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dimMARION COUNTY BUILDING INSPECTIONSA INDIVIDUAL ON-SITE SEWAGE SYSTEM RECORD <br /> 5155 Silverton Rd NE (to be completed by system installer) <br /> 5 3-88EM OR4 97305 PERMIT NO. A.5,S —.7 ii-00 )3 0 <br /> MARION _ <br /> J7 !V <br /> COUNTY http://www.co.marion.or.us/PW/BuildingInspection SITE ADDRESS: &0793 R. 'rs.J' r``�� <br /> 'AS-BUILT PLAN OF CONSTRUCTED SYSTEM: <br /> Scale: 1"= T <br /> A -) )g North <br /> • /.''' . . <br /> ga <br /> • DsR.P 4\ • . . <br /> ris <br /> > — ,— 0. 1 G - `Rt~p tat e mg/I <br /> . 5] i o , )©0' — e i G <br /> D�S•Y 4 s t � I v >✓ <br /> L— .4, Areak <br /> 55 <br /> • 1D )00 <br /> l i- <br /> 1 ' 4- <br /> S(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 'L")7J Gallons/Day STALLED AT THE ABOVE ADDRESS WAS CONSTRUCTED IN ACCOR- <br /> TANK Size: )$00 total gallons $ single compartment DANCE WITH THE REQUIREMENTS OF THE PERMIT AND THE RULES <br /> WA [ ] double compartment OF THE ENVIRONMENTAL QUALITY COMMISSION. <br /> Manufacturer: <br /> Material: £01L c 1 e [ ] flow-through p4 I have tested the septic tank and certify it to be watertight. <br /> Effluent Sewer:- i/ Header Pipe:, //. The system was installed by: <br /> Size/Mat'l y Sc.L go 4S Size/Mat'l y 30.3yT v L. I I Property Owner(permittee) <br /> p4 Licensed Sewage Disposal Service <br /> DRAINFIELD rock depth(inches) Box(es) / <br /> Rock and under pipe 4' I I Drop )4 Concrete DEQ License Number: 3 65 / <br /> 8 ( {� <br /> Pipe total depth )4 ,7 Distribution I I Plastic <br /> DEQ Certification Number: 3-0 q7 J 7 7 <br /> Drainfield Material(Altemative or perf.pipe) <br /> Total Drainfield Footage / Trench Depth Minimum )� Maximum 30 �_ / <br /> Curtain Drain Depth Signed:_ <br /> Z-.5*/ <br /> Effluent Pump: Pump Model . <br /> Pump cycle <br /> times in minutes: on off Gallons per Cycle_ Company name: / iC/•$r ' 0,14-1 ( (,L C <br /> ATT Make and Model 'j(please print) <br /> Attach an additional sheet for components and materials not listed above. Date: g// /;? <br /> (For Marion Count se Only) The above septic system has been inspected by Marion County. The information has been determined to be accurate <br /> and the system is: reiAp roved [ ] Approved with corrections: see inspection report I ] Denied <br /> Signed: Title: :,- 51 10 7,- -5 l---3-g Date: __1_____ <br /> MC:S-41 rev:3/03;4/12;5/14;11/17 G:\Forms\Septic\S-41 As-Built20l5Version20l7.doc WHITE:Marion County; YELLOW:Owner;PINK:Installer <br />