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NIAjuuoNCOUNTY RUJILDINC TN * CTIO ' INDivI�DUAL ON-SITE SEWAGE SYSTEM RECORD <br /> �'' •• S 15S Slivctton Rd NL (to be carrapteted by system installer} <br /> sALEMMM OR 97305 <br /> p� 503:5S8-S147 PERMIT NO, <br /> INUI <br /> httpadtnwtiv.co.0 rlonoor.uslP'WIBuiidinghtsttcctlon SITE ADDRESS: iCi 7 T v f�,v , e cti t rt <br /> AS-BUILT PLAN OF CONSTIZUCTEJ)SYSTEM: <br /> Scale: t"_> T <br /> North <br /> t = <br /> ee <br /> gg <br /> (show all details and dimensions necessary to locate all components of the system in the future) <br /> ,� <br /> SYS-t k.M MATERIALS AND SPECIFICATIONS: INSTALLERS CERTIFICATION: <br /> Syst as Design Selvage Flow_ 0allons21ay, I HEREBY CERTIFY TFIATTHE ON-SITE SEWAGE SYSTEM IN- <br /> e STALLED AT THE ABOVE ADDRESS WAS CONSTRUCTED IN ACCOR= <br /> TANK Size: j 5OD total gallons single compartment DANCE WITH THE REQUIREMENTS OF THE PERMIT AND THE RULES <br /> [ ]'double compartment OF TILE ENVIRONMENTAL QUALITY COMM[SSION_ <br /> ktanufactur. futi t C=[, t?L$ <br /> • <br /> atesia3s CeI t*3 CY-.t --A <br /> ();flow-through I;have tested the septic tank and certify it to be watertight. <br /> Efilut sewer. Header pipe: The system was installed by: <br /> s• I.%° 5 eA q0 f v sizr/Pvtat'i I L Sch+ Lto rvC: ( I Property Owner(permittee) <br /> I " Licensed Sewage Disposal Service <br /> 'DRAINFIELI) z rock depth(inches) Box(es) <br /> Kock under pipeI I Drop l !Concrete DEQ License Number,. -7 1 I c� <br /> -S-b <br /> l'zp� total depth I I Distribution I I Plastic p 7 �� � 2i?Z <br /> DEQ Certification Number: it <br /> Li <br /> DeakEeld Ms1 9.aI(Alternative or pert'.pipe) ` "I nr t t Irt>tt)l b r' <br /> Total t3rafnGeld Footage r i?(-} Trench Depth lviinitnttm 1`2 ,MazimtSmLL-" ,ei'It �-' `� ��'�� <br /> Curtain Drain Depth Signed:_ 0 1 j J <br /> Effluent Pump: Pomp Model <br /> s era=in Minot :-on off Gallons per Cycle Company name, i✓ "" L- o fr I t vt 5 _`-/V C . <br /> • <br /> AT F Maize and Model ?R e n rr_t Jf r'C 22. Q� (please punt) <br /> Attach en additional sheet far coat onents and materials not listed above,. Date: _ - <br /> t`FFor Marion County se Onlvl The above,eptic system has im inspected by Marion County. The information has been determined to be accurate <br /> ti e sys!ern is: >•p ed L j Approved with corrections:see inspection report I I Denied <br /> I Side ' Title.; Date: 1 ,II <br /> VC- - I =.45ris:4112;5,44:11t17 G:IFaens,epite -41 An,Built2Dl5Version20174oc WcJ1TE:UarwrnCounty. Y OW: •ner;P/NK'Insfrrlier <br />