357 Septic Checklist 2014 PROJECT NO.: 20 t'l— it
CITY/TOWN: t' - -°Pr 7
APPLICANT: C1 tt /cE its-St.-rte ,e..1e(� 7—Nog— Setr�-T
ADDRESS: 3`J-"� [ S V-�Flao [ct 2aoa
DESIGN FLOW: 33-v
REVIEWED BY: "Sim SPA.•M1
an.0024S P P Wive, (e"-SCa �
gpd
DATE: gaJteyJ CO
Tit
doe
N/A OK NO
Legal boundaries denoted [310 CMR 15.220(4)(a)]
Street, Lot,tax parcel number and lot number noted on plan [310
CMR 15.220(4)(u)]
ALppc.
*
Locus Provided [310 CMR 15.2204(t)]
Plan proper scale? (1"=40'for plot plans, 1"=20' or fewer for
components) [310 CMR 15.220(4)]
its 3Dri
Ole-✓
Easements shown [310 CMR 15.220(4)(b)]
&owe:iv
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)]
f
/
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)]
System Calculations [310 CMR 15.220(4)(f)]
✓,
daily flow
septic tank capacity (required and provided)
f
soil absorption system(required and provided)
,/
whether system designed for garbage grinder
✓(,T)
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)(i)]
/
�✓
Percolation test results match loading rate? [310 CMR 15.242]
/
Certification statement by Soil Evaluator [310 CMR 15.220(4)(j)]
/
Observed and Adjusted groundwater(method for adjustment
given or indicated) [310 CMR 15.103(3) and 310 CMR
I5.220(4)(n)]
Address
as-Ynufl5
Sheet 1 of 13
Location of every water supply,public and private, [310 CMR
15.220(4)(k)]
of surface water supplies and gravel packed public water supply
wells
✓
within 250 feet of the proposed system location in the case
of tubular public water supply wells
within 150 feet of the proposed system location in the case
of private water supply wells
J
Location of all surface waters and wetlands located up to 100 ft.
beyond setbacks listed in 310 CMR 15.211 and any catch basins
located within 50 ft. [310 CMR 15.220(4)(1)]
�� ,
51 4 6'3 A
Water lines and other subsurface utilities located [310 CMR
15.220(4)(m)] (if water line cross see 310 CMR 15.211(1)[1])
1
Profile of system showing invert elevations of all system
components and the bottom of the SAS [310 CMR15.220(4)(o)]
/
Stamp of designer [310 CMR 15.220(1) and 310 CMR 15.220(2)]
J ,
Stamp of Registered Land Surveyor(required if construction
activities within 5 ft. of lot line) [310 CMR 15.220(3)]
`//
etia5 A rr
r 406.1E1
Test Holes adequate(two in each of the primary and reserve
unless trenches as permitted in 310 CMR 15.102(2)or as
approved for an upg'ade under LUA at 310 CMR 15.405(1)(k)]
,p---
Test hole adequate to demonstrate four feet of suitable material?
[310 CMR 15.103(4)]
—��
Test Holes adequate to confirm adequate groundwater separation?
[310 CMR 15.103(3)]
p
Benchmark within 50-75' of system [310 CMR 15.220(4)(q)]
sic
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
Sheet 2 of 13
Size OK? [310 CMR 15.223(1)]
Inlet tee located ten inches below flow line[310 CMR 15.227(6)]
Outlet tee 14" or 14" +5"per foot for increase ft depth [310 CMR
15.227(6)]
Outlet tee with gas baffle or approved filter [310 CMR 15.227(4)]
V
Note regarding installation on stable compacted base [310 CMR
15.228(1)]
Separation between inlet and outlet tees (no less than liquid
depth) [310 CMR 15.227(2)]
Inlet/Outlet elevations at least 12" above high groundwater
(except as described 310 CMR 15.227(5))or permitted for
upgrades under LUA [310 CMR 15.405(1)(k)]
I,
Minimum cover 9" (Tanks buried more than 9" must have risers
on all openings and on the d-box) [310 CMR 15.22280)and 310
CMR 15.232(3)(f)]
Three access covers(inlet and outlet must be 20" or greater) -
middle access at least 8" (by 7/07) [310 CMR 15.228(2)]
Access to within 6 " of grade - one port for systems<1000gpd
two for systems>1000 gpd [310 CMR 15.228(2)]
All at-grade covers secured to unauthorized access? [310 CMR
15.228(2)]
> 10 ft from building foundation [310 CMR 15.211(1)]
Buoyancy calculation Required/Done [310 CMR 15.221(8)]
H-20 Where appropriate? [310 CMR 15.226(3)]
Setbacks from resources [310 CMR 15.211]
✓/
Required when other than single-family dwelling or flow>1000
gpd [310 CMR 15.223(1)(b)]
First compartment 200%daily flow; Second compartment 100%
daily flow [310 CMR 15.224(2) and(3)]
"U" pipe through or over baffle, outlet of each compartment with
gas baffle or approved filter [310 CMR 15.224(4)]
I
I
Address
Sheet 3 of 13
Located at least ten feet from any
15.222(2)]
ater line? [310 CMR
Disposal piping at least 18" below water line (when water and
sewer cross, see 310 CMR 15.211(1)[1])
Cleanouts required/provided ? [310 CMR 15.222(8)]
J
I
Thrust blocks specified in force mains? 310 CMR 15.221(6)(c)]
Slope of sewer line not less than 0.01 (1/8"/ft) 0.02 preferable
[310 CMR 15.222(6)]
Proper pitch on all runs? (.005 within gravity-distributed trenches
and beds) [310 CMR 15151(9) and 310 CMR 15.252(2)(c)]
Siphon problem/(leachfield below pump chamber)
J
1
Endcaps or vent manifold specified?
Size and orientation of discharge holes specified? (not smaller
than 3/8" not larger than 5/8") [310 CMR 15.251(8)and 310
CMR 15.252(2)(h)]
f
Materials specified (310 CMR 15.251(5) specifies various pipe
types allowed)
Stable compacted base [310 CMR 15.221(2)and 310 CMR
I5.232(2)(a)]
Splash plate or baffle tee required on inlet/provided?(when
pressure sewer to d-box or steep pitch of gravity sewer) [310
CMR 15.323(3)(a)]
Riser if deeper than 9" [310 CMR 15.232(3)(f)]
Inside minimum dimension 12" [310 CMR 15.232(2)(6)]
Minimum sump 6" [310 CMRI5.232(3)(e)]
Watertight cover if<2000gpd);waterproof manhole if>2000gpd
[310 CMR 15.232(3)(d)]
I
::a
Capacity(emergency storage above working=design flow)? [310
CMR 231(2)]
Proper setbacks [310 CMR 15.211 (same as septic tanks)]
Watertight 20-in minium access manhole at least 20" MUST BE
TO 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)]
Stable Compacted Base [310 CMR 15.221(2)]
Buoyancy calculations needed ? Provided? [310 CMR 15.221(8)]
Address
1,31-Er i
t0 D-ic4
NO
7
h 5
Sheet 4 of 13
Dosing chamber capacity(required and provided),pump curves
and specifications, number of dosing cycles and depth per cycle?
[310 CMR 15.220(4)(r)]
Effluent tee filter provided? [310 CMR 15.231(10)]
Address
Sheet 5 of 13
Calculations correct?
4 feet of naturally occurring material demonstrated? [310 CMR
15.2400)]
Required separation to groundwater? [310 CMR 15.212)]
Aggregate specified as double washed [310 CMR 15.247(2)]
System Venting required/provided? (system under driveway or
>36" deep) [310 CMR 15.241]
Inspection ports specified and within 3"final grade? [310 CMR
15.24003)]
Breakout requirements met? (No violation of breakout elevation
within 15 ft of SAS unless barrier) [310 CMR 15.211(1)[4] and
Guidance Document]
Chambers and Gal in trench configuration supplied with inlet
every 20 ft. [310 CMR 15.253(6)]
Each structure with one inspection manhole (if>2000 gpd must
be to grade) [310 CMR 15.253(2)]
Aggregate 1'minimum- 4'maximum. [310 CMR 15.253(1)(b)]
2' sidewall credit maximum [310 CMR 15 253(1)(a)]
In bed configuration, inlet every 40 sq. ft. [310 CMR 15.253(6)]
Width 2'minimum 3'maximum [310 CMR 15.251(1)(6)]
100 feet- maximum length [310 CMR 15.251(1)(a)]
Minimum separation 2x effective depth or width whichever
greater(3x if reserve between trenches) [310 CMR 251(1)(d)]
Situated along contours [310 CMR 15.251(2)]
Breakout OK? [310 CMR 15.211(1)[4] and Guidance Document]
minimum 2 distribution lines [310 CMR 15.252(2)(a)]
Maximum separation between lines 6' [310 CM RI5.252(2)(d)]
Maximum separation between lines and outside of bed 4' [310
CMR 15.252(2)(e)]
Aggregate depth below discharge pipes 6" minimum, 12"
maximum. [310 CMR 15.252(2)(g)]
Separation between beds 10' minimum. [310 CMR 15.252(2)(f)]
Bottom area used in calculations only [310 CMR I5.252(2)(i)]
Address
r
I & I `t
Sheet 6 of 13
Pressure Dosed System ? Provided pump and piping
calculations as required [310 CMR 15.220(4)(r)]
Groundwater Separation Per 310 CMR 15240(12)does the
groundwater separation take into account mounding.
Pressure dosing required on all systems>2000gpd or alternative
systems under remedial approval [310 CMR 15.254(2) and I/A
Remedial Use Approvals]
If used in gravelless system-make sure jet is directed as not to
scour soil interface [Guidance Document]
Inspections once per year(systems<2000 gpd) or quarterly
(>2000gpd)good to note on plan [310 CMR I5.254(2)(d)]
Construction in Jill -Did the plan specify that the fill shall meet
the specification of 310 CMR 15.255(3)?
Impervious barrier and/or retaining wall ? [Guidance Document]
Impervious barrier installation must be supervised by
designer [310 CMR 15.255(2)(6)]
Retaining wall must be designed by Registered Professional
Engineer [310 CMR 15255(2)(a)]
Side slope not exceed 3:1 ? [310 CMR 15.255(2)]
Breakout requirements met? [310 CMR 15.252(2) and
Guidance Document]
At least 5 ft. from impervious barrier to edge of SAS (10 ft.
recommended) [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
to scour soil interface
Was DEP Approval Letter provided and/or have you
reviewed the letter for conditions?
Is the technology being properly applied and does it meet all
DEP Approval Conditions?
V
Is there a note on the plan regarding the requirement for
perpetual maintenance agreement?
V
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)]
RLS Stamp necessary on plan if a component is within five
feet of property line [310 CMR 15.412(4)]
Address
Sheet 7 of 13
New construction or increased flow proposed- [Refer to 310
✓
CMR 15.414]
Address Sheet 8 of 13
Is the system in a Designated Nitrogen Sensitive Area(Zone 11 for
a public supply well)? [310 CMR 15.214, 310 CMR 15 215 and
310 CMR 15.216 - also refer to Policy regarding upgrades of such
existing systems]
A
Is the system proposed on the same lot as served by private well ?
[310 CMR 15.214(2)]
Are the nitrogen loads proposed in compliance? [310 CMR
15.216(1)]
Pumping to septic tank? [310 CMR 15.229]
Shared System [310 CMR 15.2901
Address
Sheet 9 of 13