"Submission Details" - Nova Scotia, Canada

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In keeping with the privacy provisions of the Nova Scotia Freedom of Information & Protection of Privacy Act, Nova Scotia
Environment will only use the personal information for the purpose for which the information was obtained or compiled, or for a
use compatible with that purpose.
SUBMISSION DETAILS
On-site sewage system application for approval required attachment
QP/P.Eng. NAME:
PID:
Soil evaluation results
Test pit profile (m)
Total depth:
soil layers
soil type
depth of
density
moisture
m
soil (mm)
bedrock at:
m
ORGANIC
organic mat
first
water table at:
m
%
slope:
second
m
roots to:
third
mottling at:
m
fourth
System selection or design specifications
Type of Disposal Field:
Imported sand fill required
YES
” NO
Distribution Trench
Length:
m
Minimum permeability of
Dimensions:
Width:
m
imported sand
m/sec
Width of Buffer - downslope
m
Cut at Toe of Trench:
mm
- upslope
m
Interceptor Trench
YES
NO depth:
mm
Depth of Buffer
mm
Liner:
YES
NO thickness:
(at 5 m from trench)
Pump or Siphon Capacity
litres
litres
Septic Tank Capacity
Watertight Testing:
YES
NO
YES
NO
Watertight Testing:
Minimum clearance distances as illustrated on attached site plan
From
To
To
From
To
To
From
To
To
Nearest
Field
Tanks
Nearest
Field
Tanks
Nearest
Field
Tanks
Lot Boundary
m
m
Cistern
m
m
Water Distribution
m
m
Downslope Boundary
m
m
Watercourse
m
m
Foundation Drain
m
m
Drilled Well
m
m
Wetland
m
m
Other
m
m
Dug Well
m
m
Intermittent Drain
m
m
Other
m
m
Revised MAY 2016
page 1 of 2
In keeping with the privacy provisions of the Nova Scotia Freedom of Information & Protection of Privacy Act, Nova Scotia
Environment will only use the personal information for the purpose for which the information was obtained or compiled, or for a
use compatible with that purpose.
SUBMISSION DETAILS
On-site sewage system application for approval required attachment
QP/P.Eng. NAME:
PID:
Soil evaluation results
Test pit profile (m)
Total depth:
soil layers
soil type
depth of
density
moisture
m
soil (mm)
bedrock at:
m
ORGANIC
organic mat
first
water table at:
m
%
slope:
second
m
roots to:
third
mottling at:
m
fourth
System selection or design specifications
Type of Disposal Field:
Imported sand fill required
YES
” NO
Distribution Trench
Length:
m
Minimum permeability of
Dimensions:
Width:
m
imported sand
m/sec
Width of Buffer - downslope
m
Cut at Toe of Trench:
mm
- upslope
m
Interceptor Trench
YES
NO depth:
mm
Depth of Buffer
mm
Liner:
YES
NO thickness:
(at 5 m from trench)
Pump or Siphon Capacity
litres
litres
Septic Tank Capacity
Watertight Testing:
YES
NO
YES
NO
Watertight Testing:
Minimum clearance distances as illustrated on attached site plan
From
To
To
From
To
To
From
To
To
Nearest
Field
Tanks
Nearest
Field
Tanks
Nearest
Field
Tanks
Lot Boundary
m
m
Cistern
m
m
Water Distribution
m
m
Downslope Boundary
m
m
Watercourse
m
m
Foundation Drain
m
m
Drilled Well
m
m
Wetland
m
m
Other
m
m
Dug Well
m
m
Intermittent Drain
m
m
Other
m
m
Revised MAY 2016
page 1 of 2
SUBMISSION DETAILS
Site plan for proposed on-site system
Site plan must include drawing of lot layout illustrating the location of the test pit(s), direction of and % slope, location of
structures (proposed or existing), watercourse(s), well(s) and other confining features identified in the Standard including
required clearance distances, in relation to the planned system location.
*may include separate attachment for site plan*
Professional engineer or qualified person:
DATE:
(Signature)
QP or P. Eng. #:
(Print name)
Revised MAY 2016
page 2 of 2
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