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• <br /> 1 .1 • <br /> I . , <br /> . . <br /> •••••••••••• •, .. <br /> NIARION COUNTY BUILDING INSPECTION 0 ccluetal4 <br /> 155 COURT ST NE/PO BOX 14500 • <br /> — SALEM OR 97309-5036 <br /> MAIlION 1 INDIVIDUAL ONSITE SEWAGE SYSTEM RECORD <br /> COUNTY • <br /> (to be completed by system insta . . . <br /> SITE ADDRESS:AO:1(ot Ru)Le RI Ak. $r PERMIT NO. ell .." OS f' * : <br /> AS-BUILT PLAN OF CONSTRUCTED SYSTEM: <br /> 1%4-- <br /> . vat owl.fet dillir •1 4s ii•--- <br /> 1 . • . •, North <br /> so 1 <br /> - .2.41/4111..."-•?‘.. ----""'/''r--:lr.":. / . I <br /> r"" --- • ' . pit .26' o*. • V 418 ! <br /> I / 1 1 / Ae.• a <br /> i . • <br /> 7 .1 . •1 <br /> I <br /> ; <br /> I 1 . .I..: 1 I sioz <br /> I <br /> ha. <br /> t t <br /> III <br /> 0 •\ • % <br /> % \ % ‘ <br /> % / <br /> % % • <br /> - <br /> •• 5$.---1 <br /> (show all details and dimensions nechary to locate all components of the system in the future) <br /> O SYSTEM MATERIALS AND SPECIFICATIONS: INSTALLERS CERTIFICATION: - <br /> System Design Sewage Flow: ')SO Gallons/Day I HEREBY CERTIFY THAT THE ON-SITE SEWAGE SYSTEM IN <br /> AT THE ABOVE ADDRESS WAS CONSTRUCTED IN ACCOR- <br /> Sepdc Tank:Size: •E...)k9Vtiti Marl_c_Cs_ 4411;fg: DANCE WITH THE REQUIREMENTS OF THE PERMIT AND THE RULES <br /> OF THE ENVIRONMENTAL QUALITY COMMISSION. . . <br /> O X t e6D° 5A4‘31 Dosing Tank:Size: Mfg [1 I have tested the septic tank and certify it to be watertight. <br /> Effluent Sewer:Size: 4/ft' Meek 50Vi flft... The system was installed by: <br /> (I Property Owner(pennitee) <br /> Box(es): 1 I Distribution;.K Drop/ (i Concrete; pt Plastic Licensed Sewage Disposal Service • <br /> O <br /> Drainfleld Pipe:Size: ;Material:Header:l'i"F1;10;Perf: DEQ License Number: 1.34/t SO <br /> Total Drainfield Footage:15o •;Rock Depth:Total: ;Under Pipe: DEQ Certi tion Number: <br /> Signed: <br /> O Alternative Drainfield Materials: Cilsou:r..14. 4 r.."4;11..skoir <br /> .... <br /> Trench Depth:Minimum: .2,4;maxi.m: 214 ;Curtain Drain Depth:NS"# Company name: •rf 1 C.& a:16 <br /> (please print) <br /> Effluent Pump:Pump Model:. ;Static Head in System ..a. <br /> Date: 1-All-09 <br /> Pump Cycle Time: ;Gallons per Cycle: . <br /> Attach an additional sheet for components and materials not listed above. <br /> (For Marion County Use Only) <br /> Th ove septic system has been inspected by Marion County.The information has been determined to be accurate and the system is: <br /> , Approved • 0 0 0 <br /> 1 j Approved with corrections:see inspection report •O 5/?,______ _t______ <br /> [I D • <br /> Signed: • 11111frrij, Title:toisa,0 Date glr t <br /> : ' <br /> • • / ....... / I <br /> O MC:S-41 WHITE:Marion County;YELLOW:Owner;PINK:Installer <br /> rev:8/00,6/01;3/03 <br /> • <br />