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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 /> SALT M OR 97305 <br /> 503-588-5147 PERMIT NO. 555-23-004442 <br /> Cd N7Ys http:I!www.co.marion.or.us%PW/Buildinglnspection SITE ADDRESS: 22988 Northfork Rd SE Lyons <br /> AS-BUILT PLAN OF CONSTRUCTED SYSTEM: <br /> Scale: lir . .. <br /> North <br /> • <br /> See.Attached <br /> (show all details and dimensions necessary to Iodate all components of the system in the future). <br /> SYSTEM MATERIALS AND SPECIFICATIONS: INSTALLIiES(:EIrfIFICA'I'ION: <br /> I HEREBY CERTIFY THAT THE ON-SITE SEWAGE SYSTEM IN- <br /> System Design Sewage Flow na Gallons/Day STALLED AT THE ABOVE ADDRESS WA.S CONSTRUCTED IN:ACCOR= <br /> TANK Size: EXiBhtGigllons [ I single compartment DANCE WITH THE REQUIREMENTS:OF THE PERMIT AND THE RULES <br /> Manufacturer: na [.I double compartment <br /> OF THE ENVIRONMENTAL QUALITY COMMISSION: <br /> Material; ( 3 na flow-through I (I have tested the septic tank and certify it to be watettight. <br /> The system--was installed by: <br /> Effluent Sewer: Header Pipe: <br /> Size/Marl na Size/Marl na (A Property Owner(permittee) <br /> [ )Licensed Sewage Disposal Service <br /> DRAINFIELD rock'depth(inches) Box(es) na <br /> Rock and under Pc na ':I p ;I pipe .. . Drop Concrete DEQ.License Number: na <br /> ll <br /> Pipe; total depth _ I 1 Distribution I I Plastic <br /> DEQ certification Number. na <br /> Drainfield.Material(Alternative or pert.pipe) ;' <br /> -Total Draintield Footage ExiStilmeh:Depth Minimum. Maiiimunt <br /> Curtain Drain Depth na Sign X <br /> Etttuent Pump: Pump Moiler. List Control.pane( model #� :: <br /> Pump cycle property'owner <br /> dines in minutes: on off Gallons per Cycle Company named <br /> ( lease pri t) <br /> ATT Make:and Model na X 2 <br /> J <br /> Attach an additional sheet for.components and materials not.listed above. na Date: <br /> (For Marion County Use Only) The above septic system has been inspected by Marion County: The information has been determined to adcurate <br /> and the system is: VI Approved [ I Approved with corrections:see inspection.report I I Denied <br /> Signed: C/1/Yy,,CPA U/ . a V..? /9 / e. 7—I/t/ I O I"l r ci Pate:. ct 7 /V <br />