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MARION COUNTY BUILDING INSPECTION <br /> , 5155 Silverton Rd NE INDIVIDUAL ON-SITE SEWAGE SYSTEM RECORD <br /> (to be completed by system installer) <br /> SALEM OR 97305 5-5g „ILI. . coo <br /> MARION L1.1,0 <br /> 503-588-5147 PERMIT NO. ----_ <br /> COUNTY , <br /> httpth'www,ca.marion.ar.us/PWilluildingInspectiun SITE ADDRESSL1 I 191 PQ <br /> AS-BU1LT PLAN OF CONSTRUCTED SYSTEM <br /> Scale: I" North <br /> "2.0$ <br /> 1 <br /> • 126 <br /> LW 6 f) <br /> Jlefi <br /> .. . <br /> til I <br /> (NI , <br /> . - <br /> r•, <br /> 1/4., • „ -,..- Oea 6.--,,.....• 1 Oil <br /> L.. <br /> 1 Cie-All 004- <br /> , <br /> ' . <br /> r-- ..1--v.r.e,„ O.."41N.,--- <br /> , . 1 <br /> 1i <br /> . i <br /> 1 .. .. <br /> ,., <br /> , <br /> . , <br /> (show all details and dimensions necessary to locate all components of the system in the fitful- ) <br /> I SYSTEM MATERIALS AND SPECIFICATIONS: INSTALLERS CERTIFICATION: <br /> ,. I HEREBY CERTIFY THAT THE ON-SITE SEWAGE SYSTEM IN- <br /> System Design Sewage Flow Gallons/Day STALLED AT THE ABOVE ADDRESS WAS CONSTRUCTED IN ACCOR- <br /> TANK Size: i'500 total gallons [ 1 single compartment DANCE WITH THE REQUIREMENTS OF THE PERMIT AND THE RULES <br /> OF THE ENVIRONMENTAL QUALITY COMMISSION, <br /> tvlanufacturer v....six.%Ire 4:.r.<ouble compartment <br /> Material: C.rsr..r,. f j floW-through. krkhave tested the septic tank and certify it to be watertight. <br /> Effluent Sewer: it `- Header Pipe: 1 I.,f,r The system was,installed by: <br /> Size/Mad -1. . N.( Siza/Mael i (m (Vc• 14Propeny Owner(permittee) <br /> 1 1 Licensed Sewage Disposal Service <br /> DRAINFIELD rock depth(inches) "Boxiest <br /> ; <br /> Rock and under pipe ic I j Drop A../ Manacle DEQ License Number: .3Tr".5347 <br /> Pipe <br /> total d tIep_i_j I f Distribution 1 I Plastic <br /> DEQ--Certification Number' I 3-Al 9r3- <br /> Drainrield Material(Alternative or pen.pipet , <br /> Total DrainfieldFootage 406 'Trench Depth Minimum t./C. tvlaximuntta, <br /> Curtain Drain Depth Signed: <br /> - Effluent Pump: Pump Model FF- 0 . <br /> Pump cycle .... . <br /> times in MillUICS: on _off_ _ Gallons per Cycle Company narne:_624,4tel15-rv$1-y LiCti trir, i nc 1 , <br /> (please print). l' <br /> ATT Make and I IA-- <br /> Amid.au additional sheet fur cow orients and materials uot listed above. Dale: r <br /> , <br /> ,(For iVIarion Coun Use°idyl The above septic system has been inspected by Marion County. The intbrmation bas.been determined to be accurate - <br /> and the system is: WIApproved I J Approved with corrections:see inspection report H Denied !.1 <br /> Title: 5kA 'ay lots-6-il Date:Ci/S/EC1 <br /> ...._ I <br /> MC:S-41 rev:3/03;4/12;5/14:11/17 G:Worms‘Septic‘S-4 I As-3uilt2015Version3017,doc JEVITE`Marron County:YELLOiY:(Novr,:PINK:hrstalter <br /> . 1 <br />