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MARION COUNTY BUILDING INSPECTION INDIVIDUAL ON-SITE SEWAGE SYSTEM RECORD <br /> 5155 Silverton Rd NE (to be <br /> completed by system Installeer) <br /> 503-588-514797305 PERMIT NO.3 r I S-2If• OD Z# 2 " PT1($17- <br /> MARION <br /> COUNTY bttp://www.co.marion.or.us/PW/Buildinglnspection 1 <br /> SITE ADDRESS; L�1�7 pG^ t h LI <br /> Tt.ln cr <br /> AS-BUILT PLAN OF CONSTRUCTED SYSTEM: _ / 1 <br /> Scale: 1"_ �lO - - —— — 1NG/i <br /> orth <br /> % <br /> to i <br /> p we C. <br /> D .b A- 25, 4so <br /> �k0A- aq' 'AA. 0 17 rnO,Ie- <br /> £ F0C_ti2' o hone. . <br /> Pt <br /> It rt I <br /> T . <br /> n- - <br /> 7 _t -- -. to <br /> 6• 4' <br /> -11' • 10 • <br /> ---____ dL -} I <br /> lip <br /> • <br /> t , <br /> • <br /> 3: <br /> .fi0 <br /> Z <br /> 7 <br /> 1 <br /> _ -1-.1-_Q-cx4..._:-.- ' --------- 6 <br /> (show all details and dimensions tie ssary to locate all commonents of the s stem in the future). <br /> - . <br /> SYSTEM MATERIALS AND SPECIFICATIONS: INSTALLERS CERTIFICATION: <br /> I HEREBY CERTIFY THAT THE ON-SITE SEWAGE SYSTEM IN- <br /> System Design Sewage Flow ZI SU Gallons/Day <br /> STALLED AT THE ABOVE ADDRESS WAS CONSTRUCTED IN ACCOR- <br /> TANK Size: I 1 QQO total gallons Iel•single compartment DANCE WITH THE REQUIREMENTS OF THE PERMIT AND THE RULES <br /> OF THE ENVIRONMENTAL QUALITY COMMISSION. <br /> Manufacturer: 10,►14 <br /> ( J double compartment <br /> N <br /> Material: east t-ree. I ] flow-through 14.1 have tested the septic tank and certify it to be watertight. <br /> Effluent Sewer Header Pipe: t, The system was installed by: <br /> Size/Mat'I ti %Ort• Size/Mat'1 LI QVL I I Property Owner(permittee) <br /> 14,1_Licensed Sewage Disposal Service <br /> DRAINFIELD rock depth(inches) Box(es) / ) <br /> Rock and • under pipe G Ilq-Drop { 4 G 1 Concrete DEQ License Number: , <br /> Pipe 'total depth, a l' I I Distribution I I Plastic �3� <br /> DEQ Certification Number: <br /> Drainfield Material,(Altemative or perf.pipe) . <br /> Total Drainfield Footage who Trench Depth Minimum"V'( Maximum 30 t t <br /> Curtain Drain Depth Signed: (?�;�'k// <br /> Effluent Pump: Pump Model - <br /> Pump cycle ryry i► /I <br /> times in minutes: on off Gallons per Cycle U Company name:_ G 1 6}e..k�►,�h rlS <br /> (please print) <br /> ATT Make and Model <br /> Attach an additional sheet for components and materials not listed above. Date: el(1 2 y <br /> is system has been inspected byMarion County. The information has been determined to be accurate ' <br /> CountyUse Only) The above septic s sp ry <br /> (For Marion( op Y <br /> and the system is:hhI I�A��p��provedd nI proved with corrections:see inspectionreport I I Denied qpopfl <br /> Wined: , A,141&U►A, Di, tLA Tj]a 54'4 4OI Nl'T/"{�' Date:MC:S-4I rev:3/03;4/12;5/14;11/17 G:1Forms epticl.S-41 As-Built20l5Vcrsion2017.doc WHITE:Marion County:YOW: rNK:Installer <br />