235 Septic System Checklist 2018 . Moa/t-3 ;35 d/ Nem
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Commonwealth of Massachusetts
ii City/Town of 1/_307/8
t " Septic System Installation ChecklistCik
.�.51 J
B. Application Checklist (cont.)
2. Construction Inspection
a) Building Sewer(310 CMR 15.222) Approvedve/ N/A Problem
•
All waste pipes bed into building sewer Basement check L7 _
• Schedule 40 PVC 4" or cast iron Verify by reading pipe EV ❑ ❑
Minimum slope of 0,01-0,02 e ❑ 0 Li
Pipe laid in continuous straight line a�AA -1) . C ElPipe laid on compact, firm base IM�I ❑ ❑
Cloanouts precede alt changes in Verify by visual/tape Er ❑ ❑
atlgnmenegrede ,.,J
Cleanout provided every 100 ft. Verify by visual/tape C7 ❑ ❑
Backfill material clean Visual [] • ❑ E.
b) Septic Tank(310 CMR 15.223) Approved N/A Problem
Tank is
(15.228)set level with 6"stone under Check with level 21/-. C. ❑
Tank is required size4oading per plan Verify with plan [# U ❑
• Inlet and outlet are at proper locationVerEl ❑
(15.227) Test withpinnI /�� LI
Tank is water tight(15.726) Test / o/ ! ❑ ❑
Outlet toes extend 6"above flow line Verify byvisual/tape d� ❑ El
Approved filter device placed at outlet DEP list 0 V LI] ❑
Gas baffle installed at outlet tee 0 CJ ❑ ❑
Intel and outlet tees on center lire ❑ ❑
Tank is baddlled with acceptable material Must V ❑ ❑
Notes:
41/e/
Septic System Installation Checklist 11-09,doc•data Form sterno•Pae¢2 lite
Commonwealth of Massachusetts
At City/Town of
if 'I 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 �f 0 0
Number of outlets {/��p!_f"�"'JNary Number of laterals
pm plan
Inlet tee min. 1"over outlet e a w/type S- -/ n ❑
D box set on level base 4cry 0 -2Top of D box 36" max depth ua d w/tape l[117. - 0 ❑
D box is water-tight Add water IEK ❑ ❑
• D box has a minimum of 2" thick wall and ,_.,
12"Inside dimension fd' o
d) Pump Chamber(310 CMR 15.231) Approved N/A Problem
Tank is set level Visual and w/lave) ❑ ).< ❑
Proper volume is provided Check plan and tank 0 0 ❑
Float elevations set per plan Measure w/tape ❑ ❑ 0
Mn,i2.delivery line to D box Visual 0 0 ❑
Number of pumps: 0 a ❑
Specified pump provided or designers
approval for equal pump ❑ ❑ 0
Correct pump sequence 0 0 ❑
Covers set to grade ❑ ❑ ❑
Electrical permit provided
5"of stone beneath chamber Visual 0 0 ❑
Chamber is water-tight "fest 0 0 0
Min. 9"cover provided Visual ❑ ❑
Correct loading provided per plan Visual on tang C ❑ E.
Notes
eeptic S»tam Inslafatlon Checklist 11-031.doc•date
Form Noma'Page 3 of 8
1 Commonwealth of Massachusetts
it
I City/Town of
it Septic System Installation Checklist
B. Application Checklist(cont,
•
e) Leaching Facility(310 CMR 15.240) Approved N/A Problem
No frozen material used including back fill Visual 0 0
No clay, tailings or stones larger than 6" for
cover material a.-Y- 0 0
Soil at bottom/sides of excavation matches
info on deep holes IV
AU impervious layers removed a 0 Ci
No remaining NB horizons 0 LNC 0 0
Groundwater conditions match plan an.
`.I -ck [[� Cj
deep holes �'�l-,/f'' plan E
Vented if under impervious cover per plan
(15.241)
Vent is protected from precipitation _,., /
and animal entry t1� ❑ (]
Cover of a minimum of 9" over leach area / 0 Cl
Pipe slope equal to 0.005 Check w/transit V [J .- . 0 0
Leach area per design(15.241) ['er----- ❑ 0
Excavation is level and at required dap :COI eck plan 279- 0 0
Removal of 5 ft material and replacemen ,,.,, /
(if in fill) ' eck plan 0 ED
Back fill material is acceptable datCL)/ 0 -'
Final contours correct per plan Check with plan ur 0 0
Surface/subsurface drainage away from �,
leach area 0 0
Final grade end side slopes are stable 1---- 0 0
Distribution lines are capped, vented, or
connected together [P/ [ 0
Impermeable barrier(15.255[2j) 0 0 0
Retaining wall inspected by PE 0 0 0
Retaining wall is water-proofed 0 0 0
Retaining walVbarrier is at correct
• depth/height 0 0 0
Septic System IMtddOn CImokliet 11-e2.400•date
Form Name•Page 4 of 13
Commonwealth of Massachusetts
V! City/Town of
`= N Septic System Installation Checklist
B. Application Checklist (conn
0 Leaching tenches (310 CMR 15.251) Approved N/A Problem
Number of trenches: ❑ ❑
Depth of tenches: ❑ ❑ ❑
width of trenches: _._.____..__._____... ❑ 0 ❑
•
Trench spacing per plan ❑ 0 0
Stone is double-washed(3/41 to 1',4")(15.247) ❑ 0 0
g) Leaching fields (310 CMR 15.242)
•
Length of field: _.__. __._ ❑ X
Width of field: - ..______._.... ❑ ❑ ❑
MM. of 2 distribution lines ❑ ❑ ❑
Separation distance conforms to plan ❑ ❑ ❑
Stone is double-washed(314" to 114'1 (15.247) 0 ❑ ❑
h) Leaching Pits(310 CMR 15.253)
Number of pits: ...__..__. ______ ❑ �{ ❑
Depth of pits: ..._ ❑ �❑ ❑
Stone is double-washed(3/4w to 1W)(15.247) 0 . 0 0
Each pit has min. 1 20"access cover ❑ ❑ 0
Piping network and configuration of ❑ ❑ ❑
pita/chambers per plan
i) Tight Tank(310 CMR 15.260)
Tank is set level with r stone under Visual and with level ❑ ❑
Tank is proper size per plan Visual with plan ❑ ❑ ❑
• Pumping contract has been provided ❑ ❑ ❑
Covers to grade Visual ❑ 0 ❑
AN alarm set at 3/5 tank capacity Check floats by raising ❑ El ❑
. AN alarm test on separate circuit Set off alarm ❑ ❑ ❑
Septio System Installation Checklist If-09.doo•date Form Name•Pant 5 of 6
Commonwealth of Massachusetts
4 y City/Town of
( Septic System Installation Checklist
B. Application Checklist (cont.) �.
1) Certificate of Compliance(310 CMR 15021)
As Built Plan Submitted --- -
Uatad
Signed by Installer - / t� �o
Date --_....__._..__.
Signed by Designer _._._.._.....___.—._--...._...__-,.-..____-.....__._A.__...
Dote
Certificate of Compliance Issued Da
ta
• Notes: / / ' -7
/
m ,✓1./11...._ . .1 _ _, /n/
Sep*System Instatleryen ChmkNat 11.09 doe•date
Form Name•Pape 6 of 0