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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 /> 503-588- 147 97305 PERMIT NO.13 -t 0 31119 <br /> MARION ,,/ <br /> COUNTY , http://www.co.marian.or.us/PW/Buildinglnspection SITE ADDRESS: 47�j 1 .50 E(G{te <br /> AS-BUILT PLAN OF CONSTRUCTED SYSTEM: J <br /> Scale: I"= T <br /> North <br /> if <br /> fl <br /> bt . 1 t". <br />, / 4.Y t <br /> 01-7 C °4--- ' <br /> • <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 /> I HEREBY CERTIFY THAT THE ON-SITE SEWAGE SYSTEM PS- <br /> I System Design Sewage Flow Gallons/Day STALLED AT THE ABOVE ADDRESS WAS CONSTRUCTED IN ACCOR- <br /> TANK Size_ _ 1 tal w I ns I I single compartment DANCE WITH THE REQUIREMENTS OF THE PERMIT AND THE RULES <br /> Manufacturer: <br /> r c ( ] double compartment OF THE ENVIRONMENTAL QUALITY"COMMISSION. <br /> Material: [ jflow-through I I I have tested the septic tank and certify,it to be watertight_ <br /> Effluent Sewer: Head The system was installed by: <br /> Size/Mat'I Size/MatI I (Property Owner(permittee) <br /> I I Licensed Sewage Disposal Service <br /> DR.AINFIELD rock depth(inches) Box(es) - n �j� <br /> Rock and under pipe Drop I I Concrete DEQ License Number: j`/ <br /> I Pipe depth I I <br /> total d thDistribution XPlastic <br /> DEQ Certification Number: — <br /> Drainfieid Material(Alternative or perf pipe) <br /> Total Urainfield Footage Trench Depth Minimum _ Maximum __ <br /> Curtain Drain '. Signed: <br /> z <br /> Effluent Pump: Pum. V•.el �J,( f j� / 'j p <br /> Pump cycle 1/it+�+ "A 6 �i rvic,L <br /> times in minutes on off ns per Cycle Company name: /J / l � ' ✓ <br /> amr•a_.........�a...a_. , (pleassprint) <br />