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<br /> ri.74. MARION COUNTY.BUILDING INSPECTION INDIVIDUAL ON-SITE SEWAGE 8SYSTEMRECORD
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<br /> 5155 Silvetton Rd NE
<br /> SAISIVIOR 9'7305 1(10 be completed by system.installer)
<br /> • 503,5884147 PERMITNO. '..6
<br /> RION
<br /> •' MA
<br /> :., COUNTY -•
<br /> htti):11:Www.ico,mariian:or.us/PW/Nujidittglitapettitiri SITE ADDRESS 9f i a7i7 S ;hie,:E.7.", "(/ / ./
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<br /> (show all details d dimensions necessary to locate all components of The system'in the Suture) ' S
<br /> SYSTEM MATERIALS A4 SPECIFICATIONS: ENISTALLERS-CERTIFICATION:
<br /> • THEREBY:CERTIFY THAT THE ON-SITESEWAGE SYSTEM IN-
<br /> Systetit pogo Sewage FIOW Gallbrisibay STALLED Q. ABOVE ADDRESS WAS:CONSTRUCTED IN ACCOR-
<br /> TANK Size: /000 total:gallons Kigle eotiinattnient DANCE WITH THEiREQUIREMENTS.OF.THEPERMITANP THE RULES
<br /> OF THE ENVIRONMENTAL QUALITY COMMISSION
<br /> Manufacturer: 3,' ,[ I deable compartment • .
<br /> Material: Ciareld er-k• I. I tow4hronitx ,Kr have:tested:the-septic tookand CetWit to be:watertight;
<br /> Effluent Sewer: j., fii. „,,, _ i Header Pipe: • The vstem was installed by:
<br /> Size/Mgt 7 "-"z/371-e,•, 'Size/Mgt I .1 Property Owner(pertnittee). -
<br /> • „1,040Lipensed Sewage Disposal Serviee
<br /> DRAINFIELD . icek depthrithes) : 'BOx(es)
<br /> • '.22,-.1,./.2'
<br /> ;• Rock and :under pipe. 4 .."" : krDrop joii;Concrete: . DEQ License Number:_.,,,,,--,, ,/..,:). :
<br /> Pipe' total depth /70/17?:- I I Distribution I IPlastic i ,5/9
<br /> DEQ Certification Nunibes.:-.4. ', :'
<br /> Dialitfield Materiel:(AlteniatiVe dived.:pipe): ,"P""'"- ,
<br /> TotalAtainfierdFOotaga&_ Trench Depth lvlinintoglaxiinurn391./
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<br /> Curtain Drain Depth 4 g9 Signed . . -•:" • • ,„ . ,
<br /> EllinenfPump:Pump Model ‘c_j
<br /> NitIP cYC1O -0 - ,
<br /> times in minutes::on -..-- oft' ----- Gallons per Cycle "--" Company ii:ii,.*:-
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<br /> Art mgikeantiviodet : , - --: (pleaseP t)
<br /> Attach an additional shcefforcomponents and materials not listed above. , Date:_7
<br /> (For Marion CottittYAISe Only) The,above septic system has been InSpected by Marion:County. The information:hasteertdetenniaid to beaccurate:
<br /> and the system.is:- [ 1 Approved. j I Approved With e0toetionSitee InSpeetin0 report- I 1.1)enied
<br /> $igned; Title: Date:
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