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Home My WebLink AboutTitle V Inspection Report - 1423 SALEM STREET 5/5/2017 FILE# KA 1 1 , TITLE V INSPECTION F, ,. 01Dean G. Luscomb II ,& Sons P.O. Box 1.35 Middleton,, MA 01949 978.774-4465 Licensed Plumber # 2.0285 jSUBSURFACE SEWAGE E IU ISP©SAL SYSTEM INSPECTION FORM PROPERTY OWNERS NtME .� PROPERTYADDRESS �r DATE OF INSPECTION I c. .. .. SAME of INSPECTOR ,� . j j 1 QUALITY IS NUMBER ONE TO US I, Commonwealth of MassachuseM . "�"�N� � ��~�N N�� Title �� Official� @ �� Form . �� ~_ �� wm��w ��um �� Subsurface Sewage Disposal System Form Not for Voluntary Assessments 1423Salem Street `-- Property Address ---- � -- O0urttna 8 s Owner — ---- mfonnmUonis required for North Andover MA 01845 N1e 1 �O17 every page. City/Town State Zip Code Date nfInspection Inspection results must be submitted on this form. Inspection forms ma d in any way. Please see completeness checklist atthe end nfthe form. � Important: A ��4�U�«��U U��z��^��U� �J� - 10, VV�onhUin8ou� ^ ^~ General Information ~^ ' - forms vnthe ' uompu0er,umo 1. |napootoc101 ` on�the�bkey �~ humove your Dean G� Lueoornb || cu�m'donca Name of|napeomr use the return key. Dean G. LUGOQ[ObU & Sons Company Name 2R8 (Na / §treet ----- TompanyAdUmoe Middleton MA 01949 Qty/Town State Zip Code 978-774-4065 S1848 Telephone Number License Number B. Certification | certify that| have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site mowegg disposal systems. |am m DEP approved system inspector pursuant to Section 15.340 of Title 5 (310CMR 1S.O00), The system: PoesoG Conditionally Passes Fl Fails [] Needs Further Evaluation bythe Local Approving Authority May 1, 2017 Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board ofHealth orDEP)within 8Udays ofcompleting this inspection. |fthe system ina shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report bzthe appropriate regional office ufthe DER The original should besent tothe system owner and copies sent tVthe buyer, ifapplicable, and the approving authority. °^^°TNisreport only describes conditions atthe time qf inspection and under the conditions mfuse atthat time.This inspection does not address how the system will perform 7nthe future under the same mrdifferent conditions ofuse. mns'3n3 Title sOfficial inspection Form:Subsurface Sewage Disposal System'Page`w`/ Commonwealth of Massachusetts Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1423 Salem Street �M Property Address Courtney Scruggs Owner Owners Name informatiover for y �on is required North AndMA 01845 May 1 2017 every page. Cityfrown State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Chec6A�,C,D or E 1 always complete all of Section D A) System Passes: ((✓�// ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass" section geed to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following statements, If"not determined," please explain. The septic tank is metal and over 20 years old* or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): 15ins 311: Title 6 Official Inspection Form:Subsurface Sewage Disposal Syslem-Page 2 of 17 Commonwealth of Massachusetts 4Title 5 Official inspection Form of Subsurface Sewage Disposal System Form -Not for Voluntary Assessments %M 1423 Salem Street _ Property Address Courtney Scruggs _—__-- Owner Owner's Name required on is North Andover MA 01845 May 1, 2017 required for — -----_-- every page. Cityfrown State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due �1 to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will v pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ NCS (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR px� 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•3113 Title 5 official Inspection Form:Subsurface Sewage disposal System•Page 3 or 17 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments v M 1423 Salem Street Property Address Courtney Scruggs _ Owner Owner's Name information is required for North Andover _MA 01845 Ma 1, 2097_ _—_�..__..._... __ __.—...__. every page. CityfTown State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: V ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within U 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well, ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool El ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ® Liquid depth in cesspool is less than 6" below invert or available volume is less than 1/day flow t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form R Subsurface Sewage Disposal System f=orm -Not for Voluntary Assessments " 1423 Salem Street Property Address Courtney Scruggs Owner Owner's Name information is North Andover MA 01845 May 1, 2017 required for every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. El ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a,Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system falls. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd: For large systems, you must indicate either"yes" or"no" to each of the followi in addition to the questions in Section D. Yes No ❑ ❑ the system is within-400 feet of a su a drinking water supply El El system is within 200 fee a�tributary to a surface drinking water supply E] F1the system is located ' a nitrogen sen.isitive area (Interim Wellhead Protection Area--IWPA)or apped Zone II of a public-water supply well If you have answered"yes"to a question in Section E the system is considered a significant threat, or answered "yes" in Sectio above the large system has failed. The owner or operator of any large system considered asigpi cant threat under Section E or failed under Section D shall upgrade the system in accordanc, 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 15Tns•3113 Title 6 Official Inspection Form:Subsurface Sewage Disposal System•f age 5 of 17 Commonwealth of Massachusetts v _ = Title 5 Official Inspection Form Subsurface Sewage Disposal System f=orm - Not for Voluntary Assessments 1423 Salem Street Property Address Courtney Scruggs �� Owner Owner's Name information is required for North Andover MA 01845 May 1, 2017 ----- �— every page. City/Town State Zip Code Date of Inspection i C. Checklist Check if the following have been done. You must indicate"yes"or"no"as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? El ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (if they were not available note as NIA) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? Was the facility owner(and occupants if different from owner) provided with ® ❑ information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)J D. System Information Residential Flow Conditions: Number of bedrooms (actual): 4 Number of bedrooms (design): 4 ---- _ DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 440 gpd l5ins.379 g Title 5 Official Inspection Form:Subsurface Sewage Disposal system•Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 1423 Salem Street JProperty Address Courtney ------- Owner Owner's Name information is North Andover MA 01845 required for ------- 201 ......... every page. Cityrrown State Zip Code Date of Inspection D. System Information Description: owner and town Number of current residents, Does residence have a garbage grinder? Yes ❑ No Is laundry on a separate sewage system? (Include laundry system inspection El Yes F1 No information in this report.) Laundry system inspected? El Yes M No Seasonal use? El Yes 2 No Water meter readings, if available (last 2 years usage (gpd)): Detail: Sump pump? EJ Yes No current Last date of occupancy: Dat,e Commercial/Industria[ Flow Conditions: Type-Q,f Establishment: e 310 CMR 1 --------------- ---------- Design flaw(base 310 CMR 15.203): Gallons per da If ripsia low r Basis of design flow(fseats/�per ��/sqfftt., etc.): Grease trap present? El Yes D No Industrial waste holding tan sent? F] Yes [I No Non-sanitary w discharged to the Title 5 system? El Yes E] No Water meter readings, if available: t51ns-311 TiYe 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17 Commonwealth of Massachusetts N F Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments M 1423 Salem Street Property Address Courtney Scruff - Owner Owner's Name information Is required for North Andover MA 01845 May 1, 2017 -- -�� every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe b9low');-- � General Information Pumping Records: Source of information: Last pumped 6 ears a o-owner mm Was system pumped as part of the inspection? ® Yes ❑ No 100D gallons- ...�_ If yes, volume pumped: gallons by measurements How was quantity pumped determined? ��- he�avy solids Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system 11/1 P(4P" ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the IIA system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): l5ins•3113 Title 5 Official inspection Form:Su»surfaoe sewage Disposal System•Page a of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments H 1423 Salem Street Property Address Courtney Scruggs Owner Owner's Name information is required for Noah Andover MA 01845 May 1, 2017 _ — — every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: System is from 2002 - 15 years old. _ ---_-_--_ Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: feet �— Material of construction: ® cast iron ❑ 40 PVC ❑ other(explain): - � Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): Main line and joints are in good condition. Septic Tank (locate on site plan): 22" Depth below grade: feet / Material of construction: / ®concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) Precast rectangular concrete- 1000 gallons _ If tank is metal, list age: - years Is age�n firmed by a Certificate of Compliance?(attach a copy of certificate) Dimensions: CIF Sludge depth: T t5ins•3l73 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of f 7 Commonwealth of Massachusetts 5 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1423 Salem Street Property Address Courtney Scruggs _— _— _ Owner Owner's Name information is required for North Andover MA 01845 May 1, 2017 - — every page. CitylTown State Zip Code Date of Inspection D. System Information (cont.) Septic Tank (cont.) Distance from top of sludge to bottom of outlet tee or baffle 20 - - Scum thickness 5„ 3 --- Distance from top of scum to top of outlet tee or baffle — - 13" Distance from bottom of scum to bottom of outlet tee or baffle - - - How were dimensions determined? by measurements Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Septic tank and baffle are in very good shape. The solids are heavy and do require pumping at this time. The liquid.is running at it's correct working hei kg h. Grease Trap (locate on site plan): Depth below grade: feet Material of construcfiw ❑ concrete ❑ meta;l `- ❑ fiberglass ❑ polyeth e ❑ other(explain): Dimensions: —— Scum thickness --_--------.__.__.— Distance from top of scum to to outlet tee or baffle Distance from bottom scum to bottom of out tee or baffle Date of last pu ing: Date t5in3•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 17 Commonwealth of Massachusetts w Title 5 official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1423 Salem Street Property Address Courtney Scruggs Owner Owner's Name information is North Andover' MA 01845 May 1,2017 required for - every page. CitylTown State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.), y Tight or Molding Tank (tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concreteEl metal ❑fiberglass ❑ polyethyle( ❑ other(explain): Dimensions: ,.- — —- Capacity: ga—IE ns Design Flow: — gallons per day Alarm present: Yes ❑ No ^e. 'N. Alarm level: - Alarm in working order: -1 Yes El No Date of last pumping: rate Comments (conditio f alarm and float switches, etc.): k *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No 151rns.3113 Title 5 Official Inspection Form.Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1423 Salem Street --_-- Property Address Courtney Scru s Owner Owner's Name information is North Andover MA 01845 May 1, 2017 required for - -- every page. CitylTown State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert Zero Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): The d-box is 16"x 16" and is 12" below grade. The d-box is in ve ood shape. _ I Pump Chamber(locate on site plan): Pumps in working order: dyes ❑ No* Alarms in working order. [eyes E] No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): 1� Rw Gc.�T W n(a�'� ase- tattz /� csio'W +?-- _ S�14,611011 d.r 1600f.01 to z cak'44 tnu �- * If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: SAS was located by asbuilt drawings and d-box to vent location. n 15[ns•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1423 Salem Street Property Address Court ie Scru Owner Owner's Name information is required for North Andover MA 01845 May L2017 - every page. City/Town State Zip Code Date of Inspection D. System information (cont.) Type: ❑ leaching pits number: - ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ® leaching fields number, dimensions: 1 - 1g x 50' — ❑ overflow cesspool number: — ❑ innovative/alternative system Type/name of technology: -- -� Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): The SAS is in good condition. There are no signs of ponding or breakout. � C0 ccs u3 Ie, C, Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configur ltiarl - -- Depth—top of liquid to init erf� / Depth of solids layer " Depth of scum layer — Dimensions of cesspool — _ - Materials of constru Indication roundwater inflow ❑ Yes ❑ No t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °wW 1423 Salem Street _ Property Address Courtne Scru s Owner Owner's Name information is required for North Andover MA 01845 May 1 2017 -- every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc,): �k Privy (locate on site plan): �J Materials of construction: V Dimensions Depth of solids --�_ Comments (note condition of soil, signs of hyd Ic ft+lui e, level of ponding, condition of vegetation, etc.): t5ins•3113 Title 6 Official Inspection Form;Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts Title 5 Official np ion Form Subsurface Sewage Disposal S tern rm - Not for Voluntary Assessments 1423 Salem Street - - – — Property Address Courtney Scru S _ -- Owner Owner's Name information is North Andov MA 01845 May 1, 2017 required for every page, cityfTo State Zip Code Date of Inspection ystem Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately 8fo-ra. t {3�D1 ~ 3q b_PDX T`6(- Ab Pl !., I z n► A P1 + � � 2 " 7 Q DL ,(,mac!I►-,y `�1 � _ A I i d P P p iF t5ins•3113 Title 5 WSW Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1423 Salem Street Property Address Courtne Scru Owner Owner's Name information is North Andover MA 01845 May 1, 2017 required for State Zip Code Date of Inspection every page. Cityfrown D. System information (cont.) Site Exam: ® Check Slope ® Surface water Coj ® Check cellar ® Shallow wells 3 2.5'to 4' _ Estimated depth to high ground water: Leet Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record 09/19102 If checked, date of design plan reviewed: Date ® Observed site (abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health -explain: Permit, proposed and asbuilt on file._ -- -- ❑ Checked with local excavators, installers- (attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: Test hole# 1 showed ESHGW at 47". Test hole#2 showed ESHGW at 47". Test hole#3 showed ESHGW at 31". Test hold#4 showed ESHGW at 30" and Fest hole#5 showed ESHGW at 48". The basement is 5' below grade of SAS, Before filing this Inspection Report, please see Report Completeness Checklist on next page. Title 5 Official inspection Form:Subsurface Sewage Disposal System Page 16 of 17 t5ins•3113 Commonwealth of Massachusetts N Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments w„ m 1423 Salem Street Property Address Courtney_§cTgqs Owner Owner's Name information is _ required for North Andover MA 01845 May 1_,_2017 every page. CitylTawn State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins•3113 Title 5 official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 11