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MARION COUNTY BUILDING INSPECTION INDIVIDUAL ON-SITE SEWAGE SYSTEM RECORD <br /> 5155 Silverton Rd NELEM OR 97305 (to be completed by system installer) <br /> SA <br /> 503-588-5147 PERMIT NO. S<s-a 1- DO3O30 <br /> MARION <br /> COUNTY //www.co.marion.or.us/PW/Buildin Ins ection <br /> ` htt P� g p SITE ADDRESS: /15 Ned'ti .rAhilak-in //tii� �,,� o,Q <br /> AS-BUILT PLAN OF CONSTRUCTED SYSTEM: ct73G <br /> Scale: 1"_ T <br /> ( „ r2etLW g-L . „ North <br /> iUt- <br /> Pe frfrse) geinc s,'f� <br /> , <br /> � �r,se-J, go //pe ' C- <br /> c% recitir <br /> 401 S1� <br /> � <br /> : n Iv <br /> e/ <br /> ' <br /> fF�o - /Op r19oc COr cv6r. <br /> ' I% , . 11 <br /> � �e��pd <br /> l° p © p s DT <br /> — <br /> • (show all details and dimensions necessary to locate all compone is of the system in the future) <br /> SYSTEM MATERIALS AND SPECIFICATIONS: INSTALLERS CERTIFICATION: <br /> �7 J I HEREBY CERTIFY THAT THE ON-SITE SEWAGE SYSTEM IN- <br /> System Design Sewage Flow O 0 Gallons/Day STALLED AT THE ABOVE ADDRESS WAS CONSTRUCTED IN ACCOR- <br /> TANK Size: /5 00 total gallons [ ] single compartment DANCE WITH THE REQUIREMENTS OF THE PERMIT AND THE RULES <br /> Manufacturer: (gf�r7fe� <br /> [ double compartment OF THE ENVIRONMENTAL QUALITY COMMISSION. <br /> [ ] flow-through IQ I have tested the septic tank and certify it to.be watertight. <br /> Material: ee,Yt c we,h� <br /> Effluent Sewer: it Header Pipe: /r The system was installed by: <br /> Size/Mat'I /� p(f c S'eG LID Size/Mat'l a Sec, lid I I Property Owner(permittee) <br /> - b4 Licensed Sewage Disposal Service <br /> DRAINFIELD rock depth(inches) Box(es) <br /> Rock and under pipe / I I Drop t- i 1 Concrete DEQ License Number: g ! i q D <br /> Pipe total depth /G I I Distribution I I Plastic DEQ R f -' ( <br /> Certification Number: ,J <br /> Drainfield Material(Alternative or pert.pipe) <br /> Total Drainfield Footage a D® Trench Depth Minimum/j Maximum/2 <br /> 1 a <br /> Curtain Drain Depth_____10. Signed:_ 7.p4,--Av A),,cj <br /> Effluent Pump: Pump Model PF.5'0O,S II . <br /> Pump cycle <br /> times in minutes: on off - <br /> d Gallons per Cycle S'0 Company name:_Cfe�f Y2 S(0� <br /> ATT Make and Model . N t\---- <br /> (please print) <br /> Attach an additional sheet for components and materials not listed above. Date: j/.— t <br /> (For Marion CountyUse Only) The above septic system has been inspected by Marion County. The information has been determined to be accurate <br /> and the system i ; [)sAppro 146h, [ I Approved with corrections:� V) see inspection report [ ] Denied <br /> Signed:_I) ! I) Title: Y 101 I-3'1/5°1Date: a- <br /> MC:S-41 rev:3/03;4/12;5/14;1 /17 G:\Forms\Septic\S-41 As-Built2015Version2017.doc WHITE:Marion County; YEL OW:Ow r;P1 K:Installer <br />