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APPLICATION FOR DISPOSAL WORKS CONSTRUCTION PE IRMIT
DATE: CTj-RRENT D,�STALLER'S L10E, -`,Er4/,
L 0 CXE 0 N:
LICENSED LNSTALLER:
SIGNATURE: TELEPHONES
C=CK ONE:
REPAIR: NEW CONSTRUCTION:
IT NEW CONSTUCTION, PLEASE ATTACE FOUNDATION AS-BUILT.
Ai rninistrative Use Only
575,00 Fe-- Attached? Yes 0
Foundation As-Bunt? Yes No
Floor Plans? Yes f No
Approval Date:
rA,
INSTALLER PROJECT MANAGEMENT OBLIGATIONS
As the North Andover licensed installer for the construction of the septic system for the property
at qre j relative to the application of
dated ' ,,'' for plans by ,�� ,_ A and dated > with
revisions dated
I understand and 6gr ee to the following obligations for management of this project:
1. As the installer I am obligated to 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 two shall be applicable .
2. 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 Title 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 BOR 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.
3. As the installer I understand that persons or companies not associated with my company may
not perform the work required by my company 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 in the Town of North Andover plus
significant fines to all persons involved.
4. 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.
d) Installation of tank,D-box,pipes, stone,vent,pump chamber,retaining wall and other components.
5. 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 Li ease Se is Installer
n Date: Z t1
INSPECTION CHECKLIST FOR SEPTIC SYSTEMS
Yes NO Initials
A. Bottom of Bed
1. Excavation to proper depth
2. With trenches,sides of excavation are beneath B horizon
3. Edge of excavation specified distance from foundation,etc. �.-
Comments:
B. Retaining Wall
1. Wall height and width as specified _ W
2. Waterproofed
3. Wall minimum 10'to leaching facility
4. Wall meets specifications of plan
Comments:
C. Building Sewer
1. Pipe diameter minimum 4"
2. Schedule 40 pipe
3. Watertight joints
4. Inlet to tank cemented
5. Slope minimum 0.01 or 1/8"per foot minimum
6. Pipe properly set on compact firm base
7. Pipe laid on continuous grade in straight line
8. Cleanouts precede all change in alignment and grade
9. Manholes at any 90°change
10. 10' minimum offset to water line
Comments:
D. Septic Tank
1. Level
2. 1,500 gal minimum
3. Gas baffle present on outlet
4. Manhole to grade
5. Manholes over center and each tee
6. 3-20"manholes
7. Inlet tee minimum 12"under invert
8. Outlet tee minimum 14"under invert
9. Outlet line cemented
10. Air space 3"above tees
11. 2"-3"drop from inlet to outlet
12. Pipe set
13. Compact base with 6"of 1/4"crushed stone under tank
14. Tank is watertight
Comments:
Yes NO
E. Pump Chamber
1. If separate from tank,compact base with 6"of 1/4"stone underneath
2. Minimum 2"pipe to d-box if gravity system
3. 20"access manhole
4. Tank level
5. Watertight
6. Tank size agrees with plan specification
7. Manhole to grade
8. Check valve and bleeder hole present
9. Alarm in building on separate circuit
10. Alarm functions
11. Manual operating switch
12. Pump delivers liquid to d-box
Comments:
F. Distribution Box
1. D-box level i
2. Minimum 0.17"(2")drop from inlet to outlet
3. Minimum 6"sump
4. Outlet pipes show equal distribution �p /
5. Compact base with 6"of stone beneath box G ✓ G� L"
6. Box is watertight
7. All lines cemented with hydraulic cement
8. Schedule 40 pipe
Comments:
G. Soil Absorption system
1. All stone double-washed-3/4 - 1 %z" �
-pea stone
Bucket test done?
2. Minimum 2".of pea stone above distribution lines
3. Minimum 6"stone beneath pipe
4. Distribution lines capped or connected together
5. Grading meets 3:1 slope
6. Minimum of 9"of fill graded over system
7. Toe of slope stops minimum 5' from edge of property; if not,then Swale.
Comments:
H. Leach Trenches
1. Minimum 2 trenches
2. Length of trenches agree with plan. (Max. length 100')
3. Width of trenches agree with plan-Minimum 2';maximum-4'.
4. Vent present if<50 feet or specified
5. Distance between trenches minimum 4' and maximum of 6'
6. Minimum distance between trenches 10'
7. Pipe slope minimum 0.005 or 6"per 100'
8. Depth of trenches below outlet invert minimum of 6".
Yes NO
9. Pipes set on stable base.
Comments:
I. Leach Field
1. Maximum length of field 100'
2. Pipe slope minimum 0.005 or 6"per 100'
3. Separation between pipe 6'maximum
4. Pipes connected at end
5. Separation between adjacent fields 10'minimum
6. Pipes set on stable base
7. Maximum 4' separation from edge of field to first line
8. Minimum two distribution lines
9. Maximum perc rate 20 mpi
Comments:
I Leaching Pits
1. Minimum inlet pipe 4"
2. Pits of concrete
3. Sidewall between 12"and 48"wide
4. Access manholes on each pit
5. Pipes cemented with hydraulic cement
Comments:
K. Final Grade
1. Slope over soil absorption system minimum 0.02
2. All system components covered by at least 9"soil
3. Cover soil free of stones larger than 6"
4. Grading slopes away from dwelling
5. No areas over system that may pond