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MARION COUNTY BUILDING INSPECTION INDIVIDUAL ON-SITE SEWAGE SYSTEM RECORD <br /> 5155 Silverton Rd NE • (to be completed by system installer) <br /> SALE503-588-5147MOR 97305 PERMIT NO. cc- <br /> MARION <br /> COUNTY http://wwvii,cri.marion.or.us/PW/BuildingInspectionSITE ADDRESS: gpd <br /> ie Z► .-Dt- a,4 (d n•-e.- <br /> . <br /> AS-BUILT PLAN OF CONSTRUCTED SYSTEM: . <br /> Scale:1"_ ' 9 <br /> I T::: <br /> rth <br /> t <br /> ' C=T,,A4. L• . <br /> 7 _, , <br /> .\f‘. <br /> le 1,Itik4 <br /> ' 3.. . :..: <br /> • <br /> 1 • )iC. igli A9 . ,.. <br /> '(show all details and dimensions necessary:£dcate:all components of the system in the future) • • <br /> SYSTEM MATERIALS AND SPECIFICATIONS: f.� '-:- ; INSTALLERS CERTIFICATION:`'" ' <br /> I HEREBY CERTIFY+THAT THE ON-SITE SEWAGE SYSTEM IN- - <br /> System Design Sewage Flow Gallons/Day STALLED AT THE ABOVE ADDRESS WAS CONSTRUCTED IN ACCOR- <br /> TANK Size: gallons single compartment DANCE WITH THE REQUIREMENTS OF THE PERMIT AND THE RULES <br /> �' Q[, total OF THE ENVIRONMENTAL QUALITY COMMISSION. - <br /> Manufacturer: (/�.)6.i 1,5 [ ] double compartment <br /> flow-thro havetested septicny watertight. <br /> Material: CO/ICI/Ys�'t [ I- ! h ��1 the tank and certify it to beaterti <br /> � <br /> Effluent Sewer: I/ Header Pipe: - The system.was installed by: <br /> Size/Mat'I' y ...34_44" Size/Mat'i ' [ I Property Owner(permittee) . <br /> icensed Sewage Disposal Service <br /> DRAINFIELD rock depth(inches) °" Box(es) < <br /> Rock and under pipe -- I I Drop I I Concrete DEQ License Number <br /> PiPe total depth • . I I Distribution I I Plastic , <br /> DEQ Certification Number: . SCS <br /> Drainfield•Material(Alternative or perf pipe) <br /> Total Drainfleld Footage. Trench Depth Minimum_ Maximum <br /> Curtain Drain Depth Signed: j i . / , 40,4-_,-,.g•,- <br /> Effluent Pump: Pump Model `, ••-1;',i:;;- .4..-.• <br /> Pump cycle , <br /> times in minutes: on off Gallons per Cycle Company name:,; 4Ec...-... C- r ., <br /> (please print <br /> ATT Make and Model u <br /> Attach an additional sheet for components and materials not listed above.. : Date: .S I 1 1 i <br /> (For Marion CouUse Only) The above septic system has been inspected`by Marion County. The information has been determined to be accurate <br /> and the system is: Approved I "1 roved with corrections;see inspection report I 1 Denied <br /> Signed:i)jA(. j 7/LL C a Title: ell V10/. ._`-1 .Date: Olfg/. <br />