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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 /> SA5 3L 88 O47 97305 PERMIT NO..S 35-2 y -00 3 160 - PRAT- <br /> MARION COUNTY http://www.co.marion.or.us/PW/Buildinglnspection SITE ADDRESS: SW/ 9 * I l I /v S� <br /> AS-BUILT PLAN OF CONSTRUCTED SYSTEM: - \ 7 r e OR , - - e <br /> Scale: 1"= 0 ' • <br /> - N r)h <br /> 4 Fa4- i <br /> --..,1 \, s O T f L. <br /> Nw ) <br /> • 1'• . 444...1 <br /> 4-)-J Q u'�tot <br /> } <br /> L Z <br /> w <br /> 13 - G .7 <br /> ,- 1 2 3 _....�----.- .>_ - zip <br /> t 1Iv - - <br /> .7 f <br /> t <br /> IZ <br /> L)' 1- <br /> G b z' r <br /> I c t 11' t'"`" <br /> 7' <br /> log - � 2u, <br /> v 0 c7 - <br /> (show all details and dimensions necessary to locate all components of the system in the future) Pro pub•-r t,i+c. <br /> SYSTEM MATERIALS AND SPECIFICATIONS: INSTALLERS CERTIFICATION: .1..(v....kJ <br /> IN- <br /> System Desi n Sewage Flow Gallons/Day • ;• •• • • •g g Ll�(� <br /> TANI1'Size! I tpow total gallons [ 1 single compartment •DANCEF THE •• • QUALITYNMENTAL •COMMISSION.' , • <br /> THE RULES <br /> Manufacturer. [ J double compartment <br /> Material: Galt.t Cle- [ 1 flow-through I I I have tested the septic tank and certify it to ' <br /> e watertight. <br /> Effluent Sewer: Header Pipe: I, ' ' <br /> Size/Mat'l tl'' QUC.,• Size/Mat'1 H lul1I I I Property• <br /> IA...Licensed Sewage Disposal Service <br /> DRAINFIELD rock depth(inches) Box(es) <br /> Rock and under pipe 6 N I)1J.Drop 1 .Concrete • • <br /> I,icense Number. G <br /> Pipe p '� I I total depth I2 I I Distribution Plastic • <br /> Certification Number: els <br /> Drainfield Material(Alternative or perf.pipe) <br /> Total Drainfield Footage 3 So Trench Depth Minimum'ttj Maximum 5ed <br /> Curtain Drain Depth eff,4 4'lSigned:,2.4e_ geolli a <br /> Effluent Pump: Pump Model . <br /> Pump cycle t <br /> times in minutes: on off Gallons per Cycle Company <br /> . (please print) <br /> ATT Make and Model <br /> Attach an additional sheet for components and materials not listed above. •. <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: [ I Approved I I Approved with corrections:see inspection report [ I Denied <br /> Signed: Title: Date: <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 />