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'�. MARION COUNTY BUILDING INSPECTION INDIVIDUAL ON-SITE SEWAGE SYSTEM RECORD <br /> ,. 5155 Silverton Rd NE (to be completed by system installer) <br /> > 503-588-5147S0lem,OR 97305 PERMIT NO. c: -5 /7 6 701 <br /> �� <br /> MARION <br /> COUNTY http://www.co.marion.or.us/PW/Buildinglnspection // <br /> SITE ADDRESS: 4G%? <br /> / pirg,2- �- �� <br /> AS-BUILT PLAN OF CONSTRUCTED SYSTEM: A4lrls,�ii ®� �� <br /> Scale: 1"= T <br /> North <br /> Ofri44 , <br /> iiiiidiP" <br /> C 0-ailliOf <br /> eZ <br /> 306 / of , xiS1ib <br /> °� �4- New <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 1/2g- 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 3 ow gallons Mat'I �.ruf4e Mfg pt/A(t DANCE WITH THE REQUIREMENTS OF THE PERMIT AND THE RULES <br /> OF THE ENVIRONMENTAL QUALITY COMMISSION. <br /> Dosing Tank:Size/6-4943 gallons Mat'I et Mfg ,/ <br /> 14...!have tested the septic tank and certify it to be watertight. <br /> ATT Make and Model NI Box(es): <br /> hhi/ e� � Distribution The s stem was installed b <br /> Effluent Sewer:Size o,1 Mat'I 544 7 0 f 116 ($.Drop y by: <br /> I I Property Owner(permittee) <br /> II <br /> Concrete Licensed Sewage Disposal Service <br /> Drainfield Pipe:Size i 1 Plastic <br /> Material:Header Pipe 3034e Perforated Pipe_Ads (i Z FL") DEQ License Number: 3 7 ' 7 <br /> / e j1 <br /> Total Drainfield Foota AYI SS— <br /> Rock Depth:Total �' Under Pipe — Curtain Drain Depth�=1�I51"; �' • <br /> Alternative Drainfield Materials Z — r" Signed�=( `—. '/ <br /> I <br /> Effluent Pump: Pump ModelraM (x 2). ?f,tL/N i t01�1/� /et+• <br /> Pump Cycle minutes minutes /// Company name:_ / �t <br /> Time on off Gallons per Cycle _yi(please print) <br /> s- <br /> Attach an additional sheet for components and materials not listed above. <br /> Date: 2 <br /> (For Marion County e O i ly) <br /> The above septic syst'. •,s b- n inspected by Marion County.The information has been determined to be accurate and the system is: <br /> XApproved', • pproved with corrections: see inspection report Ii Denied <br /> Signed: A Title: S Date: 5I I i <br /> MC:S-41 rev:3/03;4/12,x/14 WHITE:Marion County; YELLOW::Otivner;PINK:Installer <br />