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f <br /> MARION COUNTY BUILDING INSPECTION INDIVIDUAL ON-SITE SEWAGE SYSTEM RECORD <br /> 5155 Silverton Rd NE (to be completed by system installer) <br /> 503: 4R 97305 <br /> SS- 1 PERMIT NO. 5 55' Z Z'01 j 1 I <br /> MARION <br /> COUNTY http:/Iwww.co.marioa.or.us/PW/Buildinglnspection Cc <br /> SITE ADDRESS: gcn 5'I tt- dt 1 .. ..) r..)E <br /> AS-BUILT PLAN OF CONSTRUCTED SYSTEM: JCiU,i�tSV�l lie. OR C11 2, <br /> Scale:1" -- / <br /> North <br /> 1311 <br /> _•NA,' <br /> ( <br /> 7Ip� le <br /> x ., ,. X X \� 7- X X X/ <br /> ...t..4..10,1 <br /> 3 CI eX > 'r <br /> Cnh xr' keliNif <br /> �r <br /> xN‹ x - <br /> ., v r %ve-toilz) hi 0 mt., <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 /> �s GallonslDa I HEREBY CERTIFY THAT THE ON-SITE SEWAGE SYSTEM IN <br /> System Design Sewage Flow y STALLFD AT THE ABOVE ADDRESS WAS CONSTRUCTED IN ACCOR- <br /> TANK Size: 1 OC o total gallons M single compartment DANCE WITH THE REQUIREMENTS OF THE PERMIT AND THE RULES <br /> Manufacturer. E x \S a" 1 no [ 1 double compartment <br /> OF THE ENVIRONMENTAL QUALITY COMMISSION. <br /> Material: ce,,c_r.. I I flow-through . >rI have tested the septic tank and certify it to be watertight. <br /> Effluent Sewer Header Pipe: The system was installed by: <br /> Size/Marl 1 u 30/3`1 •1 \G_-Size/Mat'I I i Property Owner(permittee) <br /> )(Licensed Sewage Disposal Service <br /> DRAINFIELD rock depth(inches) Box(es)z <br /> Rock and under pipe XDrop 1 1 Concrete DEQ License Number: 6.1 <br /> y <br /> Pipe <br /> total depth 1 Distribution ;)(Plastic. ` <br /> -• DEQ Certification Number: �a —9 1 <br /> Drainfield Material(Alternative or pert.pipe) td,$J I r l L.C3 1 Total Draiafield Footage 216`i Trench Depth Minini Minimum lit Maximunt 3 G'I <br /> Curtain Drain Depth Signed: <br /> Effluent Pump: Pump Model 1_ � <br /> P Y R <br /> Pump cycle 1 c yy�� <br /> times in minutes: on off :a to :per Cycle Company name:. V e St J e'p-1 1 e_ <br /> ATT Make and Model (please print) <br /> Attach an additional sheet for components and materials not listed above. Date: S- LS-Z 3 _ <br /> i (For Marion Coun Use Only) The above septic system has been inspected by Marion County. The information has been determined to be accurate <br /> and the tern is; Approved I �. i it ved with corrections:see inspection report I I Denied <br /> Signed: /1 A la a / • .,: .i V 1 O1 Lt� Date: 4 tgo <br /> MC:S-41 rev:3/03;4112;5/14;'l 1/17 G:lFormsLSeptic\S-41 As-BuiIt20.15Version2017 doc WHITE:Marion County; YELLOW: r;PINK:Installer <br />