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MARION COUNTY BUILDING INSPECTION INDIVIDUAL ON-SITE SEWAGE SYSTEM RECORD <br /> diki • 5155 Silverton Rd NE (to be completed by 3- OREM system installer) <br /> 503 97305 <br /> -588- 1PERMIT NO. � c " i2 01 `� 2t <br /> MARION � ��j� -� <br /> COUNTY http://www.co.marion.or.us/PWBuildinglnspection SITE ADDRESS: 362 Q a\rei �(r- - ' `'\v(�G ( 2 <br /> n <br /> AS-BUILT PLAN OF CONSTRUCTED SYSTEM: qr3 f <br /> Scale:1"= 1' <br /> North <br /> 7 <br /> —....›-" (141W14-(") <br /> • <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 /> System Design Sewage Flow anon ay I HEREBY CERTIFY THAT THE ON-SITE SEWAGE SYSTEM IN- <br /> System AT THE ABOVE ADDRESS WAS CONSTRUCTED IN ACCOR <br /> TANK Size: \SC c ) total gallons [ ] single compartment DANCE WITH THE REQUIREMENTS OF THE PERMIT AND THE RULES <br /> Manufacturer:(_,l �� �1j,/�PA(L C <br /> double compartment OF THE ENVIRONMENTAL QUALITY COMMISSION. <br /> Material: op if kQ , [ ] flow-through IfijI have tested the septic tank and certify it to be watertight. <br /> Effluent Sewer: j I/ Header Pipe: ri system was installed by: <br /> Size/M ,% <br /> at'l . �n23% Size/Mat'1 y 3 e/Iy Property Owner(permittee) <br /> I I Licensed Sewage Disposal Service <br /> `DRAINFIELD rock depth(inches) Box(es) <br /> Rock and under pipe (�1� [ ]Drop I ]Concrete DEQ License Number: <br /> Pipe total depth) r) <i — Distribution I ]Plastic <br /> DEQ Certification Number: <br /> 1 Drainfleld Material(Alternative or perf.pipe) p )pry( <br /> Total Drainfleld Footage t0°s Trench Depth Minimum Maximum <br /> 1 <br /> Curtain Drain Depth Signed: c:-\11-1 1-- ( A.- -' <br /> Effluent Pump: Pump Model i <br /> Pump cycle <br /> times minutes: on tch I off y 4Gallons per Cycle 6 0 <br /> Company name: \--\b(v..Q GA-..-1V011/ <br /> NIT Make and Model (please print) <br /> Attach an additional sheet for components and materials not listed above. Date: <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: y]Approved �,[ 1 Approvedpp withp corrections:see inspection report [ ]Denied a 5/ <br /> Signed: [ •�V Title: f���5 Date: �/ <br />