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1 MARION COUNTY BUILDING INSPECTION <br /> 555 COURT'S1'NE/PO BOX 14500 if <br /> SALEM OR 97309.6036 <br /> fl <br /> INDIVIDUAL ONSITE SEWAGE SYSTEM RECORD <br /> `�'' C � (to be completed by system Installer) <br /> SITE ADDRESS: 1 17M I er5 ?c • JE.,S a l PERMIT NO. 10~oz i r <br /> AS-BUILT PLAN OF CONSTRUCTED SYSTEM: <br /> Scale:1"__• ? <br /> Nara <br /> 140° ' ....3 . <br /> NotteScotLE to- _ 1' t_ -azsi- r " .Z' <br /> coout •t10 to. — '�- A. <br /> cone CB_sir <br /> !2S'_ <br /> Q.1 <br /> A-€.87' A- 1. cm <br /> d-0°Z718-d = 108' A -2= Io8' <br /> d- do,ANovr=LI0 G9t A -3 = 113 <br /> D- cL ...maul' = 16.5' <br /> : POI =a - <br /> `i awEss Rd• <br /> (show all details and dimensions necessary to locate all components of the system in the future) <br /> SYSTEM MATERIALS ANDD SPECIFTCATIONSt INSTALLERS CERTWICAT1ON: <br /> Fl <br /> System Design Sewage ow: 4 Cial onaDDay I HEREBY CERTIFY THAT THE ON-SITE SEWAGE SYSTEM IN- <br /> STALLED AT THE ABOVE ADDRESS WAS CONSTRUCTED IN ACCOR- <br /> Septic Tank:Sia: MOO ettfirlbOMMT Lill Ares Mfg:CO_Mteti DANCE WITH THE REQUIREMENTS OF THE PERMIT AND THE RULES <br /> OF THE ENVIRONMENTAL QUALITY COMMISSION. <br /> Dosing Tank:Sia: INCc _Mat Mfg: I I Ikon tested the septic tank and certify It to be watertight. <br /> Effluent Sewer.Size: 1.S 1, Matt f vSCA4 4.1 0 The system was installed by: <br /> Bos(es):)(Distribution;I1 Thop I:Connate; ill Plastic WLiceosed Sewage Disposal rService <br /> Ill �27arl ;Pert:Q.7 aq DEQLicense Number: 3C7 6 <br /> Dralnhld pipe:Size:"7 ;Material:Header _ 8 <br /> Total DralafteldFootage:J..3801;Rock Depth:Total:Mil <br /> ;Under Pipeli DEQ Certification u r Q _ - <br /> Signed: <br /> Alternative DrainBeld Materials: <br /> u <br /> Trench Depth:b�*Mrt :Maxinsun _Curtain Drain Depth:AWL__ avow name:______________________l _ <br /> (Phase poet) <br /> Effluent Pump: toplZ oriel:Al53;StaticHeadinSystem S Ft, <br /> PlaMay 17,Ao l 0 <br /> Pump Cycle Time: I.3""tri ;Gallons per Cycle: 60 <br /> Attach as additional sheet for components and materials not listed shove. <br /> (For Marion County Use Only) <br /> The.'ove septic system has been inspected by Marion County.The information has been determined to be accurate and the system is: <br /> IV/Approved• ' <br /> I I Approved with corrections:see inspection report <br /> [IDe • <br /> Si d: f Tide:Pat 11.1 Date:a 1 b <br /> MC:S-41 WHITE:Marion County;YELLOW:Owner;PINK:Installer <br /> rev:8/00,6/01;3/03 • <br />