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
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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
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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