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: <br /> MARION COUNTY BUILDING INSPECTIONSA INDIVIDUAL ON-SITE SEWAGE SYSTEM RECORD <br /> iiiii5155 Silverton Rd NE (to be completed by system installer)_ <br /> 5 3-88 EM 04R 97305 PERMIT NO. 555 2 Li -002-7 I <br /> MARION <br /> COUNTY http://www.co.marion.or.us/PW/Buildinglnspection SITE ADDRESS: 15 2-1Vvr pl�f� r 11 I CJ� ""�- <br /> AS-BUILT PLAN OF CONSTRUCTED SYSTEM: <br /> Scale: 1"= 10' T <br /> North <br /> D e r -_"- <br /> .171 <br /> y_BeAo ' _ _. `I' <br /> M Z _ <br /> V\CJ11‘ Lou you Litt► <br /> 01 <br /> , �l I <br /> 5' <br /> • <br /> 51 <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 /> I HEREBY CERTIFY THAT THE ON-SITE SEWAGE SYSTEM IN- <br /> System Design Sewage Flow �/� Gallons/Day STALLED AT THE ABOVE ADDRESS WAS CONSTRUCTED IN ACCOR- <br /> TANKSize: X� ( ' `�\ total gallons [ ] single compartment DANCE WITH THE REQUIREMENTS OF THE PERMIT AND THE RULES <br /> Manufacturer: <br /> J [ ] double compartment OF THE ENVIRONMENTAL QUALITY COMMISSION. <br /> Material: [ ] flow-through I ] I have tested the septic tank and certify it to be watertight. <br /> Effluent Sewer: Header Pipe: The system was installed by: <br /> Size/Mat'I Size/Mat'l I I Property Owner(permittee) <br /> [ 1 Licensed Sewage Disposal Service <br /> DRAINFIELD rock depth(inches) Box(es) 2 n�G2. <br /> Rock and under pipe I I Drop I I Concrete DEQ License Number: ••7`� J <br /> Pipe total depth _ I-I Distribution I I Plastic S.33o, <br /> ,,p DEQ Certification Number:_ -- <br /> Drainfield Material(Altemative or pert.pipe)p, `s( Ye D'Pt, <br /> Total Drainfield Footage lip D Trench Depth Minimum IC) Maximum]Z <br /> Curtain Drain Depth Signed:_ <br /> Effluent Pump: Pump Model PF30e5] 1 . <br /> Pump cycle <br /> times in minutes: on off Gallons per Cycle Company name lne4S C_ -. -v 1 <br /> ATT Make and Model Yt <br /> (please print) <br /> Attach an additional sheet for components an materials not listed above. Date: 1.40 30—Z4 <br /> (For Marion Count 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: 0 Approved [ I Approved with corrections: see inspection report [ ] Denied ` <br /> Signed: Title: '‘'N ST 2 39- S Date:-'"./(' i °`"l <br /> MC:S-41 rev:3/03;4/12;5/14;11/17 G:\Forms\Septic\S-41 As-Built2015Version2017.doc WHITE:Marion County; YELLOW:Owner;PINK:Installer <br />