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MARION COUNTY BUTLDLNG INSPECTION <br /> SSS COURT ST NE/PO BOX 14500 <br /> SALEM OR 97309-5036 M M INDIVIDUAL ONSITE SEWAGE SYSTEM RECORD <br /> 1.i•� <br /> Per, (to be completedtl by systeminstaller) <br /> SITE ADDRESS: J�2-1 It S LtiVi At ti Lop jl SE 1Z tav PERMIT NO. 0 $�-C7 s"6a D.s.' <br /> AS-BUILT PLAN OF CONSTRUCTED SYSTEM: I7 1 StYie:1i-lD0' n- l3-fai A' — —(Z' tt t <br /> 1 ' RR—A—lz9, 13-c- 19' i eel -`l-il: Ho43Q :rower <br /> AR-k- tiC, c_0-ti5s <br /> AR- F"157� G-4{- /31S' I <br /> �.,P G,r i r : serfic <br /> Bs— E- i19 c-P- I a^ I <br /> l " <br /> � BB'F -l�3' 12'9 — ° INr " Oo7. s,,' <br /> 88-A— (7S ._ LA1— — '"nk lG �I — <br /> �g-G-13g ='>�s_ _ <br /> v • <br /> A <br /> . 50.1. 8 <br /> '-1.- Lis 4.5' <br /> 'E ' y'I z( , <br /> i _ 0 r(✓c Wol. .-- - 4--�T r 7.s <br /> p. <br /> k s �---- ZOO laut <br /> ea b0Y riff i�Q—C, Z_0 —st$ d — , <br /> I 1--1.— Ti'1 3—Z ` �° /f F. <br /> ,r <br /> (show all details and dimensions necessary to locate al l components of the system in the future) t��- P• <br /> SYSTEM MATERIALS AND SPECIFICATIONS; LYSTALLERS CERTIFICATION; <br /> System Daly Sewags flaw: 211— itS.P Gallons/Day I HEREBY CERTIFY THAT THE ON.STTE SEWAGE SYSTEM IN- <br /> STALLED AT THE ABOVE ADDRESS WAS CONSTRUCTED IN ACCOR• <br /> Septic Task:Sit. /000 Mart Cnn4f Mfg:1 DANCE WITH THE REQUIREMENTS OF THE PERMIT AND THE RULES <br /> OF pus ENVIRONMENTAL QUALITY COMMISSION <br /> Desist Task Sme:, ,Sn 0 Mane*bac* Mfg: �[have l stod the septic tank and ce fy it to be smerrc� <br /> f 6 <br /> ( ./ was instaled <br /> Mast Sewer:Size / Mal7:p{�e The•Y�O by <br /> / �, ) <br /> Bastes): ,1 DistrsbuIimn Isp D op t I I Concrete; 6/41astc TI Se+'age Dispml service <br /> Drstnfcld Pipe:Size: :Material deader: ;Pat DEQ Uceosa Nu ber ,y <br /> tt'' //++�� DEQ Certification Number <br /> Total Draiaflr d Footage:' f c ;Rock Depth:Total: _ •Under Pape:_ <br /> Alternative Draiafield lfattttar:fee <br /> - <br /> rrrackiepth:Niniansen ;Maamat Curtain Companycame L,,tst d✓ l Jen s As <br /> f <br /> (please post) <br /> Emoeet Pump:Pump Model.___ Static Hod in System _ft, ^/�/"0( <br /> Dust /�[ <br /> Pu_-ttp Cycle Time: :Gelons per Cyclm <br /> Attach an sddltioaal sheet For comp ocats mad materials not toted above. <br /> (For Marlon County Use Only) <br /> The ve septic system has been inspected by Marion County.The information has been determined to be accurate and the systemt� <br /> [{ i pproved <br /> I I Approved with corrections:see inspection report <br /> I - / 4 <br /> ice; Title: ,E .l' 0WS Date: /21 a 1 <br /> ; <br /> MC:S-41 WHITE:Marion County;YELLOW.Owner:PINK installer <br /> rev:8/00,6/01;3103 <br />