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BUILDING INSPEC~RON DIVISIC, N <br /> .... 220 HIGH S~REET NE <br /> SALEM, OREGON 97301/ ,~/ <br /> <br />~R: , ~; ~N-SITE SEWAGE SY~Ea INSTALLATION INSPECTION <br /> <br />OWNER: (' <br /> <br />INSTALLER: ¢¢" ¢¢-,~ L,~.~..~ '-" PERMIT NO. <br />SEPTIC TANK: DISPOSAL FIELD: <br /> NO. GALLONS: ~¢~, ~¢~. ~ <br /> MATERIAL: ~~ ~. ~/~ <br /> MANUFACTURER:-~'~/~ ' , <br /> <br />BUILDING SEWER <br />EFFLUENT S EWER.,J. MAT'L: <br />COMMENTS: <br /> <br />TOTAL LENGTH: <br /> <br />TRENCH DEPTH: <br />ROCK DEPTH: <br />DIST. TO WELL: <br /> <br />In accordance with Oregon Revised Statute 454:665; this certificate isissued as ewdence' of satisfactory <br /> <br /> completion of a subsurface or alternative sewage disposal system at the above location. <br /> 3~ DATE: <br /> T I T L E :,~--~ .~1~ ~/¢~,/,.~: ..~y-~' <br />MC 15.S6 Rev. 12¢92 <br /> <br /> <br />