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iiki' MARION COUNTY BUILDING INSPECTIONSA INDIVIDUAL ON-SITE SEWAGE SYSTEM RECORD <br /> 5155 Silverton Rd NE (to be completed by system installer) <br /> 503�8>&OR 97305 PERMIT NO. a;3 oCo 3 7. ? 8 <br /> MARION <br /> COUNTY http://www.co.marion.onus/PW/Buildinglnspection <br /> SITE ADDRESS: 3,11 7 /aoJ SC 54(41,41174 e....4 <br /> .S 1 Pain Ur' <br /> AS-BUILT PLAN OF CONSTRUCTED SYSTEM: <br /> Scale: l"_ - T <br /> � � � North <br /> Nor , Pr-o co/tj L t a <br /> 1. <br /> 4. <br /> CO/I S <br /> - T 8 a <br /> ►°O' ro 2 <br /> 1 .pl f <br /> -6 o <br /> ,..v f I. t00' o - <br /> .04 V <br /> � �� Rio' -9 r <br /> c. <br /> pC 11esj DrNe„v4A4 <br /> 3S4 <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 IN- <br /> System Design Sewage Flow 21 S Gallons/Day STALLED AT THE ABOVE ADDRESS WAS CONSTRUCTED IN ACCOR- <br /> TANK Size: /SO& total gallons [ 1 single compartment DANCE WITH THE REQUIREMENTS OF THE PERMIT AND THE RULES <br /> compartment <br /> OF THE ENVIRONMENTAL QUALITY COMMISSION. <br /> Manufacturer: L.) A .It- D'�double corn P <br /> Material: V Crb ( I Flow-through krI have tested the septic tank and certify it to be watertight. <br /> Effluent Sewer:/ 't f Header Pipe:/,p The system was installed by: <br /> Size/Mat'I K)JC., Li Size/Mat'l 7 ..17v2q I I Property Owner(permittee) <br /> 'Licensed Sewage Disposal Service <br /> DRAINFIELD rock depth(inches) Box(es) r�'O 7�j C! <br /> b <br /> Rock and under pipe 6 I I Drop V Concrete DEQ .-S License Number: <br /> Pipe total depth f L Distribution I I Plastic <br /> DEQ Certification Number: 70# r.2. 9y g <br /> Drainfield Material(Alternative or pert.pipe) <br /> Total Drainfield Footage,LJ5'0 Trench Depth Minimum aMaximum Pi <br /> ` ^4/..., <br /> Curtain Drain Depth_Jg dfw c.,.. .o Signed: �i <br /> Effluent Pump: Pump Model )r 311,5f i <br /> Pump cycle (� `iv' <br /> times in minutes: on off Gallons per Cycle Company name: ter{C;- 1 C J.L) g x c C L c..' <br /> ATT Make and Model (please print) <br /> Attach an additional sheet for components and materials not listed above. Date: 5 I.1.a 2.3 ___ _ _ <br /> (For Marion Coun Y Use Only) The above septic system has been inspected by Marion County. The information has been determined to be accurate <br /> and the system is: pproved I I Approved with corrections: see inspection report I I Denied ha <br /> [Signed: �` . ��Title: f�/ � � Date: ( ( � <br />