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iiiiMARION COUNTY BUILDING INSPECTION INDIVIDUAL ON-SITE SEWAGE SYSTEM RECORD <br /> 5155 Silverton Rd NESA • (to be completed by system installer) <br /> 5 3-88 OREM 4 97305 PERMIT NO.SS' —VI - 0 —P f <br /> +MARION- <br /> COUNTY http://www.co.marion.or.us/PW/BuildingInspection SITE ADDRESS: 5 of 6 7. - cf A'zr e,(f <br /> "t t <br /> AS-BUILT PLAN OF CONSTRUCTED SYSTEM: <br /> Scale: 1"_�o A- ��, bo !'%61' <br /> . c Sc® .Sr; . �® r g North <br /> a <br /> �� s 'le <br /> '`p6�cl, ;1 . p�S� � � <br /> 2,, <br /> 60' 1„' <br /> ,121 L <br /> 1� <br /> L6 r <br /> s . I <br /> B n ev <br /> ,--/ <br /> Cl, 6' <br /> an n <br /> ed <br /> 4 Q _v� �Gs.6y <br /> - <br /> b " <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 I SO Gallons/Day STALLED AT THE ABOVE ADDRESS WAS CONSTRUCTED IN ACCOR- <br /> o [ ] single compartment DANCE WITH THE REQUIREMENTS OF THE PERMIT AND THE RULES <br /> TANK Size: CI<1 ,(1 IS®total gallons <br /> compartment <br /> OF THE ENVIRONMENTAL QUALITY COMMISSION. <br /> Manufacturer: ‘„y6.., ,.! o-double com p <br /> Material: (o.yGrP.4- <br /> [ ] flow-through [ I I have tested the septic tank and certify it to be watertight. <br /> Effluent Sewer: Header Pipe: r The system was installed by: <br /> Size/Mat'I CA i+,115 Size/Mat'l 1'14 c Ire.- I I Property Owner(permittee) <br /> laLicensed Sewage Disposal Service <br /> DRAINFIELD rock depth(inches) Box(es) <br /> 11 Rock and under pipe I I Drop I I Concrete DES License Number: gliq I <br /> ' Pipe total depth_ I I Distribution I I Plastic <br /> DEQ Certification Number: <br /> Drainfield Material(Alternative or pert.pipe) Wei)N'l-e.„ I Cc-eoc-p kJJ . <br /> Total Drainfield Footage ISO Trench Depth Minimum 6 Maximum_ 1 <br /> Curtain Drain Depth_ "P p'�"r'N 4� Signed: c7' f6-641e4/ <br /> Effluent Pump: Pump Model . fr,e,4- 4 <br /> Pump cycle Otr- 0.1.5 ..— <br /> times in minutes: on off Gallons per Cycle Company name:_ elKe"' cetvrt lad <br /> ATT Make and Model 7- , 70, G?`r- <br /> (please print) <br /> Attach an additional sheet for components and materials not listed-above. Date: 61 i„d /7,1 <br /> (For Marion County 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: y A,proved [ ] Approved with corrections: see inspection report [ ] Denied <br /> ‘ ` U0 <br /> Signed: ;_ ,A A 4i)i._ Title: E IA YV . O Date: - . 1 . de, <br /> MC:S-41 rev:3/03;4/12;5/14; 11/17 G:\Forms\Septic\S-41 As-Built2015Version20l7.doc • WHITE.:Marion County; YELLOW:Owner;PINK:Installer <br />