218 Title 5 Inspection 6-2020i!TI �uf(ap(: 'Irdhei'
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�orqirnoriwealth of Massachusetts
�ie 5 Official Inspection Form
`Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
P pereu Address iAe
vi •�-s �� .n --
fU���iCG%USG-___s�n2U
CI,yCe��r. State Zip Code Date of Ins coon
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.
1,k. Inspector Information
R,.
;dame of ,nspe=r ,r ---
..�%Wi:
Company Name ---
Address
'elepnone Number
y/ 3 to z-7
�,eruuca€lon
State Zip Code
SCSg-
License Number
i certify thac3 am a DEP approved system inspector in full compliance with Section 15.340 of Title 5
i31 ft CPAR 15.000);1 have personally inspected the sewage disposal system at theproperty address listed
above: the information reported below is true, accurate and complete as of the time of my inspection; and
the inspection was performed based on my training and experience in the proper function and
maintenance of on-site sewage disposal systems.After conducting this inspection I have determined that
the system.
Passes
2. Conditionally Passes
Needs Further Evaluation by the Local Approvin(
4. ] F a:is
z
n ... )cc,or's Signature
?he system inspector shall submit a copy of this insp
of FiealM or DEP) within 30 days of completing this inspection. If the system has a design flow of
0,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate
regional office of the DEP. The original form should be sent to the system owner and copies sent to
the buyer, if applicable, and the approving authority.
P"c:ease note: 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.
lc';' du` '1 `L.6"")!, Tltle S Offdal Inspedlon Forth: Subsurface Sewage Disposal System • Page 1 of 1a
Conivnonwealth of Massachusetts
-p= „
1 i t I e, Official Inspection Form
it WNI Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
s
o'.2ve C0f�s !�-ti�.o flC3tcs
Property Address
.T_O/1 /u 1-14c,
Owner's Name p
clop"r town State Zip Code Date of Inspection
.�.�nsp cfion Summary
inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6.
1) System Passes:
I I ave not found any information which indicates that any of the failure criteria described
ir: 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are
indicated 'below.
Comments:
2) System Conditionally Passes:
] One or more system components as described in the °ConditionalPass" section need to be
ep faced or repaired. The system, upon completion of the replacement or repair, as approved by
he ooard 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.
I he 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
ealti .
A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of
Compfiance indicating that the tank is less than 20 years old is available.
j Y ❑N ❑ ND (Explain below):
I. • grZO i-. Title 5 Oficial Inspection Porch: Subsurface Sewage Disposal System • Page 2 of 18
Coamionwealth of Massachusetts
=�
5 It le � Official Inspecti®n Farm
'.i Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
"" Properly F•cdress •.
O- ll Owner's (Jame
on , `7 f1 ti /�/f eve GG ��i1e%ride,
r'cto. even ". --N--�—��—�'-�--
f"6yjTown State Zip Code Date of Inspection
-i5pe icru Summary (cont.)
i_} System Conditionally Passes (cont.):
71 Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if
pumps/alarms are repaired.
..,! Observation of sewage backup or break out or high static water level in the distribution box due
o broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will
puss inspection if (with approval of Board of Health):
broken pipe(s) are replaced
obstruction is removed
distribution box is leveled or replaced
❑ Y ❑N ❑ ND (Explain below):
❑ Y ❑N ❑ ND (Explain below):
❑Y ❑ N ❑ ND (Explain below):
[_j he 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):
I obstruction is removed ❑Y ❑N ❑ ND (Explain below):
3) 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.
a. System will pass unless Board of Health determines in accordance with 310 CMR
15.303(1)(b) that the system is not functioning in a manner which will protect public health,
safety and the environment:
%"_t 1, ^,t Title 5 Official Inspection Foran: Subsurface Sewage Disposal System • Pages of 18
c- �iror<wealth of Massachusetts
I ° P ae 5 Official Inspection Form
,.
`ubsu; rase Sewage Disposal System Form Not for Voluntary Assessments
`-'roperty .AMress ---
,J�
liN1nn,r 5 �Tm F)
ur Cdv''c� State
f
- - — P Code Date of Inspection
C. Inspection Summary (cont.)
L Cesspool or privy is within 50 feet of a surface water
.I Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh
i:'. 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:
iThe system has a septic tank and soil absorption system (SAS) and the SAS is within
00 feet of a surface water supply or tributary to a surface water supply.
1_.i i he system has a septic tank and SAS and the SAS is within a Zone 1 of a public water
poly.
he 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:
rlis system passes if the well water analysis, performed at a DEP certified laboratory, for fecal
r:ok'orm 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.
C other.
41 Systen! FaIiure Criteria Applicable to All Systems:
ou _ngst indicate "Yes" or "No" to each of the following for all inspections:
,as No
Backup of sewage into facility or system component due to overloaded or
r clogged SAS or cesspool
I—; N-141 Discharge or ponding of effluent to the surface of the ground or surface waters
due to an overloaded or clogged SAS or cesspool
Title 5 Offidal Inspa<Uon Fo m' Subsurface Sewage Disposal System • Page 4 of 18
iii° s5�fea±th Of Massachusetts
tt Official Inspection Form
�. qz
1b:U „c- Sewage Disposal System Form - Not for Voluntary Assessments
Y , _perry._ `idress
�.fgC1—..
:,)Wiler s N3rjc
State Zip code Date of Inspectfon
ction Summary (cont.)
4) System Failure Criteria Applicable to All Systems: (cont.)
es No
i_ 1 �/
J
Static liquid level in the distribution box above outlet invert due to an overloaded
or clogged SAS or cesspool
J
Liquid depth in cesspool is less than 6" below invert or available volume is less
than '% day flow
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.
-"' ✓��
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 water supply
well.
Any portion of a cesspool or privy is within 50 feet of a private water supply well.
L/
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.]
J
The system is a cesspool serving a facility with a design flow of 2000 gpd-
10,000 gpd.
`t
The system fails. 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.
5) Large Sc.sterns: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 la -g-2 systems, you must indicate either "yes" or "no" to each of the following, in addition to the
questions in Section C.A.
No
❑ the system is within 400 feet of a surface drinking water supply
❑ the system is within 200 feet of a tributary to a surface drinking water supply
lI the system is located in a nitrogen sensitive area (Interim Wellhead Protection
Area - IWPA) or a mapped Zone II of a public water supply well
"` "' Title 5 Oficial Inspection Form: Subsurface Sewage Disposal System • Page 5 of 18
: Wea6th of Massachusetts
fficial Inspection For
3cubse+mace Sewage Disposal System Form - Not for Voluntary Assessments
w
rolrrllon IsA0 2-6
_ State
------Zi P Code Date of Inspe ion
"MiSpect[on Summary (cont.)
f you rave answered "yes" to any question in Section C.5 the system is considered a significant
area... or answered "yes" to any question in Section CA above the large system has failed. The
omnis or operator of any large system considered a significant threat under Section C.5 or failed
under Section CA shall upgrade the system in accordance with 310 CMR 15.304. The system owner
should contact the appropriate regional office of the Department.
5. You ;rust indicate "yes" or "no" for each of the following for all inspections:
es No
X ❑
Purnping 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?
Have large volumes of water been introduced to the system recently or as part of
this inspection?
X f
Were as built plans of the system obtained and examined? (If they were not
available note as N/A)
X ! -D
Was the facility or dwelling inspected for signs of sewage back up?
V 0
Was the site inspected for signs of break out?
YW 0
Were all system components, excluding the SAS, located on site?
ED
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?
El
Wasthe 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:
t5i ❑
Existing information. For example, a plan at the Board of Health.
x
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)]
"• Title 5 Official Inst,101n Forth: Subsurface Sewage Disposal System • Page 6 of i6
Clornfri rtweaith of Massachusetts
eF
{ ficial Inspection Form
' a^ jit! Stab°*u1*a—_f'! Sewage Disposal System Form - Not for Voluntary Assessments
a
Plop rt" mcir„ss p �
""Owr.Fr's rdarne
/�f
_ _ _ State Zip Code Date of Inspeoti n
. ,5,yslnnn itsformation
Resodential Flow Conditions;
Number of bedrooms (design): -- Number of bedrooms (actual):
DESI?iid fiowbased on 310 CMR 15.203 (for example: 110 gpd x# of bedrooms):
Descr pticn:
45
Nu)E,r of current residents: —3-
1
J
nsidence have a garbage grinder?
❑
Yes �° No
Does residence have a water treatment unit?
❑
Yes ,g(
No
If yes, discharges to:
Is laundry on a separate sewage system? (Include laundry system inspection
❑
Yes EK
cif,rn-ation in this report.)
No
r,nrfnr system inspected?
gr
Yes ❑
No
Sera, na use?
❑
Yes 9
No
\11later meter readings, if available (last 2 years usage (gpd)):
Detai!:
SUM pimp?
Last date of occupancy:
❑ Yes 9 No
I
Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 7 of 18
of Massachusetts
Uke, 5 Official Inspection Form
Subsurlaue Sewage Disposal System Form Not for Voluntary Assessments
"C
C'Miler I Nam,
State Zip Code Date of Inspedlon
D. S,,,Stesm Information (cont.)
2 Commerciaiiindustrial Flow Conditions:
of Establishment:
!)estcrl !ow (based on 310 CMR 15.203):
Gallons per day (gpd)
asis o-, design flow (seats/persons/sq.ft., etc.):
3.easa trap present? El Yes F-1 No
treatment unit present? El Yes [I No
If yes, discharges to:
nil,'.jsri ial waste holding tank present? El Yes D No
Nor: -sanitary waste discharged to the Title 5 system? El Yes D No
101a:ermeter readings, if available:
;.asf date Of occupancy/use:
ilA
te� �descnbe below):
— ,
Records:
Snurc D
of information:
0i
das system pumped as part of the inspection? ❑ Yes JX No
if v, --s, volume pumped:
wa:s quantity Pumped determined?
Reason for pumping:
/,/F,5j
Title 5 Of inspection Form: Subsurface Sewage Disposal system - Page 8 of 18
Comm€ ,or3afitealth of Massachusetts
' e Official Inspection Form
c=> :Sewage Disposal System Form - Not for Voluntary Assessments
,�, �✓� .._ f�/mss f""1if_!',L/�ylc.r �-aU
F'rcpedy /i1d^Ss —-
�" Utvne� s N n
�sG�iTNi-1t'e W,�
Divir0'' `° State Zip Code Date of Inspecti
a SyFtem Wormation (cont.)
y pe of System:
Septic tank, distribution box, soil absorption system
_1 Single cesspool
L] 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 I/A system by system operator under contract
Tight tank. Attach a copy of the DEP approval.
Other (describe):
A.pprox nate age of all components, date installed (if known) and source of information:
PJere se'vvage odors detected when arriving at the site?
5 Buiiding Sewer (locate on site plan):
Depth i?,iow grade:
Maienai cf construction:
_ Iron40 PVC ❑ other (explain):
e Prem private water supply well or suction line:
!i
Z -1y
❑ Yes 9 No
'00' %A yu. z.a
feet 'e/ -
Commends
%
Commends (on condition of joints, venting, evidence of leakage, etc.):
s-5 4✓01_; ,fa
,,.a....., Title 5 Official Inspection Farts: Subsurface Sewage Disposal System • Page 9 of 18
":GmMgCi 4weiE €tit of Massachusetts
o fficial Inspecti®n Form
r za e-,,vage Disposal System Form - Not for Voluntary Assessments
c7 V/z/,U "g-
pwrle"s ilane
tl -.
Ie, LzoZta
State Zip Code Date of Inspection
LJ ys wig Mormation (cont.)
5. Septic Tank (locate on site plan):
De in below grade:
feet
of construction:
cc, .rete ❑ metal ❑ fiberglass ❑ polyethylene y El other (explain)
--
,: turlk is rrletal, list age:_
years X
Is aye sontirrned by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No
Liln'tei-Sc�s: %v (� x .,i,�C"it � �f% �j%�C>!/•-'
IepLh C1
;aanc= from top of sludge to bottom of outlet tee or baffle
ti.iof<ness
Distance: from top of scum to top of outlet tee or baffle
Dista rr, ;
from bottom of scum to bottom of outlet tee or baffle
,,ere dimensions determined?
of
12X.'0/7 S C�' A—e e-1
r:nents (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
,uuici Pev-ls as related to outlet invert, evidence of leakage, etc.):
o.-- Me 5 Official Inspection Foos: Subsurface Sewage Disposal System • Page 10 of 18
wOP-1th of Massachusetts
'll 1 Official Inspection Form
SuhGCsrfaca Sevtrage Disposal System Form - Not for Voluntary Assessments
_ J
Vliln�r V lid(1re55 --
City/Town 44./
_ State Zip Cade DatDate ofof I pection
'. sYStetn Information (cont.)
Grea.;e Trap (locate on site plan): .? 4U 4
t eiow grade
feet
ivleie iui -)-construction:
❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other (explain):
Dm-.ens;ons'.
`,cunt thickness
Distance from top of scum to top of outlet tee or baffle —
!;is;ance from bottom of scum to bottom of outlet tee or baffle
Date of last pumping:
Date
i.oa-,ments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
it ie':,els as related to outlet invert, evidence of leakage, etc.):
�. ,-iy'sst or Molding Tank (tank must be pumped at time of inspection)(locate on site plan):
Depth below grade: d A0//
M�=t2anal of construction:
❑ metal ❑ fiberglass
Dimensiors:
•a IJC:Q11 �+.
r}eslan F ovv
gallons
gallons per
❑ polyethylene ❑ other (explain):
Title 5 Official Inspection Forth: Sobsudece Sewage Disposal System • Page 11 o/ 18
€:.:r;mra-nvv9aith of Massachusetts
Official Inspecti®n F®r
W'surt ce Sevuage Disposal System Form - Not for Voluntary Assessments
PrDperty Actress
Ow;er's Nar.e
n � I icI Is
f" r ever'
State Zip Code Date of Ins ecftri
K>, :_ information (cont.)
8 "i"iytat. ,or Holding Tank (cont.)
Aiarm present:
Alarm!'evel:
❑ Yes ❑ No
Alarm in working order: ❑ Yes ❑ No
last pumping:
Date
;;vents (condition of alarm and float switches, etc.):
;Atc::'*,cop) of current pumping contract (required). Is copy attached? ❑ Yes ❑ No
i7isi-iuct'son &ox (if present must be opened)(locate on site plan):
Del;tn of liquid level above outlet invert C/
nr-:r,,eanis (note if box is level and distribution to outlets equal, any evidence of solids carryover, any
�Irlr+n,^c
of leakage into or out of box, etc.):
-n-. ,r..,_ v' :- 0'' Title 50Rdal Ins
pection Form: Subsurface, Sewage Disposal System •Page 12 0 18
:*:.0 a u,clnwealfhofMassachusetts
f Official Inspection Firm
"Subs, Race Sewage Disposal System Form - Not for Voluntary Assessments
Prooeliv ,\,:dress _
nVn ,'SN Te
State Zip Code
Date of inspection
�• ��)�� `s�� �n�orrnafiion (cont.)
±`uM-p Chamber (locate on site plan):
rumps fl Working order: A2� Yes ❑ No'
lar` ^s In Working order:
Yes ❑ No*
Jolrllr:erlts (note condition of pump chamber, condition of pumps and appurtenances, etc.):
1��1�
c
If Dw–nos or alarms are not in working order, system is a conditional pass.
uotC Absorption System (SAS) (locate on site plan, excavation not required):
Sr,.3 r,ot located, explain why:
Title 5 Official Inspection Farm: Subsurface Sewage Disposal System • Page 13d 18
leaching pits
number:
LJ
leaching chambers
number:
leachi-ig galleries
number:
_J
leaching trenches
number, length:
2–� Z
leaching fields
number, dimensions:
l_
overflow cesspool
number:
innovative/alternative system
Type/name of technology: —
Title 5 Official Inspection Farm: Subsurface Sewage Disposal System • Page 13d 18
Comnn'onvveaoth of Massachusetts
Official Inspection Form
Sewage Disposal System Form - Not for Voluntary Assessments
State
Zip Code Date of In ection
D. Sys,; information (cont.)
1'i So;! Absorption System (SAS) (cont.)
11
Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of
vegetation, etc.):
,2 C esspouls (cesspool must be pumped as part of inspection) (locate on site plan):
ivurnbe, and configuration
top of liquid to inlet invert _
upih or solids layer _
Dc--oth of scum layer _
Eilirlersions of cesspool _
Pate ea of construction
nil; tto!, of groundwater inflow ❑ Yes ❑ No
Cem;Tlents (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
etc
..t i I 7.1 /elji e, Title 5 Official Inspection Form, Subsurface Sewage Disposal System • Page 14 of 98
C; mrnonwealth of Massachusetts
t: Official Inspection Fr
si ' S esti 7a; , Sevwage Disposal System Form - Not for Voluntary Assessments
Pr000ttv
l 5 f��i `L/iG t21 %Zf�
f��CJ /'l fC �a7JZ�75� t-,/
C if,10th State Zip Code Date of Insection
intormati0n (cont.)
tS Pr'ivy (uca=.e on site plan): A-14
l?aienals of construction: --
Diin...'SIonS '-
i.ey;th of solids ----.—_
ur ::;erlts (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 15 of 18
i, ❑2.t:nf 15
=',mrd 'or ever/
Cza ,--�,ovi vealth of Massachusetts
IPide 5 Official Inspection f=orm
Subsui�a,? Sewage Disposal System Form - Not for Voluntary Assessments
'rirer'r;
State Zip Code
D. �G sro k-: d''d Wormation (cont.)
14 51*1eret? Uf Sewage Disposal System:
Pts rite a view of the sewage disposal system, including ties to at least two permanent reference
<an; -i ks Or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters
tJne cuiiding. Check onQ, of the boxes below:
hand -sketch in th
X cra wing attached
(P3,
TD
600 L�f4 z
I tN P [�
6Q rvL)
below
z� � ��jj
gC
L�
0
t� je
I-/ Z—
A Qr
8 O -r
Tire 5 M091 �ffn Bwa§wrf@p@ B@wa®@ ®igpos®I Bysi€m • P@go 1@ of 1§
/.
A0o
Dd5F !'cyst
rte-
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6
77j J
Tire 5 M091 �ffn Bwa§wrf@p@ B@wa®@ ®igpos®I Bysi€m • P@go 1@ of 1§
of Massachusetts
Yui5 Official Inspection Form
" Ss *:uri`ace Sewage Disposal System Form
Not for Voluntary Assessments
Prod e�/_..�--l.i�C.%. �' i f`i�r%f�'C.f� /U✓
I Ill(
eVex'I /� l'fU� CJ rj�otG
—__ State Zip Code Date of Inspection
iU ,; j?'b'r_' rr Wm (cont.)
eck Slope
'n@ce water
cellar
shai!ow wells f� s
_:sill;�ated depth to high ground water: / v`%r7.;,�✓v /�-� 7� `�-i fo
feet IF—A
I `;Pas, Indicate all methods used to determine the high ground water elevation:
Obtained from system design plans on record
If checked, date of design plan reviewed: < �7 A
Date
Observed site (abutting property/observation hole within 150 feet of SAS)
l! Checked with local Board of Health - explain: /
IS/ Checked with local excavators, installers - (attach documentation)
Accessed USGS database - explain:kC
You r.a_tst describe how you established the high ground water elevation:
afc+-e Mng this Inspection Report, please see Report Completeness Checklist on next page.
Title 5 Official Inspection Form: Subsurface Sewage Disposal System • Page 17 of 18
=:?m0rea€th of Massachusetts
'"t s Official Inspection Form
�r
o Sewage Disposal System Form - Not for Voluntary Assessments
Frog rtyl+: Tess —
%dei✓ Me
/✓�/d/ZTJ y
/ �
qr r nary C./�
State Zip Code Date of Inspection
'-, r,,•;z Completeness Checklist
Corn?piete a l applicable sections of this form inclusive of:
/. Inspector Information: Complete all fields in this section.
v! ` Certification: Signed & Dated and 1, 2, 3, or 4 checked
I:Ispection Summary:
2 3, or 5 completed as appropriate
<- i=;,iture Criteria) and 6 (Checklist) completed
;i %' `3ystern Information:
0 8. 1 ightYHolding Tank — Pumping contract attached
�cr 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached
f„/nor 15. Explanation of estimated depth to high groundwater included
` Title 5 Official Inspection Farm: Sub,u,f ce Sev age Disposal System • Page 18 cf 1a