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MARION COUNTY BUILDING INSPECTIONSA `��INDIVIDUAL ON-SITE SEWAGE SYSTEM RECORD <br /> dili <br /> 5155 Silverton Rd NE L OREM 97305 (to be completed by systemiinnstaller) <br /> / <br /> 5 388 4 PERMIT NO. 'j55 _)�Q <br /> MARION � v ��l + � <br /> COUNTY htt (/www.co.marion.or.us/PW/Buildin Ins ection V l &Ai Li/ <br /> p g p SITE ADDRESS: ��j' <br /> AS-BUILT PLAN OF CONSTRUCTED SYSTEM: S""J� '�' ` 9 73o5 <br /> Scale:1"=SS ' t <br /> North <br /> ye4-' / 1 <br /> v)i Ng <br /> i <br /> . .,,1( 2 4 <br /> cw <br /> ��s tL <br /> it ./'"--- "O -3d= <br /> /e' 1, <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 <br /> I HEREBY CERTIFY THAT-THE ON-SITE SEWAGE SYSTEM IN- <br /> System Design Sewage Flow Gallons/Day STALLED AT THE ABOVE ADDRESS WAS CONSTRUCTED IN ACCOR- <br /> TANK Size: total gallons [ ] single compartment DANCE WITH THE REQUIREMENTS OF THE PERMIT AND THE RULES <br /> OFTHE ENVIRONMENTAL QUALITY COMMISSION. <br /> double <br /> Manufacturer: [ ] compartment <br /> Material: [ I flow-through I I I have tested the septic tank and certify it to be watertight. <br /> Effluent Sewer: Header Pipe: The system was installed by: <br /> Size/Mat'I Size/Mat.I I I Property Owner(permittee) <br /> j*Licensed Sewage Disposal Service <br /> DRAINFIELD rock depth(inches) Box(es) <br /> Rock and under pipe I I Drop Concrete DEQ License Number: 3 7°03 <br /> Pipe total depth J1 I Distribution I I Plastic <br /> DEQ Certification Number:e�q/.3 <br /> Drainfield Material(Alternative or pert.pipe) <br /> Total Drainfield Footage �ba Trench Depth Minimum I�i Maximum f›Curtain Drain Depth Signed: l '„...-- ,--A--- <br /> ----- <br /> Effluent Pump: Pump Model . <br /> Pump cycle Q "' �1 <br /> times in minutes: on off Gallons per Cycle Company name:JY/ /� / � <<-9 27/� f <br /> ATT Make and Model (please print) <br /> f <br /> Attach an additional sheet for components and materials not listed above. Date: -�0'o (/ <br /> ''4-Marion County Use Onto The above septic system has been inspected by Marion County. The information has been determined to be accurate <br /> system is: I 1 Approved I I Approved with corrections:see inspection report I I Denied <br /> Title: Date: <br />