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- . • . MARION COUNTY BUILDING INSPECTION INDIVIDUAL'ONSITE SEWAGE SYSTEM RECORD
<br /> 5115,'Silvertott Rd i NE (to be emnpleted..by system installer)
<br /> Mil RION 5034.8841•47 ., PERMIT NO ,5.55—21—(308 14 L 1
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<br /> ,. hftiViliww1"°juari°n•°rA's/PWIBulldinglasttedibit SITE.ADDRESS:it 1 ta6baboia Dr
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<br /> A e X 1,5 17-,-ft
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<br /> show all deiniii..inid!,itiniefiiiitnig,nebeOary..lolocatealtr.omponetiof thsygfelcid,theluttre)
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<br /> :SYSTEM MATERLitS7ANO:SPECIFiCATIONS ' -- 'kiSTALLERSGEltriFICATIONg
<br /> - I HEREBY CERTIFY THAT THE ON-SITE SEWAGESYSTEMIN
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<br /> Sr.,ten!ItesiiiiiSON,nige.flo* Galloon/Day' • • ' ATAI4D.ATTRE.AgiovzADDREss•wAsco-NsgurcrEj:m•tAccpR.-
<br /> - TANK Size,-,1-.0R„;1. :total gillons 145146d Giiiikipail*Oit: ' .:,0....4Nc •scgliI-)iiig:tg9pwpiliN'.,ts.:(;0.F THE PERMIT AND THE RULES
<br /> Manufaitkie.4iiC:07.i-titiliie: t i doubit::compartment. :OFTIIEENVIRONhelb:NTAL QUALITY COMMISSION
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<br /> . ! maiicial:- poly• : i [] flow4hrotigh. I it.haittgst.cdthe. olit.#14cand.certify-it:to be watertight:.
<br /> •-Effluent Sevier: Header Pipe Th.esysternwp-installed by
<br /> •ize4faiii Siz•i iMael II P 9ierkY OwnO(lP# i4 P0)
<br /> r Licensed Sewage Disposal a ervi,
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<br /> •,:ORAiNFIELD•t 'rp4dppth(ipflgs),'-:,... „Box(es), :r4F-1.1•-t_r,- .:- -
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<br /> Rock and nOdin,:pipe , ., .. .:,,,;4,00ipit. I I.Coociete "• DEQ:LicimseNniiihdti
<br /> Pipe 'toirit depth .,f . . . . ' ''Cf Distribution' ,.14.:PlaiiiC- ;
<br /> . . . ''''D4r)COrtificatinti:Ninniitn. (3C/1?4.71
<br /> ...Draitifinkl.MilierjitIpkItnannivn in.pert pipe)
<br /> r,..• ' ..Total D6iniiiid FoOtagi, Tikiiibiiiiiii kiiiiiiiiirliy''• Maximumt
<br /> '...CuritiiiiDiiiWD'eptk Signed: t.; ;;;;;;.'. -.- ,.'.,. . • ., . ...
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<br /> ".F.M.g:erikT'iimpi,Pump brodel . .
<br /> ,P1k147.04e-
<br /> inininetes:on. off Gallinislier.CyCle itel&K Cr60r1514
<br /> c'''oititi44s,,o .• -. •.-: .1'r-' Co‘. 7 iNrk '..
<br /> (please print)-.:•, Art Make and Model ' ...,
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<br /> Attach an additional sheit.tai-:c.iiiiiiiiiiiejitiiiind,iiiiretiiii niitifitedAtboVt. . . ._ :Dale:.1/2et ttpli
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<br /> (For Marion Counts'Use Only) The abiniefseptic system ha been inspected by Marion County The information has been detennined,to benteurate
<br /> :And the system is::-',..9(AOriiiied 1 Ap roved-with-corrections:,see inipecitOnlieport 1" Denied
<br /> :Signed: •lifiVIIVA-111-()
<br /> ,Title: ,•.-7 J.01_14a&-.--CI g'' , --....,.:, :Pete:,
<br /> MG.--;S.41 r.I.i:'•310.1*,'.41120/14,t 11117: GA.Ebrint epti - I As-Built2.015VeiA020174de" ' 'WH/TE:Mation_Coiin4.S' ' M en-PINK:litstailer
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