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' �rrr�.:Ut f ar rr�Wp �k8"',°,...r+,t .,;f.:- 3t fi.rs'k�'T'rIT�iEr ?:""7,m `'�r I.✓r�`�?�"�"z'r'r"'2.::,Jr 6 r :'1 rt .;r .'P�ri d,�"�r uF., o �,,..:;, , �„ti'd',,, .. ',' .t x: Town of North Andover, Massachusetts Form No. 1 NORTH BOARD OF HEALTH H B x A ,1JJ G�Js APPLICATION FOR SITE TESTING/INSPECTION - 7 ADAATED �SSACHUS�� Applicant P�� NAMEE� ADDRESS— TELEPHONE Site Location Engineer g NAME ADDRESS TELEPHONE Test/Inspection Date and Time J-, t5 , +�� ► � rd IRMA ,BOARD OF HEALTH Fee Test.No. S.S. Permit No. D.W.C. No. C.C. Date Plbg. Permit No. Town of North Andover, Massachusetts Form No.2 f AORTM BOARD OF HEALTH o A'ex�1" lq_— F P ,,,,,.. DESIGN APPROVAL'FOR ASS"C SOIL ABSORPTION SEWAGE DISPOSAL SYSTEM Applicant Test No--A;10/- /- Site Location dz- Reference Plans and Specs. (-� ENGINEER YESfGN DATE Permission is granted for an individual soil absorption sewage disposal system to be installed in accordance with regulations of Board of Health. CHAIRMAN,BOARD OF HEALTH Fee Site System Permit No. /Q/ TOWN OF NORTH ANDOVER aowrM Office of COMMUNITY DEVELOPMENT AND SERVICES HEALTH DEPARTMENT ►° , 400 OSGOOD STREET **� NORTH ANDOVER, MASSACHUSETTS 01845 �, ^�=•a�"� $NCHU°+t 978.688.9540—Phone Susan Y.Sawyer, REHSIRS 978.688.9542—FAX Public Health Director healthdept@townofnorthandover.com-e-mail www.townofnorthandover.com-website APPLICATION FOR DISPOSAL WORKS CONSTRUCTION PERMIT DATE: LOCATION: � '7 ( �-.�...v , , . Vez..c `r z., LICENSED INSTALLER NAME: c PLEASE PRINT SIGNATURE J_/21 C_ TELEPHONE# CHECK ONE: FULL SYSTEM REPAIR: _> ($250) COMPONENT REPAIR(indicate what parts): ($125) * NEW CONSTRUCTION: * If NEW CONSTRUCTION, please attach the Foundation As-Built Plan. $250.00 or$125 Fee Attached? Yes No Project Manager Obligation From Attached? Yes—v-- No Foundation As-Built? Yes No Floor Plans? Yes No Approval of Health Agent Date: `I i INSTALLER PROJECT MANAGEMENT OBLIGATIONS I As the North Andover licensed installer for the construction of the septic system for the property at FS-_7 C iTw,7; S 1. relative to the application of �l-° / � and dated with revisions dated Z I 0 I understand the following obligations for management of this project: 1. As the installer I am obligated to obtain all permits and Board of Health approved plans prior to performing any work on a site. I must have the approved plans and the permit on site when any work is being done. 2. As the installer I must call for any and all inspections. If homeowner, contractor, project manger,or any other person not associated with my company schedules an inspection and the system is not ready then item three shall be applicable. 3. As the installer I am required to have the necessary work completed prior to the applicable inspections as indicated below. I understand that requesting an inspection, without completion of the items in accordance with Tile 5 and the Board of Health Regulations may result in a$50.00 fine being levied against my company. a) Bottom of Bed - generally first inspection unless there is a retaining wall which should be done first. Installer must request the inspection but does not have to be present. b) Final inspection — Engineer must first.,do their inspection for elevations, ties, etc. As-built or verbal OK from engineer must be submitted to Board of Health, after which installer calls for inspection time. Installer must be present for this inspection. With pump system all electrical work must be ready and able to cause pump to work and alarm to function. c) Final Grade—Installer must request inspection when all grading is complete. Does not have to be on site. 4. As the installer I understand that only I may perform the work(other than simple excavation) required to complete the installation of the system identified in the attached application for installation. I further understand that work by others unlicensed to install septic_systems in North Andover can constitute reasons for denial of the system, and/or revocation or suspension of my license to operate in the Town of North Andover; significant fines to all persons involved are also possible. 5. As the Installer I understand that I must be on site during the performance of the following construction.steps: a) Determination that the proper elevation of the excavation has been reached. b) Inspection of the sand and stone to be used. c) Final inspection by Board of Health staff or consultant. d) Installation of tank, D-box, pipes, stone, vent, pump chamber, retaining wall and other components. 6. As the installer I understand that I am solely responsible for the installation of the system as per the approved plans. No instructions by the homeowner, general contractor, or any other persons shall absolve me of this obligation. Undersigned Licensed Septic Installer Date: 12116 ©c Disposal Works Construction Permit# 05/25/2010 00:55 FAX " �� �001 r "Since 19134" 1 1 Crushed 7)'ap.Ruck&Sand Fi11&,Loam OFFICE& PLANT 900 SALEM STREET-PO.BOX 484 NORTH WILMINGTON, MA 01887 TEL,(978)658,4762•FAX(978) 658-892$ Soil Description: Screened TITLE 5 Septic Sand Soil Location: Upper N,14. Test Date: October,26,2006 Sieve Size Weight Retained Curnulative Weight Percent Retains 3 Mesh (9m) (gm) Percent Passing �1 ) ( ) 1 5'" 1" g/„ o o 100,00 #4 36 36 4,62 95.38 #8 48 84 10.79 89.21 #16 104 188 24.16 77.84 #30 240 428 55.01 44.99 #50 206 634 81.49 18.51 #100 110 744 95.62 4.3s #200 22 766 98.45 1.55 Pan 12 778 100,00 0 i i i i d v5 �N . - y: 'r - 7 n A. o f -------- „i O d I +� Cd r.- ----� -—- a � f r II _...__ r m .+ O _ O . P ;) 0 0 Lwri BOARD OF HEALTH NORTH ANDOVER, MA 01845 978-688-9540 APPLICATION FOR SOIL TESTS DATE: 1171e) z MAP &PARCEL: LOCATION OF SOIL TESTS: '&G-7 C k Es i ,00�szz I / 96.34 1 } 95.37 R') s �S \L" 96.91 C3 N � 98.42 O� DEK co rn o 97 8 10.00 W H y ?'L c.� Qo 14 99.30 0029 GC G i I i 06'091 ,00'9z = a 1A„OE,Tt o69S Iu i C� I i i 'i I C� TD i 1 r; l ✓ � s',/"�yR'� .r� F_ Y/il h'rr'��>/f�!/ �-fl� z;. � r.:rte F1 �.✓I�i� /''� Fr 7 /- / ,,,,,,,,, ,, :. �` � CI i;a ;7✓ ,� "Cm's,cr'a"�!M�� ��u`r,,'�/rs,��rirsF% b.� :m7s�rS t✓ a r / 1 ✓ //i f� h; I ��� h Y� r/F /r err✓ / / '_ ✓�f3/ fr f s i '� 1 f��/ /q✓ !i'i/f $��.lf ii�'rFl / / /f' r fT ct �y I} f �//r n/ l/ {r( �✓ � t r rrf- � �✓ � 9r"ryr r ,7c /�l ria.n " Y f f !F%` if` ✓ r� � �?( � `��rr�r'ra /�`✓ 4 / 7/ /✓rH i / rain} y JV/ '1;/,rl ffr,, -ref Y�1y r'r� �I�l�r ,✓*/n / y r 1 ,�� i / 3�yf y!i r /'/ l' rn;.�"` hf�f ",h TT ------------- - � ° 7 �,//Y 77✓/� ?7�fi�/n y/�rr F{y �/� / 7 1��rr�, � /✓?� Y.rp rr 1/ / / d ;i i i ✓& � / r r G= r / � r ✓ , J ; d f „ r I - 5 / of Y,: !r 1111'il1i111'1111 1 11111111111111rr, 11�,-WS FEE 1 ' =li 1111!-4111111111111111111111111111 I11/URi!'i1111111111111111111111 �� 11111 II��IJI!'1�!��11�111111.11!�111 111111111611111111111111�1J1111 1�111�IA1E1'O � Ii111 +: 111i1 111' IIIIF.111 11111111 l���!�:IIIi1111�111�1�1i111 IIIIIIi!.�i�l��!!�1�19ZIIa11^,���1111 11111111111 .1ng�11*IIr1111111 111111111111111 111111111 Ili 11111 �:G ! 111111111111111111111111111 a aaaaa oil aaaaWaa111 111111111/IIIIIIIII��Illllii=(III�� aeae yea �ela�ENROa�al1a111,- lii�JllIICIJLIEi1 1 -111I111111 L 111111111�1�1J1111�1111 �A1�111111 111111111.11 �!11 pollli' 1111 IIIIIIIIIila1119111� 1 E� ��IJII 111111111111111111111111 11/1111/ 111111111111111111111111111111111 11111111 111111111111111111111111 /1111/11 111111111111111111111111 IIIIIIIIIIIIIIIIIIIIIIIIIIIi11111 ' : i f L O CA.T) O, vv;i c=. COL-,i LON To.-ST . 3 =G.1 I17fV1 JC. I : G F ...0 I E\ I T ilvl`" Cr iifv1!E TIME ,".i " A Td • i T live E E T I IN EX A. �1�a� Sr, SEPTIC PLAN SUBMITTALS LOCATION c {-' W.. .�! "r Map &Parcel NEW PLANS: YES $225.00/Plan ate°' Check#: L�" 7Y P, REVISED PLANS: YES $ 60.00/Plan Check#: SITE EVALUATION FORMS INCLUDED: YES NO LOCAL UPGRADE FORM INCLUDED: YES NO DATE: � I� DATE TO CONSULTANT: DESIGN ENGINEER:hXw C-, 1;-cAA1,) elephone#: ci 7H 76 t� When the submission is complete (including check), date stamp plans, COPY for Conservation, and place in existing file with green Design Approval form. { 1 1 .. .._ ..... ..w ........... .................................. ..._...._........... ........_. ........._.........� ....�......�.�.�.�.� ..�..�...................._..�_�........�.._................_.�..........,�_........._....�.......... E ENGINEERING j SERVICES _...._. _.....��_..... ............mm.. .....���_._................. .......................... .........................INC .��wwv �..... ����� o��...m.. .. .......... ..� ���.������.�� � . ......���...��.....�.�.�...�.. j i February 19, 2003 Sandra Starr, Administrator North Andover Health Department Town Hall Annex 27 Charles Street F ° 2 W North Andover, MA 01845 Re: 857 Chestnut Street,North Andover, Septic system design Dear Sandra: Enclosed are the following documents for the above referenced property. 1. 5 copies of septic system design plans, one with an original stamp. 2. Application for approval and required fee. 3. Copy of soil evaluator sheets. This plan is being submitted for approval. If you have any questions regarding the information submitted, please do not hesitate to contact this office. Sincerely, Benjamin C. O as od �. � EIT President 60 BEEC6°IWOOD DRIVE d NORTH ANDOVER, MA 01845-(978)686-1768-(886)359-7645-FAX(978)685-1099 ��............ .�.. ..... .. .��., �....., .,, �� .. �� ..... FORM 11 - SOIL EVALUATOR FORM Page 1 of 3 No. Date: / v Commonwealth of Massachusetts -)Vo WVvvp•� , Massachusetts oil uitabi� Assessment for On-site Sewage Disposal Performed By: ...........� ��— '1 ...C_ ...T/�"`��y Date: �-- Witnessed B . 'v ii ...... ........... ......... ..................... ..... Location Address or , / �.j'.�u� Owner's Wne, Lot t ©_ ( 4 p t:;, �?L:" AiMms,ud . Telephone tN�r' New construction ❑ Repair IM 9� 041/ Office Review Published Soil Survey Available: No ❑ Yes 91 Year Published 9 �........... Publication Scale / r� o Soil Map Unit Drainage Class ��D G��G Soil Limitations .m ��....- Surficial Geologic Report Available: No E� Yes ❑ Year Published Publication Scale GeologicMaterial (Map Unit) . .......................................................................................................... ... Landform ""- r Flood Insurance Rate Map: Above 500 year flood boundary No ❑Yes Within 500 year flood boundary No ❑Yes ❑ Within 100 year flood boundary No ❑Yes ❑ Wetland Area: National Wetland Inventory Map (map unit) ........................... ...................................... .. Wetlands Conservancy Program Map (map unit) .............................................. ......._. Current Water Resource Conditions(USGS): Month Range :Above Normal ❑Normal QBelcw Normal ❑ Other References Reviewed: DEP APPROVED FORM-12/07/95 FORM 11 - SOIL EVALUATOR FOIZ\1 Page 2 of 3 Location Address or Lot No. On-site Review Deep Hole Number / Date:/'o/ / Time: 9 �� Weather? Location (i ti on site plan) Land Use �. V7-- 7,11�',�— Slope (%f Surface Stones Vegetation Landform Position on landscape (sketch on the back) Distances from: Open Water Body /Imp feet Drainage way ®a feet Possible Wet Area ;vee? feet Property Line feet Drinking Water WelL>/5-'0 feet Other DEEP OBSERVATION HOLE LOG" Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface (inches) (USDA! (Munsell) Mottling (Structure, Stones, Boulders, Consistency, % /�t m td 7 nY 1 Parent Material (geologic) _ 4"Awar 7�_L.!I-� QepthtoBedrock: __ -- Depth to Groundwater: Standing Water in the Hole: Weeping from Pit Face: Estimated Seasonal High Ground Water. -- —- DEP APPROVED FORKS- 12/07/95 FORM II - SOIL EVALUATOR FORM Page 2 of 3 Location Address or Lot 140. � On-site Review Deep Hole Number Da Z_ Time!9��� Weather��_ Location (iden ify on site plan) Land Use �_.4D4tiTL¢1, Slope M Surface Stones Vegetation I Landform Position on landscape (sketch on the back) Distances from: Open Water Body 11400 feet Drainage way `p� feet Possible Wet Area feet Property Line ' feet Drinking Water Well ?/SC' feet Other DEEP OBSERVATION HOLE LOG* Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface (inches) (USDA) (Munsell) Mottling (Structure, Stones, Boulders, Consistency, % Gravel) o;ZC T 2 ROLES KEUUIHLU A I EVERY PROPOSED DISPOSAL AKEA Parent Material (geologic) 4�-0� 4 - DepthtoBedrock: Depth to Groundwater: Standing Water in the Hole: '" Weeping from Pit Face: 2 Estimated Seasonal High Ground Water: - ------.----- DEP APPROVED PO"I• 11107/95 FORM 11 - SOIL EVALUATOR FORM Page 3 of 3 Location Address or Lot No. � -41 Determination for Seasonal High Water Table Method Used; ❑ Depth observed standing in observation hole ................ inches ❑ Depth weeping from side of observation hole ................. inches Q Depth to soil mottles .......:! inches 2'7� ❑ Ground water adjustment ................... feet Z� 7 Index Well Number .................. Reading Date ................... Index well level ............ .... Adjustment factor ................... Adjusted ground water level ............. ............... ................. Depth of Naturally Occurring_Pervious Material Does at least four feet of naturally occurring pervious material exist in IJ areas observed throughout the area proposed for the soil absorption system? -5 If not, what is the depth of naturally occurring pervious material? -- Certification I certify that on 9.�' (date) I have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with the requ' training, expertise and experience described in 310 CMR 15.017. Signature � �� Date DEP APPROVED FORM•12107195 CHECKLIST FOR NORTH ANDOVER SEPTIC SYSTEM PLANS Job The following is a checklist that incorporates all Title 5 and local regulations for septic plans. Name of Applicant: �� eral EleName of Designer: Plan Date: -z 117 Revision Date: Date of Review: — Property Address: 0`��7' ch e---,l/l C) Map: Lot: BOH Reviewer: Type of Plan(new or upgrade): V Number of Bedrooms in Assessor's Records: gpd)Garbage Disposal Allowed: General Information: N.A.=North Andover Septic Regulations Other numbers refer to Title 5 OK Problem N/A Street number and map/lot-220(4)(u) Maximum scale of 1 "=40'for plot plan-220(4) Maximum scale of 1 "=20'for profile and component details-220(4) Legal boundaries of the facility.being served-220(4)(a) Names of abutters from recent tax map- NA 8.02j Number of bedrooms,design calcs.,-NA 8.02i Name&address of record owner&applicant- NA 8.02k Name&address of designer-NA 8.021 Holder and location of all easements-220(4)(b) Date plan drawn&any revision date- NA 8.02m All dwellings and buildings,existing and proposed-220(4)(c) Location of all existing or proposed impervious areas-220(4)(d) 1/ All distances on site plan—NA 8.03a-c Elevation of proposed driveway-NA 8.02t Location and elevation of foundation drain-NA 8.02y Location and dimensions of the system incl.reserve(new const.)-220(4)(e) Limits of excavation of leach area on site plan-NA 8.02z Locus plan-220(4)(t) (Not to scale) North arrow-220(4)(g) Existing and proposed contours-220(4)(g) Locations and logs of deep holes-220(4)(h) Locations and logs of percolation tests-220(4)(i) Date(s)of soil testing-220(4)(h)&(i) / Existing grade elevation of each deep hole-220(4)(h) �✓ Elevation of percolation tests—N.A. 8.02n Name of approving authority representative-220(4)(h)&(i) Name of soil evaluator-220(4)0) Soil logs and perc test logs match BOH records Locations of waterlines,drains,and subsurface utilities-220(4)(m) Observed and adjusted g.w.elevation in the vicinity of the system-220(4)(n) Complete profile of the system to scale-220(4)(o),NA 8.02c Cross section of leaching facility-NA 8.02w (Not to scale) Location of benchmark(s)within 50-75 feet of facility-220(4)(q) Note listing all variance requests with proper citations-220(4)(p) Local upgrade approval request form submitted-403(1) ` 2 _V_ Original R.S./P.8. stamp, signature&date 220(l) 6i(2) P.K.,discipline specified within stamp. MGLC. 112o. 81 B8 '/ ofr. supplies(w/in4OO'),pub. wells(*dn25O'),yvt wells(w6nl5O')'220(4)( Location of watercourses,wetlands,wells,etc. Win ]5O'of system—y4A8.O2r _L�- _----_ ---- Wetland disclaimer—NA8.U2a kl8 plan reference 6t certification required(prop line setbacks) 220(3) __�. _----- ---- Plan contains designer's certification statement Use approvals/standards checked for I/Asystem DByducu.. yom/uie>30 MPI not allowed for new,LO&for upgrade 245(1)6i('3) _1� Pe/r rate> 60Mf/-must use mod�'eJ tight tank or&4 technology-245A0 Proposed system qualifies oa "ohmod" system 002(definitions) Flow ix over 2,000Xpd NoR.8. allowed 220(|) Design flow was set io accordance with code 203 70- Existing system location and note ou proper abandonment-354 ______ ___ Leaching facility ut least l` above Base Flood elevation—N&985 _L�� ------ ---_ All piping 8ch4U minimum—NAl8.0l Basement floor minimum |' above groundwater elevation—NA5.04 Foundation drain present with elevation—NAD.O2y On-site Soil and Groundwater Review U Problem N/A Proper deep observation hole logs onplan 220(4)(b) All deep holes and pocs shown,including aborted tests—NA8.U2u Soil evaluation forms submitted within 60 days of field work-O|D(2) � Proper percolation test log 220(4)(i) �r --- -- Ample deep observation holes iu primary disposal area(minimum 2) 102(2) Ample deep observation holes iu secondary disposal area(minimum 2)- 102(2) Aoploperu testing(one ioeach disposal area,3 in prim.>2,0U0gpd)- 104(4) � � Deep hole testing conducted within two years—NA7.O5 Hole Identification Numbers: ground elevation el. ��� v� acceptable soil el. /&2��� ------- ------- --____ LeuuhfacUim invert el. ground water el. @ refusal el. bottom uf]each facility el. | thickness of acceptable soil before&after ooi|K&K U o/ � ~Y h separation mgroundwater / separation torefusal soil class ___�_���___ 3 pert rate loading rate septic tank below g.w. table (yes or no) pump tank below g.w. table (yes or no) l.f in fill y -255(l) Setback Distances(Given in feet) 15.21 1 YES 00/ Is the lot in the Lake Cochiewick Watershed? NA 6.00&5.02 OK Problem N/A Septic Tank Leach Facility. Property line 10 10 Cellar wall 10 20 Inground pool 10 20 Slab foundation 10 10 Deck,on footings,etc. 5 10 V/ Waterline 10 10 Private drinking well 75 100 Irrigation well 75 100 Wetlands 75 100 Public well 400 400 J' Wetlands bordering surface 150 150 water Supply or trib. (in Watershed) Z/ Trib.To Surface Water supply 325 325 t✓' J Reservoirs 400 400 Tributaries to reservoirs 200 200 Drains(wat. supply/trib.) 50 100 L� Drains(intercept g.w.) 25 50 Y Foundation drains 10 20 Drains(Other) 5 10 Drywells 20 25 Downhill slope 15'to 3:1 slope 3 4 w/o barrier Building Sewer OK Problem N/A� Grease trap required for certain uses(check 230 for details) Pipe diameter listed(4" minimum)-222(1) Pipe schedule listed-222(3) Pipe cast iron or Sch 40 PVC—NA 11.02 Watertight joints specified-222(3)&(4) 17 Pipe laid on compact,fin base-222(5) Pipe laid on continuous grade in straight line-222(7)@ Cleanouts precede all changes in alignment and grade-222(8) Cleanout provided every 100 feet-222(8) Manhole at any 90 degree alignme�}t chin e-222(8) Invert elevation at building: '� `%` Invert elevation atsf nbc tank: t/ Length of run: i/ Slope: a (minimum of 0.01 -0.02 desired)-222(6) 10'offset to private well or suction line-222(2) Septic Tank OK,/Problem N/A Tank is accessible-228(3) t/ No structures above tank—(228(3) L Tank can accommodate both primary&reserve—NA 9.04 200%of flow(required&provided given. 1500 min.)-220(4)(f)&223)(1)(a) 2-3" drop from inlet to outlet-227(5) Minimum of 4'liquid depth-223(2) 3"air space above tees/baffles(minimum)-227(4) 9"air space above flow line (minimum)-227(4) Tees are not to be replaced by baffles-227(1) Tees extend 6" above flow line-227(1) Inlet tee extends 10" below flow line(minimum)-227(6) Outlet tee extends 14" below flow line(more for deeper tanks)-227(6) Gas baffle installed on outlet-227(4) Access manhole cover above center of tank&each tee(except 2 compact) j 228(2) v� 3-20" manholes-228(2) 1 childproof,24" riser/manhole w/in 6"of final grade if<1000gpd-228(2) Inlet and outlet tees on center line-227(1) v�, Soil compaction below tank specified(if soil is non-native)-221(2) 6" of<=3/4"stone beneath tank specified-221(2)&22 8(I) If> 1,000 gpd AND not a single fam.dwell.must be 2 tks or 2 comp.-223(1)(b) If plan specifies disposal must be 2 tanks in series or 2 compact. tank-223(1)(c) Buoyancy calcs.required if tank.at or below water table-221(8) Tank is watertight-221 (1) 9" of cover over tank(minimum)-228(1) H- 1 0 loading(min.)-H-20 if traffic-226(3) Top of tank<=36" below grade-221(7) All pumping to tank(if applies)in accordance with-229 Tank is set to keep old system in service during install if possible 4 5 Tight Tank(Check here if not present: J ) OK Problem N/A 500%of design flow or 2000 gallons provided—260(2)(a) 3-20"manholes—228(2) Soil compaction below tank specified(if soil non-native)—221(2) 6"of<=3/4"stone beneath tank specified—221(2)&228(1) Buoyancy calcs.Required if tank at or below water table—221(8) Tank is watertight—221(1) 9"of cover over tank specified(minimum)—228(1) H-10 loading(min.)—H-20 if traffic—226(3) Top of tank<=36"below grade—221(7) All pumping to tank(if applies)in accordance with—229 AN alarm set at 3/5 tank capacity—260(2)(c) Min. 1-24"frame w/cover at finished grade—228(2)(f) Year round access for pumping—228(2)(g) Distribution Box(Check here if not present: ) OK Problem N/A Inlet elevation: Outlet elevation: 1� 0.17'drop from inlet to outlet(minimum)-232(3)(b) 6" sump(minimum)-232(3)(e) All outlets at same elevation-232(3)(b) Outlet pipes laid level for first 2 ft. -232(3)(c) Pipe Sch 40-NA 10.01 / Number of outlets: Number of laterals: t/ Size of outlets: ' Inlet baffle/tee min. 1" over outlet invert for all d-boxes-232(3)(a), Soil compaction below distribution box specified(if soil is non-native)-221(2) 6" of stone beneath distribution box specified-221(2) Box is watertight-221 (1) Top of box<=36" below grade-221(7) Buoyancy calculations required if box is at or below water table-221(8) Pump Chamber (Check here if not present: ) OK Problem N/A Volume specified: /dbD 20(4)(r) Pump on elevation- Pump off elevation: 220(4)(r) Alarm on elevation: 9D 220(4)(r) Number of cycles per day-220 4)(r)(also 2540)(d)if gravity from d-box)'/ Minimum 2" delivery line to d-box if gravity-254(1)(c) Pressure dosed l.f. if flow>=2,000 gpd-254(1)(a)&254(2)(a) Cycles per day is consistent with chamber volume-23 1 Volume calculations include flowback volume-2') 1(2) 5 6 C 24 hour storage capacity above pump on elevation-231(2) ✓ Number of pumps:_� 2 if system serves>2 dwelling units-231(6) Capacity of pump(s)- ,�"g gpm @ /7,(5 'TDH-220(4)(r) Pump can pass 1 1/4 "solids(minimum)-231(7) Pump controls specified-220(4)(r) t� Alarm equipment specified-231(2) ✓ ' Alarm is in building and powered on separate circuit from pump-2') 1(9) ✓ Pump sequence correct(off-lead on-lag on-alan-n on)-231(8) Pump performance curves included-220(4)(r) Manual operating switch-NA 12.01 t� Check valve,bleeder hole-NA 12.01 1 childproof,24"riser/manhole to final grade-2'31(5), Soil compaction beneath pump chamber specified(if soil is non-native)-221(2) 6"of<=3/4"stone beneath chmbr. specified-221(2)&228(1), Buoyancy calculations if chamber is at or below water table-221(8)@ 9" of cover over chamber(minimum)-228(1) H- 10 loading(min.)-H-20 if traffic-226(')), ! Chamber is watertight-221 (1) Top of chamber<=36" below grade-221(7) Leaching Facility(general-complete for all designs) OK Problem N/A l 50%larger if garbage disposal-240(4) t/ Trenches to be used whenever possible-240(6) V; No vehicle or imperv. area above l.f. unless unavoidable-240(7);NA 13.02 ✓' Vented if under impervious cover-241 (1) Vented through same pipes as distribution system-241 (1)(a) Vent protected from precipitation/animal entry-241 (1)(b) t/ Vent is placed beyond traffic or impervious area-24 1 (1)(c) All lines connected to vent if bed or trenches-241(1)(d) 9" cover over peastone-240(9) Reserve area provided (new construction)-248(1) ✓ Reserve 4' from primary leach area—NA 9.04 4'(5'if perc rate<=2 MPI) separation to g.w.-212(a)&(b) t✓ 4'(down to T with variance or I/A-upgrades only)of natural soil under l.f. GW separation is adjusted to highest existing grade if facility cuts into a hillside Pipe slope minimum of 0.005 -251(9) 1/ Require 5'removal and replacement if in fill-255(5) Top of leach facility<=36"below grade-221(7) Final grade over l.f.minimum 0.02 ft/ft-240(10) Surface&subsurface drainage away from l.f. -240(1 1)&245(5) Minimum design flow 440 gpd without deed restriction—NA 13.01 3:1 slope where grading required-255(2) Toe of fill slope stops 5'from property line or swale installed-255(2) Impermeable barrier if<3:1 slope or< 15 feet to—3:1slope-255(2) Impermeable barrier/retaining wall poured concrete—NA 9.02 Retaining wall stamped by P.E. -255(2)(b) Top of retaining wall>=top of peastone elevation-255(2)(f) 10'offset from edge of leach facility to edge of ret. wall-255(2)(g) Pere test(s)done in most restrictive layer- 104(2) Pere test 4' below leaching elevation—NA 7.06 4 Design flow listed and required/provided leach area given-220(4)(f) Leach pipes SCH40 PVC—NA 10.01 Leach pipes minimum 4" diameter except for dosed system—NA 14.04 6 7 Leach lines capped,vented or connected together-251 9 PP , g ( ) Pressure dosing guidance followed if pressure distribution-254(2)(c), Pressure dosing required over 2,000 gpd or with I/A remedial use-231(1) Leaching Trenches (Check here if not present: OK Problem N/A Number of trenches: Minimum of 2 trenches-NA 9.01(2) Depth of trenches(max eff.2'): -247(l) Width of trenches(2'min.,4'max.): -251 (1)(b) Length of trenches(100'max.): -25 1 (1)(a) Trenches are vented(when>50')-251 (11) Trenches follow contour lines-251(2) Trench spacing 3 times effective width or depth minimum-251 (1)(d) In fill or reserve between trenches, 10' min. -NA 14.01& 14.03 Available leach area given(Min. 500 s.f.)-NA 9.01(2) Bottom=L x W x# — s.f. Sidewall=L x D x# x 2= s.f. Effective leach area given Loading factor: Effective area=total area s.f. x LTAR = g/day Effective area is>=design flow of facility being served 2"of 1/8"- 1/2" 2x washed peastone.-247(2) Trench depth of 3/4"to 1 1/2" double washed stone-247(1) Leaching Pits(Check here if not present: ) OK Problem N/A #of pits/pit systems: (dosing chamber if>1,231 (1)) Dimensions of each pit or system:L W D Depth of pits(max eff.2'): -253(1)(a) Available leach area given Bottom=L x W x#of systems= s.f. Sidewall=L+W x D x 2 x#of systems= s.f. Total area=bottom +sidewall — s.f. Effective leach area given Loading factor: Effective area=total area s.f.x LTAR =—g/day Effective area is>=design flow of facility being served Minimum of 2 pits at least 13'X16'—NA 9.01(3) Distribution for galleries/chmbrs.in trench config.-pipe every 20'-253(6) Distribution for galleries/chmbrs.in bed config.-ea.pipe serves<=40 s.f.-253(6) Spacing-2 times the effective width or depth(the greater)-253(1)(c) 2"of 1/8"- 1 /2" 2x washed peastone.-247(2) 3/4" to 1 1/2" double washed stone-247(1) Each pit has at least one 20" access cover. 24" CI to grade over 2,000 gpd -253(3) Surrounding aggregate thickness between 1'(min.)and 4'(max.)-253(1)(b) Vents,if necessary,extend under covers of pit(s)-241 (e) Leach Fields(Check here if not present: ) OK N/A y Number of fields:_ (need dosing chamber if> 1,231 (1)) 7 i 8 Length(100'max.): -252(2)(b) Width: ✓ Total area:L x W _ � s.f. Minimum 900 square feet-NA 9.01(1) Distribution lines connected with solid pipe–NA 15.01 Effective leach area given ✓ ' Loading factor: / Effective area=total area M0 s.f x LTAR ' 7-6 _ '�� g/dav Effective area is>=design flow of facility being served Minimum of two distribution lines-252(2)(a) Cline separation(max.)-252(2)(d) / 4'maximum separation from edge of field to line-252(2)(e) _ 10'minimum separation between adjacent leach fields-252(2)(f) Between 6" and 12" of 3/4- 1 1/2" stone beneath field-252(2)(g)&247(2) 2"of 1/8"-1/2" 2x washed peastone.-247(2) Final Grading OK .Problem N/A i /r —/ Slope over leach area minimum of 0.02 feet/foot–240(l 0) Grading shall divert drainage away from leach area–240(11) t% Grading slopes away from dwelling i 5/24/01 I 8