Laserfiche WebLink
iiimMARION COUNTY BUILDING INSPECTIONSA INDIVIDUAL ON-SITE SEWAGE SYSTEM RECORD <br /> 5155 Silverton Rd NE (to be completed by system installer)f� <br /> 503E 88-EM OR 97305 PERMIT NO. 5,�5-2y'r 60 //- 77 <br /> MARION <br /> COUNTY http://www.co.marion.or.us/PW/Buildinglnspection SITE ADDRESS: 3 ZS'9- �Li19( d r 3 / c y, <br /> AS-BUILT PVAN OF CONSTRUCTED SYSTEM: 73%z <br /> —Scale: 1"= go, I 1 s t ..y2oo <br /> • <br /> North <br /> • F (4 fo re, Re PA(Q <br /> flRE� <br /> — <br /> 7*0 is <br /> - <br /> . ,, vt, 75- <br /> b� 75' <br /> ..�'4� \ 7-5 4 13'1h. bosh <br /> N. Pi@ry <br /> -.... , at' Taw KjThg-r------ ... 110 <br /> 1 c��[� <br /> Ni. o <br /> Corvvav <br /> l , � M�'+ .. <br /> T- 5W0 P etre0, -, J?o <br /> . - - .--- NR.W-. aro`_ . - - <br /> 9 _ y� <br /> - -, Lear,too'. , .. i 9 Yb <br /> s `\, <br /> o 1.1. too u o <br /> i Lip <br /> details and dimenlsions necessary to[ilocate all compone1ts of the system inithe future) <br /> ' SYSTEM MATERIALS AND SPECIFICATIONS: INSTALLERS CERTIFICATION:gb 1 4.0 <br /> (" �f �^ 2 /_ • <br /> 1 HEREBY CERTIFY THAT THE ON-SITE SEWAGE SYSTEM IN- <br /> System Design Sewage Flow G.V- Gallons/Day /,l(X J 75�`'9'Jt ii• , STALLED AT THE ABOVE ADDRESS WAS CONSTRUCTED IN ACCOR- <br /> TANK Size: I 3 0 total gallons [ ] single compartment DANCE WITH THE REQUIREMENTS OF THE PERMIT AND THE RULES <br /> �(" r double compartment <br /> OF THE ENVIRONMENTAL QUALITY COMMISSION. <br /> Manufacturer: p�f 1'�17 0- p <br /> Material: 1 it prop �y 0e1 [ ] flow-through I I I have tested the septic tank and certify it to be watertight. <br /> Effluent Sewer:>>,J( f,p- q(4 . Header Pipe: /'/ 5c(,) The system was installed by: <br /> Size/Mat'l T v Ci— e f0 'Size/Mat'l T p[✓� F� Property Owner(permittee) • <br /> I /" I I Licensed Sewage Disposal Service <br /> DRAINFIELD rock depth(inches) 'Box(es) <br /> Rock and under pipe I I Drop I I Concrete DEQ License Number: <br /> Pipe total depth y Distribution I I Plastic <br /> DEQ Certification Number: <br /> Drainfield Material(Alternative or perf.pipe) illf A` <br /> Total Drainfield Footage Trench Depth Minimum Maximum_ <br /> Curtain Drain Depth_ Signed:_ D,_ <br /> Effluent Pump: Pump Model / . <br /> Pump cycle „` <br /> times innminutes: on off Gallons per Cycle Company name:_ 0C4JA/e-- <br /> ATT Make and Model (please print) <br /> Attach an additional sheet for components and materials not listed above. Date: 77Z4/Z- <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: Approved [ I Approved with co�rrec lops: see inspection report [ I Denied <br /> fA QI J <br /> Signed: efi - Title: R L F Date: U`l/ <br /> MC:S-41 rev:3/03;4/12;5/14; 11/17 G:\Forms\Septic\S-41 As-BuiIt2015Version2017.doc WH/TE:Marion County; YELLOW:Owner;PINK:Installer <br />