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• <br /> • MARION COUNTY BUILDING INSPECTIONSA INDIVIDUAL ON-SITE SEWAGE SYSTEM RECORD <br /> dibi <br /> 5155 Silverton Rd NE (to be completed by system installer) <br /> 503-588-5147E EM OR 97305 PERMIT NO. 5*-5 1.1- OO 0/3- ,i7- <br /> MARION <br /> COUNTY http://www.co.marion.or.us/PW/Buildinglnspection ®et <br /> SITE ADDRESS: U d`� cldl f��A� rl <br /> AS-BUILT PLAN OF CONSTRUCTED SYSTEM: ..r: `verri <br /> ely <br /> Scale: 1"= no ' h►Gvc <br /> �"'Qe w�,1-Qo North` <br /> -___- _ to' 1 10' V/ <br /> /)—C. ,30s, Jetis,t 1 fi) `�. <br /> 0 <br /> �—G i i�1 per\ _ _ a, EZ,•��- 1- 2of <br /> t=_E- z/ , <br /> j ;Zq t I/ pec-K/94:° <br /> N. <br /> I 'C. /"Seiit, <br /> SSI 9l <br /> too 4 ryry i 0-61.1 lip <br /> . A e, <br /> \\. o0 rb <br /> Pr <br /> Qr'� <br /> (show all details and di ensions necessary t)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_ 1150 Gallons/Day STALLED AT THE ABOVE ADDRESS WAS CONSTRUCTED IN ACCOR- <br /> TANK Size: l SCO total gallons [ ] single compartment DANCE WITH THE REQUIREMENTS OF THE PERMIT AND THE RULES <br /> 1 OF THE ENVIRONMENTAL QUALITY COMMISSION. <br /> Manufacturer: vicejg I f.4 double compartment <br /> Material: (fan/k le [ ] flow-through LI 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'l _ I I Property Owner(permittee) <br /> IA Licensed Sewage Disposal Service <br /> DRAINFIELD rock depth(inches) Box(es) 3 �y <br /> Rock and under pipe -- I I Drop I I Concrete DEQ License Number: 611 Q <br /> Pipe total depth I I Distribution I I Plastic <br /> DEQ Certification Number: eas- <br /> Drainfield Material(Altemative or pert.pipe) <br /> Total Drainfield Footage 80' Trench Depth Minimum Maximum <br /> Curtain Drain Depth_ Signed:_ ae., v :-/)may <br /> Effluent Pump: Pump Model V-30 . <br /> Pump cycle ,e� t �e,ljf <br /> times in minutes: on ®"ti .r off Gallonsper Cycle_ Y Company name:_ Re--I-A e.,1 ��'P-.�, l 205 <br /> ATT Make and Model (please print) <br /> Attach an additional sheet for components and materials not listed above. Date:_ Cf lig Al <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 sys em is: Approved <br /> [ I • s pro •d with corrections: see inspection report I I Denied <br /> Signed: L.A.Ai ,h, 1 "L ./ ,tle: E 1 q r-,.0 Date:1 <br /> 2 I WHITE:Marron County; YELLOW: PINK:Installer <br /> MC:S-41 rev:3/03;4/12;5/14; 11/17 G:\Forms\Septic\S-41 As BuiIt2015Version 0 7.doc ty, <br />