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MINMARION COUNTY BUILDING INSPECTIONEM INDIVIDUAL ON-SITE SEWAGE SYSTEM RECORD <br /> 5155 Silverton Rd NE (to be completed by system installer) <br /> 503E 88 OR4 97305 PERMIT NO. 2 -bo J2. <br /> MARION <br /> COUNTY � <br /> http://www.co.marion.or.us/PW/Buildinglnspection SITE ADDRESS: �:923( .. ik� y- Rdi <br /> AS-BUILT PLAN OF CONSTRUCTED SYSTEM: <br /> Scale: 1"_ ' T <br /> North <br /> ,/2 ,. ,r 7514- ?mot- 7 T4 - <br /> ,7 ri:// <br /> al /,,,/: ri <br /> ti I , <br /> ,.., <br /> 7 iJ <br /> ,\. <br /> r `, ; l rtD <br /> fj i! * p <br /> ii- c : - <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 17.5 Gallons/Day. STALLED AT THE ABOVE ADDRESS WAS CONSTRUCTED IN ACCOR- <br /> TANK Size: /CC M total gallons 4 single compartment DANCE ITH THE REQUIREMENTS OF THE PERMIT AND THE RULES <br /> Manufacturer: 6 i I'C., <br /> [ ] double compartment OF T ENVIRONMENTAL QUALITY COMMISSION. <br /> Material: Cop'1(`i'�Q-Z <br /> I ] flow-through ( 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'1 y t)-,:4k, Ca", Size/Mat'l 4`9,,.;=5 Liz„... 1 1 Pr rty Owner(permittee) <br /> ( icensed Sewage Disposal Service <br /> DRAINFIELD rock depth(inches) Box(es) <br /> Rock and under pipe G'i» 13QDrop IAA Concrete DEQ License Number: % V4 7 it <br /> Pipe total depth 1 2 iyt I I Distribution I I Plastic <br /> DEQ Certification Num r: 7' 0 <br /> Drainfield Material(Altemative or perf.pipe) terg. - - - j <br /> Total Drainfield Footage 1 i5 Trench Depth Minimum 224 Maximum=44, <br /> Curtain Drain Depth_ t/A" Signed: 171 <br /> Effluent Pump: Pump Model /�/lk s° <br /> Pump cycle , <br /> times in minutes: on off Gallons per Cycle Company name:_ �'` 2l"�_ y\r�A , Lk:, <br /> ATI'Make and Model (please print) <br /> Attach an additional sheet for components and materials not listed above. Date: <br /> (For Marion Count/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: [•/]Approved [ I Approved with corrections: see inspection report [ ] Denied Signed Title: ‘.\ ► /. 3 Date: . Z4 <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 />