245 Septic System Checklist 2017 ;,.1\ • 0///5. 4)6i-- FZ74/5 Ee.e4
Commonwealth of Massachusetts
i. -k' �
' City/Town of //7 //7
N Septic System Installation Che klist
B. application Checklist (cont.)
2. Construction Inspection
a) Building Sewer(310 CMR 15.222) Approved N/A Problem
Ali waste pipes tied into building sewer Basement check V/ ❑ ❑
• Schedule 40 PVC 4'or cast iron Verify by reading pipe ❑' ❑ ❑
Minimum slope of 0.01-0,02 Visual [] ❑ ❑
Pipe laid in continuous straight line Visual ❑ [) ❑
Pipe laid on compact, firm base Visual i❑_ ❑ ❑
Cleanouts precede all changes in Verify by visual/tape ❑ ❑ ❑
alignment/grade
Cleanout provided every 100 ft Verify by visual/tape ❑ ❑ ❑
Backfill material clean Visual ❑ • 0 ❑
b) Septic Tank(310 CMR 15.223) Approved N/A Problem
Tank is set level with 6"stone under E] ED(15.228} Check with level
a/Tank is required size/loading per plan Verify with plan [V' 0 C
• Inlet and outlet are at proper location �, /7 ❑ ❑
(15.227) Verify with plan �Y
Tank is water tight(15.226) Test ❑ ❑
Outlet tees extend 6"above flow line Verify by visual/tape g/ El ❑
Approved filter device placed at outlet DEP list jD/ ❑ ❑
Gas baffle installed at outlet tee Visual Q/ 0 ❑
Inlet and outlet tees on center line Visual L41 0 ❑
Tank is backfilled with acceptable material Visual I ❑ ❑
Notes:
______. .p.".0._d_
___________ _ __ ________ .__ . _________________________.____
_ _ _ _ _ . _ ......__________.. .... ... .. ....._____ _ __ __________ . _______
Septic System Installation Checklist 11-09.doc•date
Form Nemo Pepe 2 of 6
,, ,�
Commonwealth of Massachusetts
01fk - City/Town of
Septic System Installation Checklist
B. Application Checklist (cont.)
c) Distribution Box(310 CMR 15.232) Approved N/A Prcble
All outlet pipes at same elevation Check by adding water 1V7r-1. ❑
Number of outlets -- --- --- ---- N
per plan por pieumber of lateralsn__� ___ ._ _
Inlet tee min. 1"over outlet Visual and w/tape i ❑ ❑
0 box set on level base Visual [ ❑ ❑
Top of D box 36" max depth Visual and w/tape E7 0 0
0 box is water-tight Add water [ r i
D box has a minimum of 2" thick wall and
12"inside dimension ❑ ❑ ❑
•
d) Pump Chamber(310 CMR 15.231) Approved N/A Problem
Tank is set level Visual and w/level ❑ ❑
Proper volume is provided Check plan and tank 0
Float elevations set per plan Measure w/tape ❑ ❑ ❑
Min. 2" delivery line to D box Visual El 0
Number of pumps: ❑ ❑ f.J
Specified pump provided or designers
approval for equal pump ❑ j] ❑
Correct pump sequence
0
0 Cl
Covers set to grade ❑ ❑ 0
Electrical permit provided
0 f❑
6"of stone beneath chamber Visual 0 0 0
Chamber is water-tight Test 0 ❑ 0
Min. 9"cover provided Visual 0 ❑ ❑
Correct loading provided per plan Visual on tank 0 ❑ 0
Notes:
---
Septic System Installation Checklist t 1-09.doo•date
Form Name•Page 3 of 6
,y ,� Commonwealth of Massachusetts
0 k, CityfTown of
,'y Septic System Installation Checklist
B. Application Checklist (cont.) _ -- - -__
e) Leaching Facility (310 CMR 15.240) Approved N/A Proble
No frozen material used including back fill Visual EZ ❑ ❑
No clay, tailings or stones larger than 6" for1S2//,
❑ ❑
cover material
• Soil at bottom/sides of excavation matchesYr ❑
info on deep holes
All impervious layers removed Visual LJ ❑ ❑
No remaining A/B horizons Visual Lid' ❑ 0
Groundwater conditions match plan and ,�,/ 0 0
deep holes Visual/check plan fes'
Vented if under impervious cover per plan
0
0 ❑
(15.241)
Vent is protected from precipitation ❑ 0
❑
and animal entry
Cover of a minimum of 9"over leach area ❑ ❑
•
Pipe slope equal to 0.005 Check wltransit [] ❑
Leach area per design(15.241) 0 0 0
Excavation is level and at required depth Visual/check plan ER7[R7 0 0
Removal of 5 ft material and replacement
(if in fill) Visual/check plan ❑ 0
Back fill material is acceptable Visual 0 El ❑
Final contours correct per plan -- Check with plan [Y 0 0
Su ce//ssubsurface drainage away 6.m0
[} ❑
Final grade and side slopes are stable t� 0 0
Distribution lines are capped, vented, or
connected together ❑ ❑ ❑
Impermeable barrier(15.255(2)) ❑ 0 El
•
Retaining wall inspected by PE 0 0 0
Retaining wall is water-proofed ❑ ❑ 0
Retaining waltlbarrier is at correct
depth/height ❑ ❑ ❑
Septic System Ineteastion Checklist 11-09.doc•date
Form Name•Page 4 of 6
Commonwealth of Massachusetts
Cityfrown of
Septic System Installation Checklist
B. Application Checklist (cont)
j) Certificate of Compliance(310 CMR 15.021)
•
As Built Plan Submitted _.-__--
Date _
Signed by Installer date -- ---.- -.---_ _ __�� ___�..� _.___�_.
Signed by Designer
Date
Certificate of Compliance Issued
Date
Notes: •
_ 105 c I
444_ _
_______
Septic System Instatiation Checklist 11-09.doc•date
Form Name•Pane 6 of 6
Commonwealth of Massachusetts
ILi )11! .� City/Town of
(: Septic System Installation Checklist
B. Application Checklist (cont.)
f) Leaching trenches(310 CMR 15.251) Approved N/A Problem
Number of trenches: ❑ ❑
. u
Depth of trenches: __ ._______. _ _..__ . ❑ ❑ • El
Width of trenches: -- - --._...--- ❑ ❑
Trench spacing per plan 0 ❑ 0
Stone is double-washed [3/4"to 1'/")(15.247) El 0 0
g) Leaching fields (310 CMR 15.242)
Length of field: ___.. ❑ ❑ ❑
Width of field: __________..... ❑ 0 0
Min. of 2 distribution lines ❑ 0 0
Separation distance conforms to plan 0 0 0
Stone is double-washed[3/4" to 1W](15.247) ❑ ❑ ❑
h) Leaching Pits(310 CMR 15.253)
Number of pits: ❑ ❑ ❑
Depth of pits: ❑ ❑
Stone is double-washed[3/4`to 1W)(15.247) ❑ 0 0
Each pit has min. 1 20" access cover 0 ❑ ❑
Piping network and configuration of
pits/chambers per plan ❑ 0 0
i) Tight Tank(310 CMR 15.260)
Tank is set level with 6"stone under Visual and with level 0 0 0
Tank is proper size per plan Visual with plan ❑ ❑ ❑
• Pumping contract has been provided ❑ 0 ❑
Covers to grade Visual ❑ ❑ E
AN alarm set at 3/5 tank capacity Check floats by raising ❑ 0 ❑
. AN alarm test on separate circuit Set off alarm ❑ Q ❑
Septic System InataYation Chectidiat 11-09.doc•date Forth Name•Page 5 of 8