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. ' . . :MARKIN COUNTY BUILDING INSPECTION • INDIVIDUAL ON-SITE SEWAGE SYSTEM RECORD
<br /> '.• 5T55 Silverton Rd NE (to- be:eompleed by.systedi installet).
<br /> SAal%1:017; 9730$ .. . ... ,
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<br /> '' 503480-5147 i PERMIT'NO: . .- '.' 7 01/1,zji' -4% 44 7
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<br /> ' MARION '
<br /> COUNTY
<br /> • ' http://Www.eo.marion.or.us/PW/Buildinghispeetkin ' i /679; ftiL SITE ADD RESSr zp.11.30 ....N-r)44.'ST. -- . ' '
<br /> ..o-)31UTLYPLAI1/41-Of OONSTRUCTED SYSTPX::
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<br /> : . '.Senlei 1!!= ' - I
<br /> North
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<br /> .. (show'ali.details-and dirneriSiont necessary to:Iodate'all domPOrients cif the system in the,future): . „ . .
<br /> ' • SYSTFM MATERIALS AND SPECIFICATIONS i ' •• INSTALLERS CERTIFICATIOW — •- ''
<br /> THREDYCERTIFY'THATItig:ON-SITE,SEWAGESYSTEM IN-
<br /> System Design Sewage Flow . . Gallons/Day STALLED AT T THE.ABOVE ADDRESS WAE:c9HETRIX;LED MACc(oR-
<br /> TANKSizet Oa total tot,,i.gailons. [• • .20,41comportinent DANCE WITH THE REQUIREMENTS OF THEFERMIT AND THEautEs . :
<br /> : QUALITY
<br /> Manufabtureil 4,/,..,TV7 [ I double compartment. ••- ••i••- • -OF THE ENVIRONMENTAL• • ' •COMMISSION••
<br /> Material: .(454‘r..ftfi i [ ).flew-through . . . . ,
<br /> • [ ]I hhi/e tested the septic tank- and certify it to bewatertight.
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<br /> Effluent Sewer: ••:1/ . Header Pipe:: ii;,,,,i , .. The sytteth Ait.T.installed by:
<br /> Size/Mrit'l _ II. . ,gizefivlatq -.: ,%).' . : I 1 tttiPerEY 9Waer(pentittee). -
<br /> - • [vrLicensed Sewage Disposal Service
<br /> DRAINFIELD•• •xpeic depth(Inches) Box(es) . .
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<br /> .. Rock and under pipe; 0 : [(Drop 4;t<netete DEQ Lieensa Nintter:•. 9' - '- -- •
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<br /> . .• •. total depth -is : [ I Distribution •: 1!Plastic :
<br /> DEQ Certification Number.
<br /> DrainfieldMiltetiaL(Altemative orperf.pipe) ,.
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<br /> • Total•Draitifleld Maximum '
<br /> •Footage 1145.- Trench Depth Minimum i '
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<br /> Curtain Drain Depth / Signed- .-..: . .,. .
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<br /> EfiTisentPtititpi Putrip:Model •tiVtt,t )/ .•3 •
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<br /> : 'Pump:cycle
<br /> times in minutes: on off • Gall ps erCycle 517. ' Company name: 11f0140[/.04, 9.71/
<br /> - . ;kr mom and Model__ ' , . : . 45.1217 / (please print)
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<br /> .' Attach*an additional sheet for.conRonents and:materialsliof listedrebove.. , . . . ..Date:.7 --2.9.. .:-.-.4,,7
<br /> (For Marion COttise OnIVI The above septic SySterri has been iiispeCted by Marion County. The information has been deterinined inhe.acturate"
<br /> and the Sys4em is: [4.Approved [ I Approved with corrections:see inspection report [ 1 Denied, ,..
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<br /> . . Title:: f-M7.Sr 16 i9.5 ,I, Si et': . . • .. ....
<br /> • MC;S.:41 rev;3/03;4/12,;5114;11/17 G:\#ormsN.Septic\S,41:As.,,Euilt20.15VeriiiM2017.doe„ Wffirg:RaiiiiirCoilnly.'YEa0F".010047 PINKIii3Oriller‘
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