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1091 Septic System Checklist 2017 �r( I� 1)-0/a / Commonwealth of Massachusetts )091 W2S'tZ.wwkp yta iJ k' ' City/Town of 1 Septic System Installation Checklist #x01 1-/ 3 B. Application Checklist (cont) 2. Construction Inspection / � r s r u a) Building Sewer(310 CMR 15.272) Approved N/A Problem AU waste pipes tied into building sewer Basement check era 0 0 • Schedule 40 PVC 4' or cast iron Verify by reading pipe (Zy 0 0 Minimum slope of 0.01-a02 Visual 12" ❑ 0 Pipe laid in continuous straight line Visual Er ❑ 0 Pipe laid on compact, firm base Visual filr. 0 0 Cieanouts precede all changes in alignment/gradeVerify by visual/tape 0 Cleanout provided every 100 ft. Verify by visual/tape ❑ ❑ Backfill material clean Visual [46,..--<0 ❑ b) Septic Tank(310 CMR 15.223) Approved N/A Problem Tank is set level with 6"stone under (15-228) Check with level Or- ❑ 0 Tank is required size/loading per plan Verify With plan (7/ 0 0 • Inlet and outlet are at proper location (15.227) Verify with plan // g2"-- 0 0 Tank is water tight(15.226) Test DK 0 0 0 Outlet tees extend 6"above flow N'ne Verify by visual/tape 0 0 Approved filter device placed at outlet DEP list Ilr. 0 0 Gas baffle installed at outlet tee Visual gg/ 0 0 Inlet and outlet tees on center Ihie Visual er ❑ 0 Tank is backfilled with acceptable material Visual Vi---- . 0 0 Notes: Booth System Installation Checklist 11-09.doo•data Form Name•Pepe 2 of 0 Z\• 1/441/4 v Commonwealth of Massachusetts ;'s w City/Town of If Septic System Installation Checklist B. Application Checklist(cont.) ------------___-__._—.._"_. c) Distribution Box (310 CMR 15.232) Approved N/A Problem All outlet pipes at same elevation Check by adding water ❑ " Number of outlets I Number of laterals ❑___ per Nen --..-.... .. Inlet tee min. 1"over outlet Visual :nd w/taps 0 0 D box set on level base Visual Le Top of D box 36'max depth Visual nd w/tape QV 0 ❑ D box is water-tight Add water gr D box has a minimum of 2" thick wall and 0 ❑ 12'Inside dimension 0 ❑ d) Pump Chamber pi CMR 15.231) Approved N/A Problem Tank is set level 0 d w/level [ ❑ Proper volume is provided and tank ❑ ❑ Float elevations set per plan Measure w/tape Min. 2'delivery line to D box Visual x:/ 0 0 Number of pumps: 0 Specified pump provided or designers approval for equal pump Correct pump sequence ta' ❑ ❑ Covers eat to grade ❑ ❑ Electrical permit provided 0 ❑ S'of stone beneath chamber0erEr 0 Chamber is water-tight _ 0 Min. 9"cover provided Visual t< ❑ ❑ Correct loading provided per plan Visual on tank 1C4 ❑ ❑ Notes: Sept System ins talri on Checklist r t"e9.doo•date Farm Name P Page 3 of 8 Commonwealth of Massachusetts City/Town of Septic System Installation Checklist B.Application Checklist(cont) — T" _ _____!'_____-- • e) Leaching Facility (310 CMR 15.240) Approved N/A Problem No frozen material used including back fill Visual B ❑ ❑ No clay, tailings or stones larger Nan 6'for IGS ❑ p cover materiel • Soil at bottom /sides of excavation matches info on deep holes ❑ ❑ All impervious layers removed Visu:l 0 0 i No remaining NB horizons e ❑ ❑ Groundwater conditions match plan and ,,., , deep holes Visual [Pi.", 0 0 Vented if under impervious cover per plan ❑ ❑ (15.241) Vent is protected from precipitation and animal entry Cr ❑ CJ Cover of a minimum of 9"over leach area Z.----. El Pipe slope equal to 0.o05 Check transit ��. ❑ ❑ Leach area per design(15.241) / E1 0 ❑ Excavation is level and at required depth Visuailcheck plan , /I� ❑ ❑ Removal of 5 ft material and replacement ,,,/// / ❑ 0 (din fill) i V sual/check plan // Ej� Back fill material is acceptable Visual . / ❑ Cl ❑ Final contours correct per plan Check with plan V [Q "--- ❑ 0 Surface/subsurface drainage away from lb..--,/ ❑ ❑ • leech area Final grade and side slopes are stable j/ 0 Cl Distribution lines are capped, vented, or Y�,J / 0 0 connected together � Impermeable barrier(15.255[2)) 0 0 0 Retaining wall inspected by PE ❑ ❑ ❑ Retaining wall is water-proofed ❑ ❑ ❑ Retaining wall/barrier is at correct Cl ❑ 0 depth/height Septic System InOepation Cheoldist 11-09.kbc•date Form Name•Page 4 of 4 Commonwealth of Massachusetts H r. 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; .__._-____-_..._._._.. ❑ ❑ ❑ Depth of trenches: E ❑ 0 Width of trenches: ❑ ❑ n Trench spacing per plan ❑ ❑ ❑ Stone is double-washed[3/4"to 1W3(15.247) ❑ ❑ ❑ g) Leaching fields(310 CMR 15.242) Length of field: ❑ ❑ ❑ Width of field _._ __._,T_____ ❑ ❑ 0 Min. of 2 distribution lines 0 ❑ ❑ Separation distance conforms to plan ❑ ❑ ❑ Stone is double-washed[3/4" to 1141(1E247) ❑ ❑ 0 h) Leaching Pits(310 CMR 15.253) Number of pits; 0 0 0 Depth of pts: ..__----_-_-.--- 0 ❑ ❑ Stone is double-washed[3/4'to 1X•1(15.247) 0 0 0 Each pit has min. 1 201 access cover ❑ 0 ❑ Piping network and configuration of ❑ ❑ 0 pita/chambers per plan i) Tight Tank(310 CMR 15.260) Tank is set level with 8'stone under Visual and with level ❑ ❑ 0 Tank is proper size per plan Visual with plan 0 ❑ ❑ Pumping contract has been provided ❑ ❑ ❑ Covers to grade Visual 0 ❑ ❑ NV alarm set at 3/5 tank capacity Check floats by raising ❑ ❑ ❑ . AN alarm test on separate drcuit Set off alarm 0 ❑ ❑ Septic System Iemeaaaon Cbockaet 1 t-09.doc•Join Form llama•Paoa 5 of A • „ y Commonwealth of Massachusetts -4' City/Town of r Septic System Installation Checklist B. Application Checklist(cont.) Certificate of Compliance(310 CMR 15.021) As Built Plan Submitted . ___ Dale .___.___.—__.-..._.. Signed by Installer Dale Signed by Designer Data Certificate of Compliance Issued Dela----- .. • Notes: Sopa°System Installation Checklist 11-09 doc•data Form Name•Pape 6 of