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• <br /> Ai ..:±Ir\RFON COUNTY BUILDING INst'h:C"I'ION INDIVIDUAL ON—SITE SEWAGE SYSTEM RECORD <br /> 5155 Silverion Rd NI <br /> S:\L-S3[;,�18-51 Olt7 973t1S (lii I)c contl)leted h%'s�•stem installer) <br /> S03 1 p.E.R r NO. (2) \.\-1 <br /> NARIpN -__Z_-I-�_�__—_ �_-- -- <br /> COUNTY l �/ <br /> hllp:/hstuts,eo.tnarinn.or.usll'11'/13uildinglnspectton SI'I ADDRESS:�Z0 a `SUA�O,— bcA S ch. <br /> AS-13UIL1'PLAN OF CONSI•RUCTED SYS'1'I;11i: �I`13�1b� <br /> scale: I"_ t <br /> North <br /> --_ SOf b i,,, <br /> / I . <br /> 4 <br /> 1144-,-) i-‘4,47,...Avi, ,z\\\ <br /> tic <br /> \'b T�LwsS <br /> 1 1- 1\ '9 t r� <br /> "� i .' ... Ias�r N g4- <br /> �, lJol( ��,.{ v <br /> M <br /> 60 r 1 Z_7 S s: <br /> (show all details and dimensions necessary to locale all c0 iponents of the system in the future) <br /> til:S'ELM 11A"TI:KIa.I ti:1NU SPECIFICATIONS: <br /> INSTALLERS CERTIFICATION: <br /> --77 I HEREBY CERTIFY Ti IAT TI Ili ON-SITE SEWAGE SYSTEM IN- <br /> System Design Sewage Flotis� [_ 5 Gallons/Dm, SIALLLD ATTI IE ABOVE ADDRESS WAS CONSTRUCTED IN ACCOR- <br /> 1 I single compartment DANCE\\'I'll I TI Ili REQUIREMENTS OFTIIE PERMIT AND TIII:RULES <br /> TANK S crer OQ total gallons OF'HIE ENVIRONMENTAL QUALITY COMMISSION. <br /> 1C1 double compartment <br /> \1anufactuturr_ a_„ ----- �1 base tested the septic tank and certify it to be rsatcrticht. <br /> Material: C f.Y(S rC.E C -- I I floss-through The system was installed by: <br /> Eleader Pipe: I Property Owner(pemtillee) <br /> ize/ att Scsscrli 6 C 4- p Sve/\tart <br /> — <br /> tiize,`Afat'I =l JCS � — j4 Licensed Sewage Disposal Service <br /> URA1 NI:iLLD rock depthnns(cs) <br /> Rock and under pipe _�r ___`(inches) I I Drop I I Concrete DEQ License Number: drin3 I.4 09 _k_ <br /> �rr <br /> Pipe total depth 12 J I Di<Iribution I I I'lasuc DEQ Certification Number. <br /> � <br /> Draintield Material(Alternative or pert pipcl_ rr b,r <br /> (,�y, Trench Depth Minimumi� \Incinwnr3 <br /> Total llrainncld Pootbgey Signed:` - <br /> Curtain Drain Depth <br /> Effluent Pump: Pump Model P-f 3f'0 -- <br /> Pump cycle Gallons per('ycic----.__— Company name: �t7Se-eV t U <br /> times in minutes: on al_________ ., �t(plleeasee print) <br /> Arr Hake and Model _________--------- Date: 223 U <br /> Attach an additional sheet for mrpnnenls and materials not listed above. <br /> For Marion County se Only The above septicsystem <br /> temhas been <br /> ii spe tons:ed by Marion County. he information <br /> mation haS <br /> been determined to he accurate <br /> i <br /> and the system is: A rov d I I Approved <br /> �� ,� <br /> Date: <br /> Title: <br /> 4)) Signed: II'tt1IE:Jlariar(-oann. YE l01{'fn�rr•r•PINK:Install{Cr 11 orms`Se ti S 4I As -0I7 doe rto <br /> \I(':'ti-ll rev:.rll3;-0/12:Slla,11/17 P ..... _ ___ . <br />