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, MARION COUNTY BUILDING INSPECTION INDIVIDUAL ON-SITE SEWAGE SYSTEM RECORD <br /> -• 5155 Silverton Rd NE (to becompletedby system installer) ,�. <br /> 503-588-514R <br /> 3-88- 147 97305 PERMIT NO. S✓ ' g"0 g i ( — P pt 1 <br /> MARION <br /> COUNTY http://www.co.marion.or.0r <br /> s/PW/Buildinglnspection SITE ADDRESS: ,2,'07 RCL I it1, L ill <br /> AS-BUILT PLAN OF CONSTRUCTED SYSTEM: 54., e , U P <br /> J <br /> Scale: 1"=_' T <br /> North <br /> • \Ael ` <br /> V'\.\ <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 4 S-v 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: 7000 ff total gallons [ia,single compartment DANCE WITH THE REQUIREMENTS OF THE PERMIT AND THE RULES <br /> Manufacturer: l,J�(�fcc••x.G�C LtVct�oC� '� [ ] double compartment OF THE ENVIRONMENTAL QUALITY COMMISSION. <br /> Material: QovL6v.e.4.e [ ] flow-through I I I have tested the septic tank and certify it to be watertight. <br /> Effluent Se • (i e/ Header Pipe: The system was installed by: <br /> Size/Mat'l .1) / 5/Size/Mat'I ,', 3 013 el I I Property Owner(permittee) <br /> I I Licensed Sewage Disposal Service <br /> DRAINFIELD rock depth(inches) Box(es) Q/ \ <br /> Rock and under pipe G'2, F LO� I I Drop I I Concrete DEQ License Number: ,3 (�/o!� <br /> Pipe total depth I I Distribution [ I Plastic ]GO_ <br /> DEQ Certification Number: 39 <br /> Drainfield Material(Alternative or perf.pipe) <br /> Total Drainfield Footage <br /> ,'/? Sd Trench Depth Minimum+' ( ' Maximum <br /> Curtain Drain Depth_ (1// (, Signed: <br /> /� �J�/�� /40/(//it—''' <br /> Effluent Pump: Pump Model <% I y'cat 1�/ �, <br /> Pump cycle <br /> times in minutes: on off i. .ns per Cycle Company name: 3L�EJt/ <br /> 4 . LSti v(i vvv-L <br /> ATT Make and Model (please print) <br /> Attach an additional sheetor components and ma .rials not listed above. Date: <br /> (For Marion Count Use O f'The.'eve septic system has been inspected by Marion County. The information has been determined to be accurate <br /> and the system is: !`?.A + s •ed [ ] Approved with corrections: see inspection report [ I Denied , <br /> '` 3 20 Ici <br /> Signed: Fitter Date: t <br /> MC:S-41 rev:3/0 (4/12;5/14;11/17 G:\Forms\Septic\S-4l As-Built2015 sTV 2017.doc WHITE:Marion County;YELLOW:Owner;PINK:Installer <br />