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January 2013 Review of Plans for Individual Household Septic Systems Name of Owner: Property Tax Map # Design Professional: Date: Watershed Review: Date: Health Dept. Review: Date: Resubmitted By: Date: ITEM CODE DESIGNER’S CHECKLIST HEALTH DEPT. REVIEW COMMENTS General 75-A Y N N/A 1. Number and type of prints (3 required) 2. Prepared by licensed design professional (seal & signature required) 3. Engineer’s report, if necessary 4. Space for approval stamp 5. Approval of watershed officials, if necessary Review Application, Fee 6. Signature (owner or agent) 7. All items completed 8. Application fee paid Location Plan 9. Lot layout drawn to scale 10. Contours shown Fig. 1 11. Final grade indicated 12. Watercourses, swamps, rock outcrops, filled areas shown 13. Location sketch, as taken from U.S.G.S sheet 14. Roadside ditches, yard swales, surface flow directions indicated 15. General slope, by arrows with spot elevations 16. Finished floor elevations or acceptable benchmark (assumed or otherwise) Soil Data 17. Percolation test results (2 required; 3 recommended) 18. Include date performed, performed by, and location (all results must be included) 19. Deep hole test results and location .4(c-d) 20. Record color of soil layers and indicate layers of compaction, if possible 21. Record all groundwater (perched, apparent and seasonally high levels) 22. Record all mottling indicators (isolated pockets of grey or “washed” silts and sands etc.) ---PAGE BREAK--- January 2013 ITEM CODE DESIGNER’S CHECKLIST HEALTH DEPT. REVIEW COMMENTS Topography & Elevation 75-A Y N N/A 23. Datum elevation (based on benchmark or finished floor elevation 24. Finished floor elevation 25. Circle one: hilly, rolling, steep slope, gentle slope, flat 26. Existing wetlands on or adjoining property: indicate distance to wetlands from property line (if adjoining) or absorption field (if on property) 27. Extensive grading necessary 28. Extensive fill necessary 29. Absorption Field Slope, maximum 15% Individual Sewage Disposal 30. Compliance with watershed rules .2(a) 31. Cellar drainage, disposal method shown on plans; surface drainage to be diverted away from the absorption field .3(a) 32. Separate pumps for laundry waste and cellar infiltration indicated by note and shown on plan .3(a) 33. Size, material, slope, tight joints for raw sewage line 34. Size, material, slope, tight joints for septic tank effluent line 35. Separation between house water service and sewage (10’ min) .5(c-d) 36. Separation between any water service line/main and absorption facility (10’ min) .5(c-d) 37. Sewage treatment systems shown in front of houses, if public sewers anticipated 38. Sewage absorption system not under driveways, pools, buildings .8(b)(1)(iii) 39. Bends in raw sewage eliminated (max. Single bend 45°L, if necessary) cleanout provided .5(a) 40. Location of existing wells and absorption fields (100’ separation, 200’ if down gradient) Table 2 Fig 1-2 Distribution Box 41. Details .7(a-b) 42. Baffle 43. Inlet at least 2” above outlet .7(a)(1)(iv) 44. Box set on a bed of sand or pea gravel at least 12” thick Septic Tank 45. Distance from house Table 2 46. Tank set on a bed of sand or pea gravel at least 3” thick 47. Septic tank should be 1,000 gallon min. capacity below outlet invert, with a 250 gal. increase for garbage grinders; each septic tank should have an adequate volume and liquid depth and 1” clearance for venting .6(b)(1)(iv) Table 3 48. Sanitary tee or baffles 49. Two inch drop between inverts of inlet and outlet .6(b)(1)(vii) 50. Gas deflection baffle on outlet where required 51. Effluent filter on outlet 52. Multi-compartment tank or tanks in series when required ---PAGE BREAK--- January 2013 Tile Field 53. Gravelless leach line proposed – circle one: chambers, geotextile sand filter, other .8(c) 54. Size, material, slope of laterals (4”dia., 1/16” per ft. max., 1/32” per ft. min.) .8(b)(3-4) 55. Cross-section of lateral trench 56. Lateral trenches equal length (show length of trench) 57. Maximum length of lateral trench 60 ft. (with gravity distribution) .7(a) 58. Width & depth of lateral trenches (width 24”, depth 18-30”) 59. Separation between trenches min. between walls of adj. trenches, 5’ or more desirable) .8(b)(2)(ii) 60. Distance from property line (10 ft. min.) Table 2-Fig. 1 61. Distance from existing wells (100’ min., 200’ if uphill from well) Table 2-Fig. 1 62. Number of bedrooms indicated Table 4A 63. Required absorption area (total and per bedroom) Table 4A 64. Additional absorption area available for expansion indicated on site plan .4(5) 65. Required minimum distances: 20’ to storm drain pipe, 100’ to body of water, 10’ to water line, 20’ to open ditch Table 2 Fig. 1-2 66. Recommended distances: 10’ to natural gas, electric, and/or telephone lines 67. Ground water 2 ft. below bottom of trench .8(b)(1)(ii) 68. Pump chambers equipped with alarm 69. Dose volume specified 70. Pump chamber sized to hold minimum one day design flow above alarm level Additional Design Notes: