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MARION COUNTY BUILDING INSPECTION INDIVIDUAL ON-SITE SEWAGE SYSTEM RECORD <br /> giiiii 5155 Silverton Rd NE (to be completed by system installer) <br /> 03-588- 147 97305 PERMIT NO. 555- aLf-cc i z2.9 <br /> MARIONl <br /> COUNTY , http://www.co.marion-or.us/PW/BuildingInspection SITE ADDRESS: V,I J I 8,,,r,Lji ('v-a k p'Ird s <br /> AS-BUILT PLAN OF CONSTRUCTED SYSTEM: S?fV—v- , /O' (Z 97 <br /> Scale: 1"— t <br /> A <br /> North <br /> c...----\ <br /> 1 6 <br /> eta , <br /> y` <br /> 1' 0C -ga t <br /> �' A.D_9gl <br /> 4G t 0- -Ill <br /> 3`1) <br /> IS. <br /> P 0 us t <br /> led)5 <br /> ■ <br /> (show all details and dimensions necessary to locate all components of the system in the future) <br /> 1, SYSTEM MATERIALS AND SPECIFICATIONS: INSTALLERS CERTIFICATION: <br /> System Design Sewage Flow '-F Gallons/Day I HEREBY CERTIFY THAT THE ON-SITE SEWAGE SYSTEM IN- <br /> STALLED AT THE ABOVE ADDRESS WAS CONSTRUCTED IN ACCOR- <br /> TANK Size: I'( t7 b total gallons [single compartment DANCE wrrn THE REQUIREMENTS OF THE PERMIT AND THE RULES <br /> compartment <br /> OF THE ENVIRONMENTAL QUALITY COMMISSION. <br /> Manufacturer. WG.t. [ double com p <br /> Material: ; (30+.14,+,zA- [ ] flow-through [}N I have tested the septic tank and certify it to be watertight. <br /> Effluent Sewer: t c n Header Pipe: R The system was installed by: <br /> Size/Mat'I 1 1'i. Size/Mat'I- u pi C I I Property Owner(permittee) <br /> [ Licensed Sewage Disposal Service <br /> DRAINFIELD ' 'rock depth(inches),Li Box(es) �� <br /> Rock and 'r under pipe a " h¢;Drop [Concrete DEQ License Number. Sel6S- <br /> Pipe total depth 3U t` I I Distribution [ I Plastic <br /> DEQ Certification Number: t 7ar <br /> Draintield Material(Alternative or pert'.pipe) PeAr O--Szer"sefTw l <br /> Total Drainfield Footage I a Trench Depth Minimum 3' Maximum Lim <br /> fi <br /> Curtain Drain Depth Signed: <br /> Effluent Pump: Pump Model •— <br /> Pump cycle <br /> times in minutes: on off -- Gallons per Cycle Company name: diye,t. C' c_,,eis-• v.-- act vs_ Z.L e <br /> • KIT Make and Model (please print)Attach an additional sheet.for__components and materials not listed above. _ Date: 49^ .R / <br /> (For Marion CounqXse Only) The above septic system has been inspected by Marion County. The information has been determined to be accurate <br /> ' and the system is. hpproved I ]Approved with corrections:see inspection report 1 1 Denied <br /> a Signed: - ,� — Title: �i 1 �� �f� Date: �f �Ck �"t <br /> MC:S-41 rev:3/03;4/12;a/14; /17 G:1Foims\Septic1S-41 As-Built20l5Version20l7.doc WHITE:Marion County;YELLDW.Owner;PINK:Installer <br /> 1 <br />