall and
tY inside dimension
d) Pump Chamber(310 CMR 15.231) Approved _N/AA Problem
Tank is set level \C and w/level 17� ❑
Proper volume is provided Check plan and tank //❑" ❑
Per Pia
C� ❑ ❑
L�l ❑ ❑
31/ ❑ ❑
Cif ❑ ❑
C� C ❑
Float elevations sat per plan Measure whop, jj) ❑ ❑
t Mm. 2•delivery line to D box Visual El ❑
Number of pumps. .__ __ ❑ El
Specified pump provided or designers ❑ ❑
approval to equal pump 44
Correct pump sequence 4 fj9 ❑ ❑
Covers set to grade U ❑ ❑
Electrical Pamir provided `❑ ❑ ❑
G of stone beneath chamber Visual ❑ p
Chamber is water-fight Test I❑ ❑ ❑
i
Min. 9'cover provided Visual I, ❑ ❑
�
Correct loading provided per plan Visual on tank "L JO ❑ ❑
Notes:
lc Symbol CheceYN 11-0 .*.c•dot
Farm Nana•Poe 3 of
A
Commonwealth of Massachusetts
City/Town of
Septic System Installation Checklist
B. Application Checklist(cont.)
e) Leaching Facility(310 CMR 15.240)
No frozen material used including back fill Visual
No clay, tailings or stones larger than 6•for
cover material
Soil at bottom/sides of excavation matches
info on'lisp holes
All impervious payers removed Visual , / ❑ ❑
No remaining NB horizons Visual L�' ❑
Groundwater conditions match plan and Visual!•''= plan ❑ ❑
deep holes
Vented if under impervious cover per plan ❑ ❑
(15241)
Vent
Vera is protected from preupnatan ❑ ❑
and animal entry
N/A Problem
❑ ❑
1G/ ❑ ❑
L ❑ ❑
Cover of a minimum of 9•over leach area
Pipe slope equal to 0.005 Check w/Vansit (��.,//' ❑ ❑
Leach area per design(15241) L�1// ❑ ❑
Excavation is level and at required dap' !=' - plan L1 ❑ ❑
Removal of 5 ft material and replacement,1r plan (J ❑ ❑
(a in fill)
Back fill material is acceptable Visual ❑ ❑
^ry❑"
V/ ❑ ❑
y0 0
❑
l /❑ ❑
❑ ❑ ❑
Retaining wall inspected by PE ❑ ❑ ❑
Final contours correct per Man
Surfacrsubsuface drainage away from
leach area
Fined grade and side stapes are stable
Distribution fines we upped, vented, or
connected together
Ihpem»able barrier(15.255[2))
Check with plan
Retaining wall is water-proofed
Retaining walUbarrier is at correct
dot
b System kNYlsfen Choldie 11-09.doc•dog
Form Name•peps 4 of s
Commonwealth of Massachusetts
City/Town of / "4, 3a G: foci Pr, Lfc
Septic System Installation Checklist
B. Application Checklist(cons)
f) Leaching benches(310 CMR 15251) Approv NIA Problem
Number of trenches: — ❑ ❑
Depth of trendies: k`3
NFdth of trenches: r'-. ❑ ❑
Trench spaang par plan [k" ❑
Stone is double-trashed[3/4'to 1W1(15.247) l' U
g) Leaching fields(310 CMR 15.242)
nay (a.r) ❑ ❑
Length of field: r
Width of field. 53' u ❑
Min. of 2 distribution lines ❑ ❑
Separation distance conforms to plan [F ❑ ❑
Stone is double-washed(314'to 1%1(15.247) ❑ ❑
h) Leaching Pits(310 CMR 15.253)
Number of pits. _.- . ______ ❑
Depth of pits: ❑
Stone is doublrwaahW(314'to 1W (15.247) ❑
Each pit has min 1 20'access cover le ❑
Piping network and configuration of ❑
prhltlwrtten per plan
i) Tight Tank(310 CMR 15.260)
Tank is set level with 6' stone under Visual and with level ❑
Tank is proper size per plan Visual with plan ❑
• Pumping contact has been provided ❑
Covers to grade Visual ❑
AN alarm set at 315 tat capacity Check floats by raising ❑
. AN alarm test on separate emit Set off alarm ❑
Form rww•v.r s as
System tmeHaaw•pedal I late•dy•
Commonwealth of Massachusetts
City/Town of
Septic System Installation Checklist
B.Application Checklist(cont)
j) Certificate of Compliance(310 CMR 15.021)
As Built Plan Submitted
Signed by Installer
Signed by Designer
Certdicate of Compliance Issued
Notes
Dse
Dee;
Date
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PROJECT LOCUS FOR
32 FAIRWAY DRIVE
FLORENCE, MA