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' . MARION COUNTY BUILDING INSPECTION INDIVIDUAL ON-SITE SEWAGE SYSTEM RECORD <br /> 5155 Silverton Rd NE (to be completed by system installer) <br /> y - OR.97305 <br /> ` - 503-588-5147 PERMIT NO. - --r -- e i 6 a <br /> MARION <br /> COUNTY http:/1www.co.marion,or.us/PWBuildinglnspection em�ss'' <br /> SITE ADDRESS: q5c,�0 stjUe1r' i .tis /-4�y� <br /> AS-BUILT PLAN OF CONSTRUCTED SYSTEM itsf wtSt1/r/<../ 0 cil 5 L — <br /> Scale 1„= /S I \\.) _,_ <br /> . . <br /> - <br /> 11 <br /> North <br /> (. 1,\::::::",,,,,..„.",". '� 'p <br /> //, 05 <br /> ,, <br /> t� c.t \ <br /> �1. <br /> �1 <br /> r <br /> r'1 alb .t F ibvoce <br /> , <br /> °� @ �3 Lu to to 1 <br /> � -_ t4 14 j <br /> e <br /> all tr,y, <br /> • <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 /> Design Sewage Flow. L,7 Gallons/DayI HEREBY CERT]FY THAT THE ON-SrrE SEWAGE SYSTEM IN- <br /> System <br /> STALLED AT THE ABOVE ADDRESS WAS.CONSTRUCTED IN ACCOR- <br /> TANK Size: J total gallons [j single compartment DANCE.WITH THE REQUIREMENTS OF THE PERMIT AND THE RULES <br /> l [j double compartment OF THE:ENVIRONMENTAL QUALITY COMMISSION. <br /> Manufacturer t <br /> Material: _ (441r40./?' G p(flow-through Q(j I have tested the septic tank and certify it to be watertight. <br /> EfIluentSewer. /(//y�, ,t Header Pipe: I The system was installed by: <br /> Size/MeV] P(c.- Se.(n. 1(?) Size/Mat'1 t/ _Set,ef6 I I Property Owner(permittee) <br /> [)4 Licensed Sewage Disposal Service <br /> DRAINFIELD rock depth(inches) Box(es) l <br /> Rock and under pipe I/L Cire, I j Drop I j Concrete DEQ License Number: 3 &e <br /> Pipe total depth. IV— I j Distribution l j Plastic <br /> DEQ Certification Number: PT 76 yt <br /> Drainfield Material(Alternative or perf pipe) tz a Gas,1/k/(//1Z <br /> Total Drainfield Footage j'�� ( (�`Maximum g .. Trench Depth Minimum I _ I ,a' <br /> Curtain Drain Depth_ — Signed: _ems <br /> Effluent Pump: Pump Model areyt ri •— M?a;rtvCce.k.4.--e4--54ec5 <br /> Pump cycle <br /> times in minutes: on off Gallons per Cycle Company name: ,711 44 ‹e•A.,}z '- e' Rye.t 1-t 1.44_,1 <br /> r d � s j (please print) <br /> /`t ATT Make and Model Cfxto, �} <br /> Attach:an additional sheet for components and materials not listed above. Date: --/©Z"'.g..._ <br /> (For Marion Conn Use.Only) The above septic system has been inspected by Marion County. The information has been determined to be accurate <br /> and the system is: I Approved I ]Approved with corrections:see inspection report ( )Denied <br /> JJ.r'�( Z r— <br /> Signed: — Title: 4 i Lc (J 7 Date: ///3 72 <br /> MC:S-41 rev:3/03;.4/12;5 17 G:1Forms\Septic\S-41 As-Built2015Version2017.doc WHITE:.Marion County;YELLOW:Owner;P/NK::tnstaller <br /> ,.0"It'‘ LAA-ti % ji ca- � <br />