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{: <br /> MARION COUNTY BUILDING INSPECTION • <br /> $!55 Siivcrtan Rd NE ',:!d,I,, <br /> mi SAI.EM OR 973115 ,,Ali <br /> INDIVIDUAL ON-SITE SEWAGE SYSTEitii RECORD <br /> (to be completed by system installer) <br /> SiTADDRlSS: ?,54O4{E telanPI*. ''sf•-t L-Lfhis PERMIT NO, IS— �nC}~f <br /> AS-BUILT PLAN OF CONSTRUCTF.I)SYSTEM: •� <br /> I. Seale:I"= O' - PROPEI'x Lsty. ' <br /> jj iy �. I <br /> ! — <br /> 1,i ---o-4 ,.......__._7J' "t Zlt <br /> r .T`a .. r` O RLv>u�,,, <br /> en o—ace.--3 %• ICV _ <br /> ,n `7 <br /> s <br /> ii 33 <br /> 1-1 <br /> $ .";.' fig^ <br /> ') 3 <br /> 73 <br /> fr. <br /> / RoPE11.rt Lt•j '4,, <br /> (show all details and dtmensicins rccessary to locate all components or the system In the thturek ,,.,� v�.41 <br /> SYSTEM ofATCRIAIsANI}SPECIFICATIONS.; INSi'ALLF.t.V'CRR7'iEWA'r(t)'B: <br /> Srgem Design Sewaor Flow:l3C0 GilkrnelT ay I iRIREUY CERTIFY THATTIIECLN SITE SEWAGE SYSTEM I4. <br /> STALLED AT Ti 18 AOOVC AbCRE3S WAS COt+STAVCTCD IN ACCY)n- <br /> .)Septic Tank:Sim: Mall . blil:•. DANCE WITH THE REQUIREMENTS OF THE P"KRMIT AM)THE RULES <br /> Combo FTIIE ENVIRONMENTAL QUALE Y COMh11SStON. <br /> .Dosing rod.:sii¢:j ()0 matt(c r 1rr:•�,)A'1- 1 havc rested the ceplle tans;atuiccniF,II la kV v..�rni$)a <br /> I Alternative Treatment Technology s r t° e,� ec Tle s)stetn was imtalled by: <br /> a, 1 1 I I Property Owner(perosilet) <br /> I,EfilocatticwertSiu: I.7—Z matt . C rr-40 t.Ictoscd Sewage DieposinSemler ��{{/ <br /> i Rages):I.I Dis!tihntiom I I Ih1ip!I I Cautete:I 1 Mantle DEQ Liaise Nttmbu. 344 I,6 G <br /> I. <br /> 0ralaftl4Pipe:Si,t:iiI :Material;:header: (,��• 1FetC UEQCertifcatitinNumber• 1I a <br /> 11 d , <br /> Total Utatnr 4 rid Footage: o5 Rork Depth:Tot*1 :Ungeri5pe_6 <br /> Sipted <br />_ " Alternative Drate dd Materials: ' <br /> o <br /> • Trench Depth:Minimum:IV:Stasitnnrn i.7' :Cumin Drain Depth Company ramt•O j'1.5 i•Tt. S_ i, 7 e.xc SV4 <br /> r,,� (please print) <br /> Effluent Euent ramp:rump Mona pf 3o static Hem In s)1 s/tcni____ 11, f-h i3. <br /> DuW I' / O Y r7 G <br /> PitsapOleicTime: I�:5rflrs.:Cations pa()ele: s. 0 ! i <br /> .- Attach on addldottal ahert(or mar aortal and aunerlak nut listed doer. <br /> i, MIu(For ion County U .Only) • — ' <br /> 1 1' <br /> i The above serrtie*stun Ins been L-t .. d.by Moron County-.The iitfounnlban has been do 4 united is t,e arturn:e and the systeas Is, <br /> I" 1u4pilrovcd <br /> 1'1 I I CniedclP n s:see faspeetca report <br /> Penta <br /> I I Dl <br /> I' Si". ,-> ! cri jflllc: 't"rt- Date. 'g1l`j' . <br /> • • • <br /> 1 <br /> 'hiC:S I I . ,r_w:Mt,:4/12 - -y,..)P71l tTt.Varian Ca rear...)'ELLOWV Owner;PINi''f iwdkr <br /> \ <br />