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HomeMy WebLinkAboutTitle V Inspection Report - 21 CLARK STREET 11/3/2017 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 21 Clarks St Property Address Intergrated Paper Recycle Owner ---------- Owner's Name information is required for every North Andover MA 01845 10-4-2017 page. City[rown State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When A. General Information RECEWFn filling out forms on the computer, NOV 3 2017 use only the tab 1. Inspector: key to move your TOWN OF NORTH ANDOVER cursor-do not John DiVincenzoHEALTH DEPARTMENT use the return Name of Inspector ---------------- ----------- key. &0---h J and S Development,/Stewarts Septic Service Company Name 58 South Kimball St Company Address Bradford Ma 01835 City/Town State Zip Code 978-372-7471 s1113386 Telephone Number License Number B. Certification I certify that I 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 sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000).The system: Passes Conditionally Passes ❑ Fails [:1 L N eds Further Evaluation by the Local Approving Authority j N 10-4-2017 Atnspecto Si Date Signature Thesy teminspector sh 11 submit a copy of this inspection report to the Approving Authority(Board of Healt or DEP)within 30 days of completing this inspection. If the system has a design flow of 10,000 pd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. "This report only describes conditions at,the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. l5ins.doc-rev.6116 Title 5 Official inspection Form:Subsurface Sewage Disposal System-Page 1 of 17 / Commonwealth of Massachusetts �������� �� �����N N��������°������� ����Np��� Title �� Official� � ���0 �-��mmm � �� �� �� wu���p�� ��m � ��wbsm�ame Sewage Disposal SVstenmFmrmm ' NutforVo|untaryAmeenam�nto 21 Clarks St Property Address Into rated Paper Recycle Owner Owner's Name information is North Andover K8A01845 10-4-2017 required �� mmry -___- ---__- page. CiiyfTuwn State Zip Code Date ufInspection B. Certification (cont.) Inspection Summary: Check A'B.C.DorE/always complete all ofSection D A) System Passes: 1 have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303orin 310 CMR 15.304exist. Any failure criteria not evaluated are indicated below. Comments: 113) System Conditionally Passes: Fl one ormore system components ondescribed in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board ofHealth, 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 pose inspection ifitie structurally sound, not leaking and if Certificate of Compliance indicating that the tank ioless than 20years old ioavailable. El Y F1 N F1 NO (Explain be|ow): t5imcloc rev,6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 17 � c'~ Commonwealth of Massachusetts �� | T=tQ5 Official Inspection Form Subsurface Sewage Disposal System Form ~Not for Voluntary Assessments 21 Clarks St Property Address Intergr ted Paper Recycle Owner Owner's Name information i's required for every North Andover MA 01845 10-4-2017 ------���— ----- page. QtyfTmwn Stat* Zip Code Date m[Inspection B. Certification (cont.) F7 Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumpm/a|armsare repaired. £Q System Conditionally Passes (oont]: [l Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(m) or due to a brokon, settled or uneven distribution box. System will pass inspection |f(with approval ofBoard nfHea|th): Fl broken pipe(e) are replaced El Y [l N Fl NO (Explain be|nm): F-1 obstruction ioremoved D Y F] N 0 ND(Explain ba|ow): Fl distribution box ieleveled orreplaced O Y n N [l ND/Exp|ainbe|uvW: El The nyobam required pumping more than 4times ayear due bo broken or obstructed pipe(e). The system will pass inspection if(with approval of the Board of Health): F1 broken pipe(a)are replaced O Y 0 N F-1 ND(Explain below): � obstruction is removed 0 Y 0 N F ND (Explain below): Cl Further Evaluation is Required by the Board ofHealth: F-1 Conditions exist which require further evaluation by the Board of Health in order to determine if the mymhmm is failing to protect public health, mafob/or the environment. 1. System will pass unless Board oVHealth determines |maccordance with 310 CMR 15'3O3(1)(b) that the system |mnot functioning |nemanner which will protect public health, safety and the environment: F] Cesspool orprivy inwithin 50feet ofa surface water [l Cesspool or privy is within 50feet ofa bordering vegetated wetland or m mo|t marsh ,mn,.**'rev.v/,v Title oOfficial Inspection Form:Subsurface Sewage Disposal System`Page omo Commonwealth of Massachusetts / =��°��N�� �� ��"��U 0��������=°�°���� ����0�0��} � Title �� ��/N � ������� Inspection �-��mumm Subsurface Sewage Disposal System Form ~ Not for Voluntary Assessments 21 Clarks St _ ~ _ | Interg, ated Paper Recycle Owner Owner's Name information is North Andover MA 01845 10-4-�U1� mqv|nmkxeerY ------�����-----' ����-- -------- � page. O&yfTow» State Zip Code Date ufInspection � 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 e manner that protects the public health, safety and environment: F1 The system has a septic tank and soil absorption system(SAS)and the SAS is within 1OOfeet Vfusurface water supply ortributary toasurface water supply. El The system has septic tank and SAS and the SAS is within o Zona 1 of public water supply. [l The oymhs0 has a septic tank and SAS and the SAS is within 50feet of a private water supply well. F7 The system has mseptic tank and SAS and the SAS inless than 108feet but 5Ofeet nr more from a private water aupp|yvw*||°°. Method used todetermine 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 noother failure criteria are triggered. /\copy ofthe ono|ymia must beattached hothis form. 3. Other: OH System Failure Criteria Applicable hmAll : You must indicate "Yas" or"Nm" toeach mfthe following for all inspections: Yes No �l �� Backup ofsewage into faoi|lWorsystem component due toovedoededor �� ~~ clogged SAS orcesspool Fl �� Discharge nrponding ofe�uenttnthe au�anmofthe ground orsu�aoawaters �� �� due toonoverloaded orclogged SAS or cesspool Static liquid level in the distribution box above outlet invert due to an overloaded orclogged SAS orcesspool " F� �� Liquid depth in cesspool is less than 8'' be|ovvinvedoravailable vdume in |emm �� �� than 1/2 day flow Mns.m='rev.omo Title nOfficial Inspection Form:Subsurface Sewage Disposal System^Page*u,r Commonwealth of Massachusetts i =�"=��0�� �� �=���������N 0��������^=,������ ����N�R�� � Title �� ���� � ������� Inspection �—��mmmw ~ Subsurface Sewage Disposal System Form ~ Not for Voluntary Assessments � 21 Clarks St Property Address � IntergratedPa Re \ Owner Owner's Name / information i's required North Andover MA 01845 10-4-2017 / ' page. CdyfrStateown � Zip Code Date ofInspection � B. Certification (cont.) Yes No �l �� y� R�qu|r�dpumpingmore than 4times inthe last year OTduetoclogged Vr �� =� obstructed p|pn(e). Number oftimes pumped: _____ El 0 Any portion of the SAS, cesspool or privy is below high ground water elevation. [l �� Any pnrUVnofcesspool orpr�y |mwithin 1U0feet ofeau�acewater supply or �� �� tributary hoasurface water supply. [7 0 Any portion ofacesspool nrprivy|awithin aZone 1 ofapublic well. | Fl 0 Any portion of a cesspool or privy is within 5Ufeet ofe private water supply vme||. Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from o private water supply well with no acceptable water quality analysis. [This system passes ifthe well water analysis, performed ata DEP certified laboratory, for fecal coliform bacteria indicates absent and the pmaemmoe 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 ofcustody must beattached tothis fonm.] The system is a cesspool serving a facility with a design flow of 2000gpd- 10.080gpd. [l �� The system fails. | have determined that one nrmore ofthe above failure criteria exist asdescribed in 310 CMR 15.383, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary tocorrect the failure, E\ Large Systems: Tube considered mlarge system the system must serve a facility with m design flow of10.UnQ0pdbo15,8OOgpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions D. Yea No E-1 1-1 the system |ewithin 4OOfeet ofasurface drinking water supply El [l the system is within 200 feet of a tributary to a surface drinking water supply Fl �l the system is located in o nitrogen sensitive area (Interim Wellhead Protection �� �� Area — |VVPA)oramappedZone || ofopub||owater snpp|ywe|| If you have answered "yes" to any question in Section E the system is considered a significant threat, or answered "yea" in Section O above the large system has failed. The owner or operator of any large | system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate i regional office ofthe Department. 15ins.doc rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 17� | ` Commonwealth of Massachusetts ^ ��"��N�� �� ��=��N Inspect on ��������� � Title �� �-��|��0��@�m� �mm�� ��������um ����m mmm Subsurface Sewage Disposal System Form ~Not for Voluntary Assessments 21 Clarks St ~ Property Address Intergrated Paper__Recy | Owner Owner's Name information is North Andover MA 01845 10-4-2017 nmuina�hrnv*� -- - — -- -- page. Ci\�Tvwn — -at e, Zip Code Date ofIns pect|nn . C. Checklist Check if the following have been done. You must indicate"yes" or"no" as to each of the following: | Yee No [8 El Pumping information was provided by the owner, occupant, or Board of Health [l 0 Were any Vfthe system components pumped out inthe previous two weeks? M El Has the system received normal flows inthe previous two week period? �� �� Have large volumes ofwater been introduced tothe system reuenUyoraapart of �� �� this inspection? �l VVereasbuilt plans ofthe system obtained and examined?(If they were not �� �� available note oeNA\) ` • El Was the facility ordwelling inspected for signs ufsewage back up? • El Was the site inspected for signs nfbreak out? • El Were all system components, excluding the SAS, located onsite? • Fl 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 ufliquid, depth ufsludge and depth ofscum? VVeothafaoi|ih/owner(andoonupanbs |fdiffmrnntfromownar) providedvvith information on the proper maintenance of subsurface sewage disposal systems? The size and location ofthe Soil Absorption System (SAS) nnthe site has been determined based on: [l Existing information. For example, a plan at the Board of Health. B� �l Determined in the field (�e|d /ifanyof�hehai|ure criteria related to Part is at issue �� approximation ofdistance isunacceptable) [31OCMR 15.3O2/5>] D. System Information Residential Flow Conditions: OO Number ofbedrooms(deoign): -------' Number of bedrooms(actual): ---------- DESIGN flow based on31OCMR 15.2D3(for example: 11Ogpdx#ofbadroomo): ,mn".*oc~rev.oxv Title nOfficial Inspection Form:Subsurface Sewage Disposal System`Page vm,r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 21 Clarks St .. ........... ... ................. - ---__- Property Address Intergrated Paper Recycle Owner Owner's Name information is required for every North Andover MA 01845 10-4-2017 ............... page. Cityfrown State Zip Code Date of Inspection D. System Information Description: ............. Number of current residents: Does residence have a garbage grinder? El Yes 0 No Is laundry on a separate sewage system?(Include laundry system inspection El Yes El No information in this report.) Laundry system inspected? n Yes El No Seasonal use? El Yes M No Water meter readings, if available (last 2 years usage(gpd)): ............... Detail: . ................. . ............ --- .. . ............ ............. -- Sump pump? El Yes H No Last date of occupancy: occupied 6_aie' Commercial/industrial Flow Conditions: Type of Establishment: .r�cI ng Design flow(based on 310 CMR 15.203): ,Gallons per day -(gpd) Basis of design flow(seats/persons/sq.ft., etc.): ........... Grease trap present? El Yes 0 No Industrial waste holding tank present? n Yes H No Non-sanitary waste discharged to the Title 5 system? El Yes 0 No Water meter readings, if available: t5ins.doc•rev.6116 TiUe 5 Official inspection Form:Subsurface Sewage Disposal System-Page 7 of 17 | � | | Commonwealth of Massachusetts T �� e 5 Official Inspection nsection orm Subsurface Sewage Disposal System Form ' Not for Voluntary Assessments 21 Clarks St Property Address IntergratedP Rmy9l,e ( Owner Owner's Name information i's y �quimdhx�e� North Andover �A O184� 10-4-2O17 page. City/Town State Zip Code Date mInspection D. System Unfm`r00at~oKD (cont.) Last date ofocoupanov/ueo' occupancy/use: os$w Other(describe be4ov ): General Information Pumping Records: Source Vfinformation: Was system pumped enpart ofthe inspection? E Yes El No 1OOO If yes, volume' � Vononn ita u truck How waoquaodh/ pumooddetermined? - Reason for pumping: ina eottk Type of Symbnrn: N Septic tank, distribution box' soil absorption system El Single cesspool [l Overflow cesspool F] Privy El Shared system (yes or no)(if yes, attach previous inspection records, if any) E1 Innovative/Aternative 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 |6A system by system operator under contract El Tight tank. Attach acopy nfthe DEP approval. �� Other(describe): Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 21 Clarks St Property Address I ddressI ntergrated Paper Recycle OwnerOwner's Name Information is North Andover MA 01845 10-4-2017 required for every own State Zip Code Date of Inspection page. at—Y ....... ....... ........... ..... D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: 50 yrs .......... .......... Were sewage odors detected when arriving at the site? El Yes 0 No Building Sewer(locate on site plan): Depth below grade: 4811 feet Material of construction: E cast iron El 40 PVC F1 other(explain): Distance from private water supply well or suction line: ................... feet Comments(on condition of joints, venting, evidence of leakage, etc.): - —----- --- . ............ .......... Septic Tank(locate on site plan): B.T.G Depth below grade: feet Material of construction: FJ concrete El metal F]fiberglass n polyethylene ❑ other(explain) .............. ........... ............... ........... .............—- If tank is metal, list age: -- .............. years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) El Yes El No Dimensions: Sludgedepth: — .....................................—----------- 151ns.doc-rev.6116 Title 5 Official inspection Form:Subsurface Sewage Disposal System-Page 9 of 17 <L,\ Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 21 Clarks St Property Address Intergrated Paper Recycle Owner Owner's Name information is North Andover MA 01845 10-4-2017 required for every page. City/Town State Zip Code -- Date of Inspection D. System Information (cont.) Septic Tank(cont.) 2011 Distance from top of sludge to bottom of outlet tee or baffle Scum thickness Distance from top of scum to top of outlet tee or baffle 5il .... ......... 14" Distance from bottom of scum to bottom of outlet tee or baffle ............. Tape Measure, sluge judgeap How were dimensions determined? T- I 11-l-111 Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Both baffles-tees good , no leakage , liquid level good . .............. .. ........ .. .........----- . ...... .. .................. . . ........ Grease Trap(locate on site plan): Depth below grade: Material of construction: n concrete metal F fiberglass ❑ polyethylene El other(explain): .......... Dimensions: Scum thickness .............. Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle --... .................. Date of last pumping: Date t5ins.doc-rev.6116 Title 5 official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 17 <L",\ Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 21 Clarks St .......... ............... - -------- Property Address Interg ated Paper Recycle Owner Owner's Name information is North Andover MA 01845 10-4-2017 required for every . ..... page. City/Town State Zip Code Date of f 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.): .............................. ....... Tight or Holding Tank(tank must be pumped at time of inspection)(locate on site plan): Depth below grade: Material of construction: El concrete 0 metal F-1 fiberglass El polyethylene El other(explain): Dimensions: .. ......... Capacity: gations ....... ................ Design Flow: ... .gallons per day Alarm present: El Yes ❑ No Alarm level: Alarm in working order: El Yes El No Date of last pumping: Date Comments(condition of alarm and float switches, etc.): Attach copy of current pumping contract(required). Is copy attached? El Yes El No t6ins.doc,-rev.6/16 Title 5 Official frispection 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 21 Clarks St _.. _. .............. Property Address Intergrated Paper Recycle ownerOwner's Flame __ _ ........._ .....,. ......_ information is North Andover MA 01845 10-4-2017 required for every _ _ _...._.___ .._........__ page. Cltyfrown State Zip Code Date of Inspection D. System Information (cant.) Distribution Box(if present must be opened)(locate on site plan): Depth of liquid level above outlet invert 0 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.): Equal dist, solids carry over , pmped &jetted distribution box, no leakage . Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): * 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: t5ins.doc•rev.6/16 Title 5 official inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts x Title 5 Official Inspection nspetionF o0m Subsurface Sewage Disposal System Form ~ Not for Voluntary Assessments 21 Clarks St Property Address / Owner �wnwr'aName ' information is North Andover MA O1845 10-4-2O17 mguimd*mm�� _____ ___-' ______ page. City/Town State Zip Code Date vfInspection D. System Information (cont.) Type: i [l leaching pits number: � El leaching chambers number: [� leaching number: � �� galleries E] leaching trenches number, length: 1-20x20 leaching fields number, dimensions: El overflow cesspool number: |nnovcd|va/a|tarnat|vemyobam Type/name of technology-Comments(note condition of soil, signs of hydraulic failure, level of pending, damp soil, condition of vegetation, etc.): Nsoils Cesspools(cesspool must be pumped as part ofinspection)(locate on site plan): � Number and configuration Depth—topcf|iquid to inlet invert Depth ofsolids layer Depth mfscum layer Dimensions ofcesspool Materials ofconstruction Indication nfgroundwater inflow Fl Yea Fl No '5im.vw`rev.6nn Title oOfficial Inspection Form:Subsurface Sewage Disposal System^Page`am/, Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments t 21 Clarks St �. . ... ._._.._ Property Address Intergrated Paper Recycle OwnerOwner's Name ....... ......._.. _...._..... ..__..._.. _. information is required for every North Andover MA 01845 10-4-2017 _..._....._. ......__ _... page. CltyfTown State Zip Code Date of Inspection D. System Information (cont.) l Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy(locate on site plan): Materials of construction: Dimensions _ ....... _._ Depth of solids _ _ _.........._ Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t6os.doc•rev.6116 Title 5 Official inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Corrilmonwealth of Massachusetts Title, 5'Official Inspection Form o Subsurface Sewage Disposal System Form Not for Voluntary Assessments 21 Clarks Street Property Address Dynamic Waste Interg1rated Paper Recycle Owner Owner's Name information Is required for every North Andover Ma 01845 10-4-17 page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate water supply enters the building. Check one of the boxes below: at in the area below El drawing attached separately Q) t5ins.doo-rev.6116 Title 5 Official hspection 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 21 Clarks St .......... Property Address Intergr ted Paper Recycle OwnerOwner's Name information is required for every North Andover MA 01845 10-4-2017 page. City/Town state Zip Code Date of Inspection ...............--- D. System Information (cont.) Site Exam: 0 Check Slope El Surface water E Check cellar F Shallow wells Estimated depth to high ground water: 81 feet Please indicate all methods used to determine the high ground water elevation: El Obtained from system design plans on record If checked, date of design plan reviewed: I Date -n/a I El Observed site(abutting property/observation hole within 150 feet of SAS) Checked with local Board of Health -explain: checked file, nothing on record El Checked with local excavators, installers-(attach documentation) E-1 Accessed USGS database-explain: - ----------------- You must describe how you established the high ground water elevation: Taken m froslope of land dug down , no water r or staining .......... ........ . .................................. ........... - - ---------------- ................ . .................. ....... Before filing this Inspection Report, please see Report Completeness Checklist on next page. 16ins.doc-rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal Systern-Page 16 of 17 Commonwealth of Massachusetts =_ Title 5 Official Inspection For +, Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 21 Clarks St Property Address Intergrated Paper Recycle Owner Owner's Name information is North Andover MA 01845 10-4-2017 required for every _—............. _ .... ......— page, City/Town 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 1 i 151ns.doc-rev.6116 Title 5 official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17