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MARION COUNTY BUILDING INSPECTION INDIVIDUAL ON-SITE SEWAGE SYSTEM RECORD • <br /> 5155 Silverton Rd NE (to be completed by system instaallleer/)Y� I: <br /> E 147 97305 <br /> 50388- PERMIT NO..SS S -2y -c `T-3 110 — PRAT- <br /> MARION <br /> COUNTY htt •//www.co.marion.or.us/PW/Buildin Ins ection L� SE i. <br /> P• g P SITE ADDRESS: S� g <br /> �,) �� e I <br /> AS-BUILT PLAN OF CONSTRUCTED SYSTEM: . \ 7my <br /> /A <br /> 0 <br /> Scale:1"='o r ' 1 <br /> I <br /> fill. v� <br /> I. <br /> � � <br /> I1� 4N .hu4s7 <br /> IM 0 �a <br /> Li^ `��.J Q ,rI IO; <br /> I r I <br /> ' .1I ��9'' c 72 " <br /> 0 <br /> o <br /> O o' -nutur Li:r 4. <br /> it Iis, <br /> 1Milli <br /> It 2 C- <br /> i0 Wiz+ <br /> r <br /> 1 <br /> lo d + <br /> r 1{ <br /> 7 <br /> to i <br /> 0 <br /> U 0 C) - 0 2u <br /> i <br /> (show all details and dimensions necessary to locate all components of the system in the future) Prugu47 Ciic. 1 <br /> SYSTEM MATERIALS AND SPECIFICATIONS: INSTALLERS CERTIFICATION: re,...'I <br /> g SewageL) (� Gallons/DayI HEREBY CERTIFY THAT THE ON-SITE SE AGE SYSTEM IN- I <br /> System Design Flow <br /> SSSTALLED AT THE ABOVE ADDRESS WAS CONSTRUCTED IN ACCOR- <br /> TAedIZ'Size! S)60e 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: Curf+;r C . <br /> ( J flow-through I I I have tested the septic tank and certify it to be watertight. <br /> Effluent Sewer Header Pie: The system was installed by: 1 <br /> Size/Mat'I t1 i' ?VC- Size/Marlp LI tt Sul 61 I I Property Owner(permittee) i <br /> ($Licensed Sewage Disposal Service I <br /> DRAINFIELD rock depth b(inches) Box(es) /' <br /> Rock and under pipe (a �� ly�.Drop Jp(.Concrete DEQ License Number: I. <br /> Pipe total depth IZ I I Distribution I I Plastic DEQ 3 <br /> Certification Number: ' <br /> Drainfield Material(Alternative or pert.pipe) <br /> Total Drainfield Footage 3.50 Trench Depth Minimum 711 Maximum 50 J <br /> j <br /> Curtain Drain Depth 2yt,f.•�-',':1 Signed: frA C/ ; <br /> Effluent Pump: Pump Model . <br /> Pump cycle i <br /> times in minutes: on off Gallons per Cycle Company name: a eal G. r c ird Ol S . <br /> Model <br /> (please print) <br /> ATT Make ando <br /> Attach an additional sheet for components and materials not listed above. Date: Zti 111 - <br /> (For Marion County Use Only) The above septic system has been inspected by Marion County. The information has been determined to be accurate I <br /> and the system is: JfApproved I ] Approved with corrections:see inspection report I I Denied i <br /> �jJ 4 / �J�< /`' '54 . <br /> Signed: , %2��/vli � - Title: ��// ✓ Date: . <br /> MC:S-41 rev:3/03;4/12;5/14;11/17 G:\Formsl.Septic\S-41 As-Built20 I 5Version20 I 7.doc WH/TE:Marion County;YELLOW.:Owner;PINK:Installer <br />