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i- <br /> ' <br /> ONSITE `YS'TEMINSPECTION FORM <br /> � E <br /> Inspection Overview I INTERNAL USE ONLY: <br /> s Preliminary .:t = t a t anon, i I <br /> ® Inspection o .{ -F `tanks t fiSkg 3358th ave se;Sultan <br /> Valley Pumper <br /> • Disposalkonveyance system asWa <br /> • Absorption system inapeetion <br /> s4sment 360-913-4 6 <br /> • Identification of any alternative; hnology approved components <br /> I Rewires additional ins ' n <br /> Client Name: 'Inspector Name: ., <br /> h � ra <br /> Different from owner? 0 yes do ` I Date: 12— 12'' 1'7 <br /> 0 <br /> Client Address: <br /> S A bAresS 11530 N 1 16 to Dot F ISSDS Address(including municipality): <br /> O 1219 358 III 4;v e - S�.G <br /> ,. plj Eu rr` w,�- 9 2c'( (lb(TA-A) W -= V f <br /> 6 i 4 <br /> v ) w IIIIIIMMIIIIIIIIIIIMIIIMINON Lot: 31, <br /> Contact Method: 1 <br /> home tel. ra Was GPS used? 0 yes Q no <br /> work tel: 112.5-4151- 3573 <br /> email 'h e i'1 Q tt €itu 4 w•°i tL(Oe'k <br /> Preliminary Information: ) Yes No <br /> Weather:; or Is there a site plan or septic map available? 1 0 - <br /> Is the dwelling currently being occupied? 0 g. <br /> Last preGpitanon da,,,e--- ! If so,bow many occupants? <br /> Age of system:60se. h W-1- 11'11481 t <br /> Type cl a If no,date last occupied? <br /> of wllmg. I <br /> I If there is a washing machine,is it connected to a 1 0 <br /> (tesidential Number of Bedrooms Separate gray water disposal system? Ck- <br /> {)Nonresidential Describe: Is the dwelling free of additional gray water systems? Com- <br /> 8 <br /> ' l Is the dwelling free of garbage disposal systems? <br /> How many systems are being inspected? hobbies: • <br /> Is the dwelling free of sump pump discharges to the <br /> List any commercial activities or high impact I obbies: System? elg0 <br /> - i Is the dwelling free of any historical sewage back ups 1 <br /> Into the structure? <br /> Does all sewage enter the septic system and no type I <br /> Describe;prior problems and/or repair history eluding of sewage bypass exists? 1 t - tj <br /> soil fracturing or use of chemical additives. 'chide dates I <br /> and explain why the remedial measures have een applied Septic Tank Pumping: i) <br /> to the system(if available): Is the;septic tank pumped regularly? a. <br /> Frequency: I6bk-$s Ilk- 3 (Mods <br /> Date of last pumping._ : I <br /> Was file review completed prior to inspection?' ' 0 <br /> 0 <br /> Ifni,explahrwhy below I <br /> Date fileIreview requested with admmistratn authority: <br /> 12-12-t1. <br /> Y 1 <br /> Comments: S-le,r+n I, it-,5 /01,1,-1 I <br /> retnwlrhend 2)mpr n9 we re 2 -10 3 Veekr`S e <br /> , • <br /> I <br />