T•tiD. 013ts'
<br /> •• - , •••- ::::: ::: ..• :,. :: ::: ::: E:: :: " ::: :: :: •: :: ::::::
<br /> ::: .•• n• ...- ::- ':: ••: :: -• .::: ::: :: ;: •::. :: „ :: :: „:::
<br /> :. "i:i 4,r.,' ::;i i ii'. •::::,. r:i ::.' ::: ':i H ;:.: H ii :i :i iH.::
<br /> 1:::' ii:: . le ii i'' ii: .:.'i :::: ;•:. ii-': . ::i. "-::: ::i ,::: i:. :.. :: -i::.i:, . ,, PEliVE
<br /> 14mii oriiO*Nli'BUILDING 11111 •
<br /> i::-:,i:::,',i:,. :•'u :'.:1,•.•:.•... . . -:•:•::• ii::il:-i"::.: -liE•i: ]i:..i::-::.:::..:: Ei::iil:::iil:::ii i:E•i1:i:::.::;:::1
<br /> im15..:. 1p5E$"...•c•STlive:•rNto xn Rd ••:,.,:
<br /> 4
<br /> A1O8j21Eu2:
<br /> mARION Salem OR 9730$ MA8i0N ,
<br /> COUNTY Phone ($03) 88.5147 BUILDING INS0PN TTIyO
<br /> N
<br /> ..i i i i,: •,..:, :: H
<br /> Hi ii: - :: :: .:: :::: il ;i. :! i:. 1 ..,:: -J : .: i :ii•-:
<br /> iiii III :111 IN III li.1 III if III - -•..
<br /> ..
<br /> ..
<br /> ..
<br /> .. ..
<br /> ..
<br /> .. .
<br /> Recommended Wild Fire . -
<br /> .. ••
<br /> ...
<br /> Existing -1:: ii ''Iji •Hi ii iil* ill i yite.iirilEvaliiiatlori Report, 11 il
<br /> Mi.toiirDWtY Will ill f:'':'::ccet this InSPecion t.'iil: Pci'rtiniadiitiorito the DEQ Existing SYste.,1,
<br /> Evaluation Report(gsER)to assist with, expediting the authorization notice approval when
<br /> Pe
<br /> iforiiied by atertrifiediinstaller),NAINT crtif.)ed inspector or certified operation anand.1' .:: .:' ... • 'Evaluations' should maintenance provider ilVO',/:E. :.i :be clone ft: er all debris removal has
<br /> ::i .::: •]': .:: :-., -:i ,'; •:;i '::. :: : ::; :: ::•iiti i Ei :
<br /> been completed
<br /> •-:; :,:: ::. :, : ::: .. :: :: .. .-•t: . :: : • . .
<br /> .. •• -..
<br /> - -: - :: :, ••• :„
<br /> ::: ::. .•:. .". -.: ::: ••: ::: ••• ::: ::: .. . . i: :: :::::...
<br /> .--: :: .: ::: •::: ::: Hi 7.: ::: .,7., ":. ... :: :, '7 ::::: :!
<br /> .. ,
<br /> pplIcaht:
<br /> -- " -: •• •• :•• ::: ::: :::: ::: ::: ::
<br /> _ .
<br /> !::i iii •:::::i l': Parcel Address:f? ,:i.Le:: bj is2n 6 ,k5. F. ,g)i 9,. *1r
<br /> :. : ... •• ,,, ii .i ,,, ..• :
<br /> . :.
<br /> :.::.: ::;:, :.::: ,.,. „ •,,, .,-, „,„ „,„ ::,:i ::,.:: „„„ „„. 1. 4:1. ii ::,.: ii ii i„:„.:::i
<br /> ••• :J ::: ,, ,: ::: „„ •:: ::: ::: ::: ,„ . „ .. , e .__., --
<br /> li i..! ., .i •• :
<br /> 1..il• .::i .':'::i 11 -Plea:.se Ill!ci6 t a11flef d s*1th apphai bleiinfarmat:Ion!rega srea. iji, 1
<br /> •• :: .:•• :: •• ::: ::. •r: ::: ::: ::• •-- : : ::: :: :, .: ;: ::: : :: ::
<br /> - - -:: :,:• il ::: ::: ::, ii, : : ::: :: :: :. ,.111off 1.ie ptic Tnk.silWh 'n performing thelevaluatiOn, please flag septic tank with high visibility
<br /> ::: :: ::: :: :•:
<br /> ": ::flagging or(opeifor safety. :, •
<br /> : .• .• .
<br /> " ::: : •• ::: ::: :: ::: • ::: .: i iii ::!: ::: : ::
<br /> Is there visual,fire damage to tank an cl/„,ii:r tank riser?(Make notes and attach pictures If
<br /> P9__:_19,Ji__.,::. „...- ,eii:
<br /> •.:i ' il :i 3"i : ::: ii •.: ::: - - . :: ::: .:: :: : ::: „ ,, , ,..., :.:.,,.
<br /> :• E: .::: .. :: ... ••• ::: :: :: ::: ::, :: : i„ ,:. :: , :: :::: E:
<br /> .'• - '-• 1' " i:: ::: ::: ::: „ ::: :„ :: , ::: ::. !:.. , :: ::,,
<br /> ••• ... •• - ••• ••• ::: ::: •: ::: ::: :: : ::: :: :: : :• ;::- :: ::
<br /> :: :: •
<br /> .. ..
<br /> ':: :: ::: " :: ::: ::: ::: - '' ••• •-• :: ' :": :: i: :: - ::- : is the soil cover
<br /> . theseptic tankrso how deep -
<br /> i.i :••:: 1 :::: IS there Visul a evidence of,fire bum over and i
<br /> lie II !II ii: li: eVetith eiianf ar4I.:: what material is the tank coriptrugt:edf?(Make notes and attach pictures
<br /> if possible). :: iF: !! !! ; ;;': ;; ii ii ii- •::::
<br /> .. :: .. •• .. • ••.. •••
<br /> • :: ::•• :: :: •:• ••• ::: ..• ::• ::: - :: . - :: .:: :: :: •:.::
<br /> :::::: .. 1::: i. .. :" ':' - '' ::: E:: E: E EEE :': " :: il i:::: • ii :i- .... .
<br /> :i.. ii :..!; ,':: :' . Alp :.i i::.! IF,- :.:: :: i ,., ., •::i. 1:: iii.ii .i: ::
<br /> ... .. . .. .. .
<br /> :::: :: :.:. :.•: ;r: - i:i iii ::: :: ::.:i i.i i ::: ii :: : :::::
<br /> ,*: ': ::• " " ": •:• •::- ::: ::: ::: •, : ::: :: :: :: :: :::::. .,
<br /> ::: ": ::: :, • ::: ::: :: ::: ::: ::: ii : ::: :: :: :: :„::::
<br /> :.: •• ::: :: ::: ::: :.: i:: ::: ::: :: : ::: :: :: :i :: :::::
<br /> •
<br /> ::: :: ::: :. ::: ::: - .:: ::: ::: •: : ::: :: :: i: :: :•.• ii•
<br /> i . :: ;I:: ;.': i.•:. '::: I:: i .i, :,i :.:. :
<br /> i..!: i.i •
<br /> ::: ::-: •.:::: E: :: EEE :Ei. iii ::: ::: ::: : 1:: :: :: a ii Hi H. ,
<br /> Ei Ei •
<br /> :: ::: :::: ::: ::: :•• :: . ::: EE - :E . EE :::.::: :: s: :
<br /> 'ii: li •
<br /> i::: •• -
<br /> ::• ::• ::: ::: ::: :: : ::: :1 ,: :: :: :::::
<br /> • i: . ... :: :: ::: -::: ::: ::: ::: :: : :.• :: :: :: :: ::::: • 1: EE
<br /> : :: .::" - ,• " - ::. ::: •:• ::: •• : ::: :: :: - :: ::::. :: ::.
<br /> .. . . ,, ::: ::: :::• :.: ::: :: : ::: - :: :: :: :::::
<br /> .. .. ..
<br /> - - ... ... ... ... .. ::
<br /> '.• :• ::: :: :: - ': ::: ::: :::: i:i :: : ::: :: - :: :: ::::: :i :::
<br /> ... .. ..:: :• ::: I: „ .. ::: ::: ::: ::: ::: :: : :::. :: :: :: :: ::::: ii il
<br /> :.:: 1 ' :::: : :: 'i: ::: •:: EEi ::: ::: EEE :: E ::: :: ::: :: :: :::::
<br /> " •'
<br /> : • i" • :: ::: '-: '': ::: ::: ::: ::: :: : ::: :: :: :: „ ..:.:
<br /> .. ..
<br />, ..• • .,::: :: :: ::: ::: :::. ::: :F: ::: , :. : ...: .: :: :: 1.: ::i i: .•'.•' •".i
<br /> :..• :::
<br /> ••• • •::: • •: •:: ::: ::: ::: •:: ::: -: :: • ::: :: :: :: :: ::::: ii- E:
<br /> ::: i 4::: E: :: ::: ::i ::: ::: ::: ::: ::: i: : ::: il • :: :: E: ::::: .. ..
<br /> H : ''''':::: :: 11: ::E E:: E:: ‘EE: EEE iii :: : ii: :: i: • :: :: ::. ::,: -- :':
<br /> : : -::: ::: :: ::: .:::. :_; ::: ::: :.• -. ••
<br /> ::: :. 4:." :: '' •• ••• ••
<br />
|