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I <br /> � _ ® MARION COUNTY BUILDING INSPECTION INDIVIDUAL ON-SI'i'E SEWAGE SYSTEM RECORD <br /> 5155 Silverton Rd NE. (to be completed by system installer) <br /> SALEl12 OR 97345 <br /> 503-58&5147 PERMIT NO„555— a a � ! 1 t-- C ic,s"[T— 0;I <br /> COUNTY �` <br /> http (www.co.marlon.oruaIPWIBullding nspectlon SITE ADDRESS:/ ea Q i E. Nt... <br /> AS-BUILT PLAN OF CONSTRUCTED SYSTEM: P Y'car'a OR c11 COO <br /> p <br /> North <br /> ,' t1 1800 gat <br /> / commie <br /> # ‘ lif* , mi. two, <br /> / commas <br /> Neighboring <br /> Building • <br /> . <br /> B-St1=20' <br /> c-Stl-T /' <br /> B-Dt1-30' / F� <br /> C-Dt1=52' <br /> A-D1=71' <br /> B-Dt=49' ' <br /> Ca <br /> A-D2=69' <br /> BrD2.48` y ``o'T ..,... �+bv <br /> A-D3.8fl'6" / . Driveway <br /> B-D3.86' `" <br /> 1; . <br /> .,- .. <br /> 100n <br /> f <br /> -_ 1 <br /> I. Scale ---- <br /> (show all details and dimensions necessary to locate all componentsof the system in the'futnre) _ <br /> SYSTEM MATERIALS AND SPECIFICATIONS: INSTALLERS CERTIFICATION: <br /> I.HEREBY CERTIFY THAT THE ON-SITE SEWAGE SYSTEM IN <br /> <System=Deslgp Sewage Flow Gallons/Day <br /> STALLED AT THE ABOVE ADDRESS-WAS CONSTRUCTED 1I�ACCOR- <br /> TANI.Size gail'ons. single compartment, DANCE WITH THE REQUIREMENTS OF THE.PERMIT ANDITIE RULES <br /> I NVIRONMENEAL.QUALIT Y COMMISSION. <br /> Manufacturer: 1r-1 <� [] double compartment <br /> Material: C 0./1:L+'�:'� ['I flow-through have tested the septic tank and tpattd'y it tn:be,w,atertght <br /> Effluent Seim:. Etc The s stem was installed by: <br /> .SizefKtstt SiaeiNfat- `I I I operty Owner(permittee) <br /> Licensed Sewage Disposal Service <br /> DRAINFIELD, rock depth(inches) . Box(es) ��� <br /> toxicant." under_pipe [ I Drop. II Concrete DEQ License umber. LP <br /> Pipe total depth I 1 Distribution I I Plastic. ? z �(�� <br /> DEQ Numbe <br /> r:sr <br /> DrainfieldMaterial(Alternative orperf.pipe) <br /> Total Drainfleld Footage Trench Depth Minimum_ Mae_imam_ - <br /> Curtain Drain Depth 6 Signed:. <br /> Effluent Ptriap:.Pump Model LT vC,57-5 <br /> Pump - \ &\QA�.r\ D l <br /> times in minutes: on: off Gallons per Cale ^�0 comp.-Lynam,_ <br /> {please pl Ott) <br /> AIT Make and Mmiel <br /> Attach an addidonail sheet for components and materials not listed above. Date: t I i i Lf'i <br /> (For Marion County 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: )QAppcoviced [ ],Approved with cor eeotionsg Si see Inspe report [ I Denied <br /> ned: /l1 Title: Af 11� 'Q 1 J v Date: l f / ( <br /> MC.S-41 rev:3/03;4/12:;5ti.4 It1t7 G:SFormsl;Sept;c\S-41.As-Built2Ot5Version2017.doc WHITE:)rion County,-YELLOW:Owser;PINK:Installer <br />