Laserfiche WebLink
MARfONC011N7Y8U8D8IGINSPECf10N INDIVIDUAL ON-SITE SEWAGE SYSTEM RECORD <br /> DIVISION (t0 be completed by system installer) <br /> rannior, 555 Court St NE/PO Box 14500 <br /> COUNTY Solon,OR97309-5036 q n ,,/� <br /> (503)588-5147 SITE ADDRESS: /.5"/ 32 .S ,,,-4 Y T. •s, /�t4 , o e <br /> PERMIT NO. [�S J9,•Z 7-3 �J <br /> AS-BUILT PLAN OF CONSTRUCTED SYSTEM: <br /> scale: 1^ _ I <br /> �/a' ' '121 e��e C. //.A 4. North <br /> TAPPROVED AS_�DI�f -� <br /> DRAWING t <br /> rQC <br /> ;� . o <br /> f. <br /> v 3 `e Id <br /> � • <br /> r <br /> / <br /> V <br /> n;• ' eh <br />, /14' NI ikk L 7517 -�hh79 N. <br /> (rit _ot 1 '''' '' <br /> �' s.c <br /> � ,A . 4• � <br /> °.evyls .,, 1 9 X • <br /> (show all details and dimensions necessary to locate all components of the system in the future) <br /> SYSTEM MATERIALS AND SPECIFICATIONS, INSTALLERS CERTIFICATION, <br /> System Design Sewage Flow,,, ,410 Gallons/Day I HEREBY CERTIFY THAT THE ON-SITE SEWAGE <br /> IJ C.1U Sv� Mat'1: (_.•rnr i.r,/ SYSTEM INSTALLED AT THE ABOVE ADDRESS WAS CON- <br /> ' Septic Tank, Size: ! IC. Mfg: STRUCTED IN ACCORDANCE WITH THE REQUIREMENTS OF <br /> THE PERMIT AND THE RULES OF THE ENVIRONMENTAL <br /> Dosing Tank, Size: Nat'l: Mfg: QUALIfiF^ZOMMISSION. <br /> 'I .( I have tested the septic•tank and certify <br /> Effluent Sewer, Size: eJ t'1: Si t 4/ it to be watertight. <br /> Eox(es), ( ] Distribution; ( Drop / ( oncrete; ( ] Plastic The system was installed by: <br /> p 1 ] Property Owner (permitee) <br /> Drainfield Pipe, Size:l ; Material: Header: 3)_Ci/ ; Perf: h-1-'LIcensed Sewage Disposal Service <br /> Total Drainfield roo e,tag I. Rock Depth: Total: Under <br /> pipe: DEQ Licen r: �ri�,Xc' <br /> Alternative Drainfield Materials, J{4A 71104-- ,- 6 Q zT Signed: <br /> Depth: Minimum: ",�� �Trench D ep �t Maximum:,ZT/� Curtain Drain Depth: �/� <br /> Effluent Pump, Pump Model: ?S12.a,S-(1 ; Static Head in System; Ft. Company name: /e v►SS g:lft,4.•- CLxesa- bie. <br /> Cycle Time: (please print) <br /> Pump frn,�►. ; Gallons per Cycle: y O �/���1 I <br /> Date: � <br /> Attach an additional sheet for components and materials not listed above.(for Marion County ups only) <br /> The above septic system has been inspected by Marion County. The information has been determined to be accurate and <br /> ?system is: <br /> Approved <br /> ] Approved with corrections: see inspection report <br /> I ] Denied Signed: V2ibli'll---..---." <br /> RE1e`•��J Title: V Vti�] • <br /> Date: Co PC107 <br /> MC: S-41 WHITE:Marion County; YELLOW:Owner; PINR:Installer <br /> rev: 8/00,6/01 <br />