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<br /> NiAtION Ottrit.v:BUILDING INSPECTION . INDIVIDUAL ONSITE SEWAGE SYSTEM RECORD - \
<br /> SI55 SilvertocAd NE (to be completed by system:installer).
<br /> . • SALEM OR.97$05
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<br /> MARION
<br /> 503,58S •7-5147: PERMIT NO.5.575-.?-.2Z .—. ....__7/2•3.; X4477 . .
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<br /> COUNTY . .
<br /> *• , . . . litttp:I/www:en.inntiott.ttr.us/PW/BuiltIlugluspeption, sat ADDRESS'77 es 3- 3-70.4c$,e+_•-- fr.',v.t -r-al-', ‘ -
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<br /> AS-BUILT PLANVVCONSTRUCTED SYSTEM:
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<br /> Scale:I"i-. ' -• . ' t
<br /> No+ to'5:441f.; - •:-- , , North
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<br /> . • . • ' .1.°'al- ' '. : : $10:11. . • .
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<br /> ._ . .,. , •., (tho*:alldettilsetidtitoonaiMis tter04*:at•Si,•to locate all Oomponehtt of the sYstettrin,the:Sitire).
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<br /> • §YSTEMMATERIALS,ANW SPECIFICATIONS: INSTALLERS CERTIFICATION:
<br /> • •Syitent'Desigti Sewage Flaw 17.2"?;- Oath:Ms/Day . I HEREBYICERTIFY THAT THEON-SITE SEWAOESYSTEM a+
<br /> •srar-enkr:ree AflOYE ADDRESS:WAS CONSTRUCTED INACCOR,..
<br /> TAP/it Mee: );CO%,el
<br /> ' . 'total gallons V single compartment DANCE WITH THE REQUIREMENTS Of THE PERM1T AND THE RULES
<br /> .'OF THE ENVIRON/vIENTAL QUALITY COMMISSION
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<br /> Manefaciarcr .1.-7'. .* '.. -::s,' •I I doubk comp:team!
<br /> '' Matedat 40.0.,1:iirie,- ,4 tt:a.er ' C,i flow-.1444411 yr'have tested the septic tank and certify it tote watertight: -
<br /> . - .Egkit Sa' et v.' ' -Heider Plpe ., ..711.e sY.st'eWaaihstallgt OF
<br /> SizeMeet 10 D-0 ) aL size/Malt ty e I r.Prop.qtY Owner(0514460' •
<br /> . - -- - — , - - --• - . •- -- . lortitinaeti te2vage Disposal Service
<br /> • DRAINFIELD rock depth(inches) Box(ea)
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<br /> Ri3cIegt tuttltepipe 1.1"Dran I I Cam:tete ' ' DEQ-LiOettse Number 3 91Y
<br /> . ' Pipe- total depth . i.1 Distaution 14-Plastic . • '',1*- -,s
<br /> DEQ•Certification Number.. ..1.- z.
<br /> lailii441d.Mlieribi(Alternative or?erf•pipe) 'E.7_ 1-10.v. adirj •_ . ).
<br /> TotatOrtdaffehtFootatge ItiQ trent*Depth Minionsur 24 Mnxiitainkk>4
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<br /> Curtain Drain Depthja Signed iz,... . . ./,,,....,_ , , . • _
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<br /> Effluent Punip: Pinup Model L47-444:1 (3-1.,..f. 1060 4.te ic.i. .
<br /> Pump cYcle
<br /> rant Fli0111!: cm!' off Gams Per CYcle.e* 2.4.'16 Coinpeny name:1-:.4•2‘60 •gi...:Aile244dal...0*d 4914-
<br /> AIT Make and Model a iii /1/1-iLdia,2!..t$ il,44C 0 4.5 .....„,...,• ,,,-....,...., . ( lease print)
<br /> Attach an additional sheeefor conipiments anithiaterialinot Itstellabove: ' . . Date: ..57q.„..„„„,, ,.„,,„„„..„,_
<br /> (For Markin,CoUntv Use Oulvl The above•0-,: •syitem has•-beeninspecterl by Marion County: The-Mfotination has been deterreiriedlo be accurate
<br /> ' •and Me ay ' la: 'ALAppro ' • I . ... Dv With to: ctIons:see inspection report 1 1 Denieci
<br /> Sighed: .0 e 10/q -513' Date: Ti,- gq •
<br /> , -MC:S-41 ter.:.3/03;4/11;.5/14;11/17 '43:Wo''4 1.--: -1 As4tui1r201.5Version2017:dce. WH1TE:Mcirioti Cazinly; - ••W.' at;PINXInstaller •
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