560 Checklist 2012 �o s/lies,h7 E
Checklist for Septic System Plan Review
/Application page attached to plan
l� PE or RS stamp, date,signature
/
3 Variances to property line setback distances must have Surveyor stamp
Legal boundaries noted
3/Easements noted
<Dwellings and buildings existing or proposed noted
✓ ocation of driveway or parking areas,other impervious areas
Location and dimensions of reserve area(new construction only)
0/System design calculations
Garbage grinder,yes or no
Wi Benchmark not disturbed during construction within 75ft of facility
✓ North arrow
if Contours
V Deep hole location(s)and data
111( Perc hole location(s)and data -
@/ Elevations
V Names of approving authority and soil evaluator
VLocation of water supplies, public and private - -
o Within 400ft of system in case of surface water and gravel-packed public water supply
o Within 250ft of system in case of tubular public water supply
o Within 100ft of system in case of private wells(Soft from tank)
9t/Well statement, if applicable-
't ocation of any surface waters, rivers,vegetated wetlands
2V) cation of water lines and other subsurface utilities - -
' pbserrved and adjusted groundwater elevations in vicinity of system
t— /PProfile of system
z LL cus plan to show location of facility, including nearest street
re Materials of construction and specs for system
g../G-as baffle
V1...--Pipe in center line of tank
-i(V uouble-washed stone - --
-'Schedule 40 PVC for trafficked areas, house to tank
Distances noted from house to tank, etc.
(y n posing is proposed, design and specs of dosing system
When alternative technology is required,complete plan and spec including hydraulic profile
f,Trenches preferred over beds
q/tuoyancy calculations for tanks or components partly below groundwater level
05.41 slope outside of mound,toe ending 5ft from property line
6' Local upgrade requests on the plan,all variances Gt4- (�l l7,
❑ Local upgrade forms attached to the application
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Title V Checklist
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Installer: X17
eer:
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Before we can schedule a Perc test we must have a copy of the trenching permit
d by DPW.
Give the permit a number
' / Mark on application form if payment provided
v Give completed application and plan to agent reviewing plan
.4 /Give person submitting plan the conservation commission sign off paperwork
is need to be discussed with conservation commission staffer and a signature obtained
to the Board of Health issuing construction permit).
If Local Upgrade Approval BW needs to sign off on it.
Agent reviewing plan, approves Plan.
ore issuing construction permit ensure that the installers name is on the
B
licati n AND that that installer has a permit with us.
V6W will sign permit and stamp plans.
Contact home owner or installer that plans have been approved. Either mail them
lave them come pick up plans and permit.
If LUA is needed send form 9B to owner with construction permit
Installer calls to schedule Final Inspection (they need to give proper notice that an
pection will be needed)
Final inspection is passed and "as built" received.
Cert of compliance Issued (after as-built received).
CLOSED
to Closed: Form updated 12/29/10