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• ' MARION COUNTY BUILDING INSPECTION INDIVIDUAL ON-SITE SEWAGE SYSTEM RECORD <br /> 5155 Silverton Rd NE (to be completed-7 by system installer) <br /> 503SAE 88 OR 97305 PERMIT NO. SYS�L J— op 7 6 <br /> MARION <br /> COUNTY htt //www.co.marion.or.us/PW/Buildin Ins ection 1 /� 0'� ib'VT <br /> P� g P SITE ADDRESS: 1 86?j y /"J �� � ei � p� �' <br /> AS-BUILT PLAN OF CONSTRUCTED SYSTEM: <br /> Scale: 1"_ T <br /> North <br /> S be, k JQ'd <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 i Flow Gallons/Day STALLED AT THE ABOVE ADDRESS WAS CONSTRUCTED IN ACCOR- <br /> TANK Size: I TOO total gallons [ ] single compartment DANCE WITH THE REQUIREMENTS OF THE PERMIT AND THE RULES <br /> [ double compartment OF THE ENVIRONMENTAL QUALITY COMMISSION. <br /> Manufacturer: kra <br /> Material: Cn1Cre 1 i [ ] flow-through i I have tested the septic tank and certify it to be watertight. <br /> Effluent Sewer: i 1• I I /� Header Pipe: I The system was installed by: <br /> Size/Mat'I 4 /'i�� Size/Mat'I t'{ r I/C., [ i perty Owner(permittee) <br /> [' Licensed Sewage Disposal Service <br /> DRAINFIELD rock depth cinches) Box(es eJ+`� 9 <br /> Rock and under pipe 6, [ rop I Concrete DEQ License Number: o 7 <br /> Pipe total depth I 2I I I I Distribution I I Plastic , 'q <br /> DEQ Certification Number: <br /> Drainfield Material(Alternative or perf.pipe) /� <br /> Total Drainfield Footage 4/0 Trench Depth Minimum 1c1 Maximum/V / <br /> IQ <br /> Curtain Drain Depth Signed: <br /> Effluent Pump: Pump Model 1 3O0. . <br /> Pump cycle <br /> times in minutes: on off Gallons per Cycle Company name:_ n✓1 -A-T Ccw Slf,r4-tG,- <br /> ATT Make and Model (please print) <br /> t CI/ Z <br /> Attach an additional sheet for components and materials not listed above. Date: i <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 I Approved with corrections: see inspection report I I Denied O! <br /> Signed: Title: <br /> ,C, Date: / ___ <br /> MC:S-41 rev:3/03;4/12;5/14;11/17 G:\Forms\Septic\S-41 As-BuiIt2015Version2017.doc WHITE:Marion County; YELLOW:Owner;PINK:Installer <br />