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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 3-E88 O47 97305 PERMIT NO. 3-5_5--22-00` 2 3 <br /> MARION / „ <br /> COUNTY http://www.co.marion.or.us/PW/BuildingInspection SITE ADDRESS: / 471 ,� /�Q7.el,k �pvi!/" 1 <br /> AS-BUILT PLAN OF CONSTRUCTED SYSTEM: 5 l'eV OA eZ -?>3 6=./ <br /> Scale: 1"_ is <br /> ,IVY 11 / .... •l\4\:1 o <br /> North <br /> -/ <br /> IBA' .... <br /> a,5 - I / 3; , <br /> i` ` ` <br /> /2 S / <br /> EXPIRE® <br /> /® <br /> 1' - F <br /> , . gillytt i L., <br /> ImouS-e Kt Ak:e_ ek <br /> �®�1 <br /> �� 640Ftyt\N ±-ez,Z,7011-a0 <br /> 74/-2.—2_... <br /> ri 1 (ie-cP /ZA K <br /> , . -F/I I ed Pawl id 4-1-11 42. V y/-2_ ---/__ <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 2 S Gallons/Day STALLED AT THE ABOVE ADDRESS WAS CONSTRUCTED IN ACCOR- <br /> TANK Size: /6-60 total gallons [ ] single compartment DANCE WITH THE REQUIREMENTS OF THE PERMIT AND THE RULES <br /> o OF THE ENVIRONMENTAL QUALITY COMMISSION. <br /> Manufacturer:.) �� �'��L p.Ie l double compartment <br /> Material: arc 1 -e. j'-P <br /> [ ] flow-through I)J I have tested the septic tank and certify it to be watertight. <br /> Effluent Sewer: Header Pipe: q The system was installed by: <br /> Size/Mat'I l �Y S�.�"�a Size/Mat'I ����I t CoiProperty Owner(permittee) <br /> I I Licensed Sewage Disposal Service <br /> DRAINFIELD rock depth(inches) Box(es) <br /> Rock and under pipe 6 I I Drop [54 Concrete DEQ License Number: <br /> f <br /> Pipe total depth /2 >4 Distribution I I Plastic <br /> t,. DEQ Certification N r: <br /> Drainfield Material(Alternative or pert.pipe) I, ?oit?_i O 'pc.-/ <br /> Total Drainfield Footage 9,St) Trench Depth Minimum / Maximum_.2 1 <br /> Curtain Drain Depth Signed: <br /> Effluent Pump:�inn uZnp Mode r' 0. /L�30 <br /> Pump cycle times in minutes: �- " off' 0Gallons per Cycle c� Company name: Pe /� �At"/ / A V <br /> 4 hT..11�4 4eel �nnN r"e �/T— L �� (please print) <br /> i <br /> I� V / J <br /> Attach an additional sheet for components and materials not listed abovel kOvtAbt S Date: 7/ /1/ y_- <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: [ 1 Approved I I Approved with corrections: see inspection report I 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-Built2015Version20l7.doc WHITE:Marion County; YELLOW:Owner;PINK:Installer <br />