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dim -MARION COUNTY BUILDING INSPECTION INDIVIDUAL ON-SITE SEWAGE SYSTEM RECORD <br /> 5155 Silyerton Rd NE (to be completed by system installer) <br /> SALEIN OR 97305 <br /> 503-588-5147 PERMIT NO. 23-00Ug271- <br /> MARION <br /> COUNTY http://www.co.marion.or.us/PAY/Builttinglnspection <br /> SITE ADDRESS: P.7 r40! e-b S•� 5(}.le-3 OK <br /> AS-BUILT PLAN OF CONSTRUCTED SYSTEM: <br /> Scale: I"_ 1 T <br /> I North <br /> l } L _ 2y <br /> 7 . / / L = 1Sk+- <br /> .4. //, / <br /> -'..""ti dy/ , r. t) . too op : <br /> 7' , . <br /> y ,/tii/ `47'./ / — 16 -1;) <br /> 0 / , d- <br /> v / '''Y L, <br /> Dfc, . • , <br /> Nj� <br /> I <br /> • <br /> (show all details and dimensions necessary to locate all components of the system in the future) <br /> SYSTEM MATERIALS AND SPECIFICATIONS: INSTALLERS CERTIFIC,VtION: <br /> I HEREBY CERTIFY TI IAT TI_IF ON-BETE SEWAGE SYSTEM IN- <br /> System Design Sewage Ho►v (lallons/Day STALLED AT'I'11E AI3OVE ADDRESS WAS CONSTRtJCTll)IN ACCOR- <br /> TANK Size: }000 c11 total gallons l)(1 single-compartment DANCE WITH REQUIREMENTS OF THE'PERNIFf AND THE RULES <br /> vlf ( .} douhlccompartmem OF'I't1E ENVIRONMENTAL QUALITY COMMISSION. <br /> Manufacturer: kJct <br /> Material: C O/te YU1-4—• I I flow-through pl I have tested the septic tank and certify it to be Watertight. <br /> Effluent Sewer: !leader Pipe: The system was installed by: <br /> Size/Mall Lit n 3 '-3lf Size/Mat'I _ I I Property Owner(permittcc) <br /> LA Licensed Sewage Disposal Service <br /> ,DRAIN FIELD rock depth(inches) Dos(es) <br /> Rock and under pipe I I Drop I I Concrete DEQ License Number: 19 L-i i Li <br /> ripe total depth I I Distribution I I Plastic <br /> DEQ Certification Number: <br /> Draintield Material(Alternative or pert'.pipe) <br /> 'Total Drainfield Footage Trench Depth Minimum Maximum` /�� <br /> Curtain Drain Depth_ Signed:_-- 7t.. 4_�' !/ <br /> Effluent Pump: Pump Model <br /> Pump cycle <br /> times in Minutes: on off Gallons per Cycle Company name:__Paw Li',lg C0 15trtA-f-4 U <br /> All'Make and Model (please print) <br /> Anna'an additional sheet f9r components and materials not listed above. Date: _i 0/2 7 7 7 2 3 ___- , <br /> (For Marion Count Use Only) The above septic system has been inspected by Marion County. The information hits becn.detcmuncd to be accurate <br /> and the system is: I Approved I I Approved with corrections:see inspection report I I Denied ,(�/ <br /> Signed: Title: `1 -5" k 0 Date: 1 ' 1.? / (�3 <br /> MC:S-41 rev:3/03; ;5/14:11/17 tcaForms\Septic1S-41 As-Etu i lt201 5 Version201 7.doc 11'HITE:Ma-ionCo:inty: FELLOW:Ocner;PINK:/nstaller <br />