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MARION COUNTY BUILDING LNSPECI'ION 1Nv1 v LouxL vt.,..1 L 0..•*cl.,,a...a,"......�,...---- --'-- <br /> 5155 Silverton Rd NE. (to be completed by system installer) <br /> .®, ' SALEIYI OR 97305 503-588-5147 PERMIT NO. Ss S' 1-71,-eel 1, Z <br /> ii 4 <br /> MARiQN <br /> COUP ., l <br /> rhttpa/www.co.mrin:onus gp SITE ADDRESS' <br /> j _ k vo J k uf <br /> AS-BUILT PLAN OF CONSTRUCTED SYSTEM: <br /> ' <br /> Scale: 1 _ • , �`y 01, <br /> t'itId <br /> c th <br /> R <br /> ,y <br /> ' �r L?biz ` <br /> t 1 G <br /> • <br /> . A- 2:: 3q <br /> Li\ <br /> 1 <br /> .13 4q t-k.r olft too (show all details and dimensions necessary to locate all components of the system in the future) <br /> SYSTEM MATERIALS AND SPECIFICATIONS: INSTALLERS CERTIFICATION: <br /> )�--��--�t I HEREBY CERTIFY THAT THE ON-SITE SEWAGE SYSTEM IN- <br /> System Design'Sewage Flow 1'` L�+ Gallons/Day STALLED AT THE ABOVE ADDRESS WAS CONSTRUCTED IN ACCOR- <br /> ( aM total,gallons <br /> �{�Ssingle conpar1ment DANCE WITH THE REQUIREMENTS THE PERMIT AND THE RULES <br /> TANK Size: <br /> ` '.-1 Of.'I'HE ENVIRONMENTAL,QUALITY COMMISSION. <br /> Manufacturer: L t -e- - [; double compartment <br /> Material: �' ? <br /> ] flow-through l-have tested the septic.tank and certify it to be watertight. <br /> -.: The system was installed by: _ <br /> Effluent Sewer: 11 Header Pipe tort el, T '1 operty Owner installed <br /> ttee) <br /> Size/Mad rW31 Size/Marl -:4. 14 Pr <br /> icensed.Sewage Disposal Service <br /> `" DRt4INFIELD ,1 rock.depth(inches) Box(es) <br /> o [ I Concrete DEQ License Number: <br /> • Rock. and under pipe" - �7 P _. <br /> Pipe <br /> total [ [Distribution JS�P•lastic <br /> - DEQ.Certification Number::. Z-It.A. <br /> Drainlield.Material(Alternative or perf.pipe)_Ck.aA.uAk 'S , <br /> Total Drainfield Footage W Trench Depth Minimum $5 Maximum - <br /> '?. 7"P '''#.""if/ ' <br /> Curtain.Drain Depth. . , Signed:_ <br /> Eflluent.Pump:.Pump Model <br /> .. Pump cycle ev✓i t .1.'!� <br /> times in minutes: on off Gallons per Cycle Company name: <br /> (please print) <br /> AtT Make and Model- , <br /> Attach an additional sheet for components and materials not listed above. _ <br /> Date: ^, -22 — -- <br /> (For Marion County Use Only) The above septic system has been inspected by Marion County. The information has been determined to be accurate <br /> Denied <br /> and the system is: [ ) Approved [ I Approved with corrections:see inspection report [ ].D <br /> Signed: Title:__-___ <br /> Date: <br /> MC:S-4l rev:3/03.4/12;5/14;11/17 G:\Forms\Septic1S-47 As=Built2015Version2017.doo WHITE:Marion County:YELLOW:Owner;PINK:Insi`aller <br /> . <br />