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iikiMARION COUNTY BUILDING INSPECTION INDIVIDUAL ON-SITE SEWAGE SYSTEM RECORD <br /> 5155 Silverton Rd NESA (to be completed by system installer) <br /> 5 3-88 OREM 4 97305 PERMIT NO. 556- Z Y-oo 9/D8 <br /> 1, MARION <br /> iii COUNTY htt //www.co.marion.or.us/PW/Buildin Ins ection d l.J4 C <br /> p� g p SITE ADDRESS: � 0 Be) ��19�r� /" J ..; <br /> AS-BUILT PLAN OF CONSTRUCTED SYSTEM: <br /> Scale 1"=SO1 T <br /> /' 1\ , North <br /> .,. AV:iz.4..r_ C ,- I <br /> i . '?7• 8 -6 = i ,i..o-i' <br /> p <br /> . - <br /> 1 1 $' 6 <br /> - I'7 = 9 8t <br /> g - D - ( a ( ` <br /> •UK5 ` 0 A - �/o - 81/z �. <br /> 3, 0 <br /> 1`/ ��, C 00 <br /> - <br /> J <br /> I <br /> 0. <br /> sil <br /> i. <br /> ar j13. A L , <br /> 7-71 A <br /> \\:\1/4-G <br /> .1, , '�Ev;s 1.-} <br /> l <br /> (show all details arlikti tnsions n- to loca all co ponents of the• stem in th future) <br /> SYSTEM MATERIALS AND SPECIFICATIONS: INSTALLERS CERTIFICATION: <br /> I HEREBY CERTIFY THAT THE ON-SITE SEWAGE SYSTEM IN- <br /> System Design Sewage Flow /16-45 Gallons/Day STALLED AT THE ABOVE ADDRESS WAS CONSTRUCTED IN ACCOR- <br /> TANK Size: 16-0 0 total gallons single compartment DANCE WITH THE REQUIREMENTS OF THE PERMIT AND THE RULES <br /> `: &-S � �(. r [ ] double compartment OF THE ENVIRONMENTAL QUALITY COMMISSION. <br /> Manufacturer: � _" <br /> Material: G°wd4�trt1„ ea y [ ] flow-through I I I have tested the septic tank and certify it to be watertight. <br /> Effluent Sewer: t� Header Pipe: if The system was installed by: <br /> Size/Mat'I V PV - Size/Mat'l 'I P 1 - I I Property Owner(permittee) • <br /> - y Licensed Sewage Disposal Service <br /> DRAINFIELD rock depth(inches) Box(es) <br /> Rock and under pipe 14 Drop 14 Concrete DEQ License Number: 3l <br /> Pipe total depth I I Distribution 1 I Plastic 3 y�3 <br /> Drainfield Material(Alternative or pert.pipe) E <br /> Z 1ew DEQ Certification Number: <br /> Total Drainfield Footage y5-0 Trench Depth Minimum 2 b Maximum30 I_ 6......-6----- <br /> Curtain Drain Depth ' <br /> Signed:- _ <br /> Effluent Pump: Pump Model . <br /> Pump cycle <br /> times in minutes: on off / Gallons per Cycle Company name: Vre v• 1-01:b2e h X C, <br /> ATT Make and Model ' (please print) <br /> Attach an additional sheet for components and materials not listed above. Date: - D. Z Cf <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 ' Approved [ I Approved with cor ecti ns• ee inspection report I I Denied Zj (] ��5' <br /> Signed: Title: ^r r fi Date: <br /> MC:S-41 rev:3/03;4/12;5/14;11/17 G:\Forms\Septic\S-41 As-Built2015Version2017.doc WHITE:Marion County; YELLOW:Owner;PINK:Installer <br />