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rB��G>NsK I INDIVIDUAL ON--SITE SEWAGE SYSTEM RECORD iiiiii <br /> D:vswD1 (to be completed by system installer) <br /> YBAION 555CouaStl E/POPlor145116 <br /> COuNrr Siem,01197304.503b 5 .1,"111,-fdr 7» <br /> (503)388414/ SITE ADDRESS:. � ti l�/ <br /> PERMIT NO. l`! '1 . tf r [ 1 <br /> .S-B1IZL1' PLAN OF CONSTRUCTED SYSTEM: • • <br /> scale: 1' - 1 oreih iivfor-fy Lrnt, F • t , <br /> North <br /> \ t ill <br /> r2 1f �/ << <br /> _.,t r e ' r <br /> C. <br /> 0♦ a Ak <br /> 4 e dfr l <br /> ivcdst erve4-1, <br /> . ... <br /> . -: 2. A.,,,,6„,.., 9.:,„ <br /> . g--------1..,,,- <br /> APPROVED AS-BUILT • - i - <br /> • <br /> • <br /> DRAWING - <br /> .3 <br /> I <br /> (show all details and dimensions necessary to locate all components of the system in the future) <br /> c r ' l r ��_4 LAi.4 �ti?_g, �'_ — .— r_. tT A. a dm Fr.& ■ : lr ru w r :► _� _. i71 ►' _ 3 <br /> SYST=EAT$RZ1tiL8 AM a8>9CIl/CA=0E8e IMSTALLtRs CR?11IcMTZOMt , <br /> System Damien Sewage Flaw: 325 Gallons/Day I HERESY CERTIFY THAT THE Ow-SITE SEWAGE <br /> ��©O Nat'l: ( y„p,j SYSTEMININIt CCO ADT THEEABOVE ADDRESS .EME CON- <br /> • <br /> Septic Tank: Size: ` Mfg: STRCR:TED IN ACCORDANCE WITH THE REQUIREMENTS OF <br /> j �+ TH8 PERMIT AND THE ROLES OF THE ENVIRONMENTAL <br /> naming Tank: Size: 45l, Nat'l: r 4 '/Z. Mfg: d.+K 44 9p.LITTcomassxm. <br /> I I have tested the septic tank and certify <br /> Effluent Sewer: Sire:___________♦t Nat'l: Pki� so I� it to be watertight. • <br /> >sox(e.): ( I Distribution;j� Drop i I 1 Concreter plastic The system was installed by: <br /> I ] Property Owner-rpermiten) <br /> Dcainfielil pipet Size: L# Material: Pleader: PfiG 4 Fern '2 Licensed sewage Disposni_gervite <br /> Total Drainfisld Footage:,17• r hock Depth: Total:, •J Under pipe:„AM* DEQ License Number: .V ir'/cG1 <br /> Alternative Drainfiela ltaterie2.: E,2.. Ana ► �!/ '' <br /> 0 - �)�,. signed A <br /> treach Depth: Minimum: ; Maxima: ate Curtain Drain Depth: 'of <br /> Effluent Pimrp: Pump Model: SPL-!tie Static Read in SyaCe ; s��/0 Pt. company name: I ew + '�l <br /> J4}/1/Sl : Gallons per•tyele b lDlease prix:t) <br /> cycle Time: _ AVM— 2 --0 3 f` Date: <br /> Attach ea additional abeet for Oo onaata end antsritla tot listed above. .„ <br /> s. �-, .- J - _a - - r - <br /> ,. - .. _. 0.' ._ - - - - J s. I' - i vi-i -J - l L- O_S - L_. ( - / P - \' -- -• -- az., <br /> • <br /> (for Varian County usa only) <br /> The above septic system bee been inspected by Marion County. The information has been determined to be accurate and ` <br /> tug system is: <br /> Approved <br /> ( ] APp'-' •rrections: see inspection report <br /> I ] n4 <br /> ip <br /> r ;, CC Q s <br /> Air4 <br /> Signed: id , • t • Title: .�C' c Date: <br /> MC: S-41 WHITE:Marion County; YELLOW:Owner; PINK:Installer <br /> rev: 8/00, /01 <br />