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MARION COUNTY BUILDING INSPECTION INDIVIDUAL ON-SITE SEWAGE SYSTEM RECORD <br /> 5155 Silverton Rd NE (to be completed by system installer) <br /> SA5 3-88 OR 97305 PERMIT NO. ,�S-2- `-OD 7 /7O / <br /> MARION <br /> COUNTY http://www.co.marion.or.us/PW/Buildinglnspection 6,Q3 7 14-(b (e�r <br /> SITE ADDRESS: <br /> AS-BUILT PLAN OF CONSTRUCTED SYSTEM: S / <br /> Scale: 1"= ' T <br /> i 9p North <br /> A4ob0331 '' 6- <br /> , <br /> �� , iiir <br /> ow . details and dimensions necessary to locate all components of the system in the future) <br /> 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: /L290 total gallons ngle compartment DANCE WITH THE REQUIREMENTS OF THE PERMIT AND THE RULES <br /> Manufacturer:t vG! S [ ] double compartment OF THE ENVIRONMENTAL QUALITY COMMISSION. <br /> Material: e_eite(/ e' [ ] flow-through ,lel'1 have tested the septic tank and certify it to be watertight. <br /> tr The system was installed by: <br /> Effluent Sewer Header Pipe: <br /> Size/Mat'I —7 'O? / Pile-- Size/Mat'l I I Property Owner(permittee) <br /> 1,41,icensed Sewage Disposal Service <br /> DRAINFIELD rock depth(inches) Box(es) <br /> Rock and under pipe I I Drop I I Concrete DEQ License Number:33o 73 <br /> Pipe total depth I I Distribution I I Plastic �/� <br /> DEQ Certification Number:_/— <br /> Drainfield Material(Alternative or perf.pipe) <br /> Total Drainfield Footage Trench Depth Minimum Maximum_ <br /> Curtain Drain Depth_ Signed: <br /> Effluent Pump: Pump Model . <br /> Pump cycle <br /> times in minutes: on off Gallons per Cycle Company name: /lL� /G_ <br /> (please pri t) <br /> ATT Make and Model 7 l ? -� <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: [ I Approved I I Approved with corrections: see inspection report I 1 Denied <br /> Signed: L:____ itle: �-ksf foZ(t(G' Date: /-T1-- <br /> -41MC:S ;41 rev:3/03;4/12•5/14 11/17 G:\F As-But WHITE:Marion County; YELLO :Owne ;PINK:Installer.: • <br />