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„......._.. <br /> MARION COUNTY BUILDING INSPECTION INDIVIDUAL SEWAGE SYSTEM RECORD <br /> iiiiiii <br /> .s5AL5L5E$mlivoertRon9R73d0NsE (t0 be completed by system installer) <br /> 555- 23- 0 o 9 ii3o-Pr?rn r <br /> 5014884147 PERMIT NO. <br /> MARION <br /> COUNTY <br /> http://www,co.marion,or,u0W/BuildingInspectioo SITE ADDRESS; 405 7- 12...:oseAtxt.4 Le.:. .5 <br /> AS-BUILT PLAN OF CONSTRUCTED SYSTEM . <br /> , .- _ <br /> Scale:I”= ' 1' • <br /> North , <br /> . i _, .._ ...._ ,... _... ...„... <br /> A --, S .s'.' <br /> . . . — c 30' <br /> A <br /> e <br /> te. <br /> • <br /> . ' L <br /> _ (show all details and dimensions necessary to locate all components of the system in the future) <br /> SYSTEM MATERIALS.AND SPECIFICATION& INSTALLERS•CERTIFICATION: <br /> I HEREBY CERTIFY THAT THE ON;-STTE SEWAGE SYSTEM IN- <br /> System Design Sewage Plow Gallons/Day STALLED AT THE ABOVE ADDRESS WAS CONSTRUCTED IN ACCOR- <br /> TANKSize:: 10013 total Ions DS tingle ccitnpartment . DANCEWITH THE1tEGUIREMENT$2P THE PERMTF AND THE RULES <br /> OF THE EN VittONNIVNrAL,QUALITY COMMISSION. <br /> Manufacturer: 1:1 double compartment <br /> Material J ] flow.throtin g • 1* 1 I have tested.the septic tank and certify it to be watertight. <br /> k : triAtrt:,- .• <br /> Effluent Sewer: Header Pipe: . The systein was installed by; <br /> 1 Siidivlatif: Lj'' vVL .Size/Mat'l 1 .1 Property Owner(perniittee) <br /> [ I Licensed Sewage Disposal Service <br /> DRA.INVIELD ., :rock depth(inches) Box(es) . <br /> Rock and under pipe . 1 1.Drop 1 II Concrete DEQ License Minter: 3 7-3 <br /> PiPe total depth 1 I Distribution 1 I Plastic <br /> DEQ CertifiCation Number: R125 7 <br /> Drainfield Material(Alternative or perf.pipe) : . <br /> Total Drainfield Footage Trench Depth.Minimum Maximum. • <br /> Curtain Drain Depth. <br /> Effluent Pump: Pump Model . <br /> Pomp cycle .... <br /> timet•in minutes: on off Gallons per Cycle COnmerlY name: 4 loll I <br /> Atr Make and Model . .(pleasp print). <br /> • <br /> Attach an additional sheetTor components and materials not listed above. Date I C)//li 3 <br /> .. . <br /> (For Marton County Use Only') The above.septie system has been inspected by Marion County_ The information has been determined to accurate' <br /> and the system tat Pil Approved 1 }Approved with corrections:see inspection.report I 1 Denied si ed.. ,,, cPt/ILLi ...omekiltre:=0:1::30Dig _ .. Dat0:1D.._. I).te.1 : <br /> ,) <br /> - <br />