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� � SNOHOMISH <br />HEALTH <br />OISTRICT <br />ENVIRONMENTAL HEALTH DIVISION <br />Wator 8 Waslnwater Si � tion <br />3020 Rucker Avenue, Si.�ta 1C4 <br />Everelt, WA 98201-3900 <br />425.3:,9.5250 <br />Aeallhl' l.i/r�hir+, NanlNtY Commuriihrc <br />ONSITT SEWAGE DISI'OSh1, SYSTlilbt PI,A'r (Aii-I31)II,T) <br />"I}pcafti�slem: ❑Gravfty ❑I,PD ❑Sl� ❑!�1i,und ❑ Ripnir <br />❑Redured System ❑Other __ ' _ <br />!'ennit ho. _ Property Tax Accounl Na_ � -----'—Lat N_ <br />(hvncr �V:+me <br />l )�vnr Address ____ <br />AI:I�ItGSS OP PROPERTS'. <br />Lrg,d I)esr.ripiion -- <br />—�,��Y— <br />, . � r , „ . <br />'I.ip ���,?rq — <br />� :� <br />I )etiigner -- � � ----AJdress -- -- __I'hone - — <br />Ir.stallcr -------Address __ ' __ ----_–Phone - —_ <br />( h�sit� Ser�age Uispos•il Systero in;lalled und approved for N ot tx�Jrooms, or __ sy. fi. ul <br />aUs„rption arca installed fnr �;al. per day. <br />I hcrrhy rertify the u_cnm��unyin� Jocumeniolion is im arcurnte represemxtion nf die system installeJ at ihe ulx,cr <br />rclerenrcd property I alsn ��crtil}� :ill rcyuircmenls listed un Ihe uppru��eJ A�plicalion fur Onsile tir�s;igr I)i��,��s:�l <br />I'rnilil dulcd —_____ --_. h�ive hccn rnntplird wilh. <br />tii!,natmc ��I I)rsiEncr itt P.li. I.i.cns� H I):uc-- <br />��.. r•int ni:ni.ri� uisrittc�'r usr:cmi.v <br />❑ A('r'I'.Irll?U ❑ Nc)l'A('('f:l•II[I> I�:\'fl: . <br />`,i�n.uure i�i S�nilarian <br />Ilrmnrks - - — -- <br />. t%l �:_ i' �i , i, � , <br />ATTRN7'IOY NOMF.OWNIsR <br />1'uur ��nsite sewage disposal syslem has limitations! I[ NilS designed �fl(� IOSWIICd 10 C�fP IUI ;+n a�cr,icr �vrJ <br />t;unil�. Over-louding Ihe septic lank or dis�urh;mce �'�f the drain(icld m:ry seriously im�air sutisEi.tin} u�,craii��n <br />Puinis ro rememher: <br />I. I I;i�e yu�.ir t:;nk rhecked periodically io sec i� �umpinF is necessary levery 2 I!' tu J year<1. <br />'. 1)n n�,� channrl ground w:ner. surl'arc w:ucr, t�ioiin�; drams or downspou�s into ihr lank ur ih.unlirl�l <br />�. i�„ „„� .�x�:��;���, rn. �iacc a stn�c�urc, Jri•�cw.�y ur pa�io in, 00. Of OYl'f IIIC llfelllflt I(I Rill� 115IC�llacemc�n a�r.i. <br />d. I.imit toile� li+eture dispi,s.d to snni�.uy waste; mal luilet �issue. <br />5. I)rlrr}'enls and hleochrs Used in nom�:il liousehold quantitics will not h.um the acii�m ot Ihe septic u,nl� ;�n�l <br />�lixpusal ficl�. <br />1,. Pru�i�rcw;ncrcnnscrvatian. <br />? tinnh��mish I lealth I)islrict stron�ly « comtncnds garbage grinders ;VOT he, uscJ <br />11 is Ihr humru�rners respansibility to in�ure lhe system is prnperly aperaled and maintaincd. Refer In <br />thc l)peration und Muintenance material provided. <br />I IU.IS.q/(�R I uf : re�i ?I ^nl� <br />