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'�. MARION COUNTY BUILDING INSPECTION . INDIVIDUAL ON-SITE SEWAGE SYSTEM RECORD <br /> z -�a 5155 Silverton Rd NE (to be completed by system installer) <br /> 503-588-5147 97305 PERMIT NO. 55 — 1 ?) 6o37 Pja <br /> MARION <br /> COUNTY http://www.co.marion.or.us/PW/Buildinglnspection `- I v <br /> SITE ADDRESS: �C�v�� �I�,C,�lt'gt���P,c� W ccy <br /> Teif-erSo\ , . <br /> AS-BUILT PLAN OF CONSTRUCTED SYSTEM: <br /> Scale: 1"_ T <br /> EE Art 1 C1-1North <br /> • <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 /> System Design Sewage Flow 1350 Gallons/Day I HEREBY CERTIFY THAT THE ON-SITE SEWAGE SYSTEM IN- <br /> STALLED AT THE ABOVE ADDRESS WAS CONSTRUCTED IN ACCOR- <br /> Septic Tank:Size ��,p�allons Mat (L1 e-4 Mfg DANCE WITH THE REQUIREMENTS OF THE PERMIT AND THE RULES <br /> ��� OF THE ENVIRONMENTAL QUALITY COMMISSION. <br /> Dosing Tank:Size gallons Mat'I Mfg <br /> f] have tested the septic tank and certify it to be watertight. <br /> ATT Make and Model 5e:e. cul-6(/ f Box(es): <br /> It 'PVc- <br /> I Distribution The system was installed by: <br /> Effluent Sewer:Size Mat'I S(� e 'I VC-DL&JVDrop <br /> I Property Owner(permittee) <br /> Concrete <br /> Drainfield Pipe:Size 'G Cls i I ne.,Wi n.01$11-e- l l Plastic l Licensed Sewage Disposal Service 4Material:Header Pipe II C'Perforated wtr fi br d k 4 o31re e DEQ License Number: %76 <br /> Pipe <br /> Total Drainfield Footage 4150 I Trench Depth Minimum.4 Maximum Zh DEQ Certification Number: ,T I <br /> Rock Depth:Total Under Pipe (7,1' Curtain Drain Depth_ <br /> qq i Signed: <br /> Alternative Drainfield Materials Sex, <br /> Effluent Pump: Pump Model ��•-� pi; On—C)I 5 C 3 6xv<a rrr� <br /> Pump Cycle minutes •, Com ny name:_ <br /> Time on off Gallons per Cycle (please print) <br /> Attach an additional sheet for components and materials not listed above. Date: MCI rcJL , 2.61 9 <br /> (For Marion County Use Only) <br /> The above septic system has been inspected by Marion County.The information has been determined to be accurate and the system is: <br /> '[)01 Approved [ I Approved with corrections: see inspection report I [ Deniednn ��..�� <br /> Signed: l t�cctca , . t t - Title: 0, w .4„ a.4LtlD <br /> r .• <br /> � . ' ate: /14aAtt GOtt2'2 I /q <br /> MC:S-41 rev:3/03;4/12;5/14 WHITE:Marion County; YELLOW:Owner;PINK:Installer <br />