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BUILDING INSPECTION <br /> <br /> SALEM',, OREGON 9730~ <br /> <br /> / · ,ON-SITE SJEWAGE, S¥S~EM INSTALLATION ~NSPECTION <br /> <br />ADDRESS: . · // ~ ',. ....... ','.~,~,.,../.=,~ <br />'INSTALLER: ' ' PERM T:NO., <br />SEPTIC TANI~: " "' <br /> ~ ~, 'DISPOSAL FIELD: <br /> NO, GALLONS; /~..: i , ,, ~TOTAL LENGTH; <br />MATERiAh:.~~,~ ~ ~ '' I~IPEMAT*L: <br />MANUFACTURER: ,'/~,~G' ~ .. TRENCH DEPTH:' <br /> '. ROCK DEPTH:'_. <br />BUILDING SEWER IVIAT'L: '~''~- <br /> , DIST. TO WELL: <br />EFFLUENTSEWEJ~MAT'L: D~-- 3,~4~'--~'-~'- BOXES; <br />COMMENTS: <br /> <br />In accordance with Oregon Revised Statute 454.665;:this certificate is issued as evidence of satisfactory <br />compJetion of a subsurface or alternative sewage disposal system at the above location. <br /> <br />INS~GT~D BY: _ ~ ~ ~-~._. DATE: <br /> <br /> <br />