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<br /> .NAlifoNtouNTvIpplx.34Np INSITCTION., INDIVIDUAL ON-SITE SEWAGE SYSTEM RECORD
<br /> 5155 Silverton Rd NE - (tt,be completed by system instiller). -. ' '-.-- - •
<br /> . ' sALEM OR 97305
<br /> 503-538-5147, PERMIT: NO.'8.S- —20—
<br /> MARION , S - 0044/114. 4-,(4.041-.. . .. ,
<br /> COUNTY . -- - - a i . . .
<br /> - '114,;/.(***• Ea.110•0•10/Pwf.BuilOtgInspection SITE ADDRESS: Viq-1 :1-, ,LA.,vet •i-iollie, • '
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<br /> p.rem besigq$ivoige Finn- '. -, _•-; -1GallonsIDay I HERESYCERTIFY THAT THE ON-SITE SEWAGE SYSTEM-IN-.
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<br /> ,s'TALLED AT THE ABOYEADDRESS WAS CONSTIWCTED-IN ACCOR-
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<br /> i'Ats1C Siie: 1 Vbei ;,•tor.4I gaIldn [] tingle Ooinpiiinierit. OANCE-WITH THE EtEQIJI4EMENTS OF THE PERMTT-AND THE RULES
<br /> VIL:J%-lanufactaier 'I/J.-_tt6;S-.'NV)e .. ' &tibia coniliartnient OF THE ENRONMENTAQUALITY COMMISSION.
<br /> El ifoviiirough I-114Fiv0*04 th0.sePOOP*IF Ancl certifYit toi?PWa*tight -;
<br /> Effluent Sewer: --, , I. • Heider Pipe:- _ %..--•-, •- . - The system was installed tiY"::,
<br /> .S /Mael..- -' .il. .ge...4. LAC) . siiciwil , d•J f* . i i PIPiiittiO.vine4Pimittee)
<br /> SewageI-11'..icensed. 1009
<br /> Disposal Service
<br /> .DitAINFTEI.E. ..roct;depth Cinches)Cinches) -likes).11 t4 Ill .
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<br /> • - Tiodcanii o!lrIF lijPe 1 Z'• • ii Ppm) t I Concrete DEQ Lieense.Ntimber:. :- . •
<br /> Pipe .tatai depth- •II.'"r-24 1-. . ' --f.l DiStiibution I 1 Piattie
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<br /> DEQ Certification-Number:
<br /> Dramfield Material(Alternative or pert;pipe) - • , .- . . .. .
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<br /> Total Ditalrifield Footage 4-1.6.1.; Trench beptli'Miiiirrinin:te MinctirnL111
<br /> Curtain Drain Depth. 14*; _ , _ Signed rfitAj. i'%'...-...-,•-•"--`7-----------... .I
<br /> ' -Effluent Primp:::Nanikode:1tleAkl, _.j• i'.3 _....
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<br /> .1,.apip cycle '' .
<br /> ,times in minutes:.on 1".44 . or._ .. ,Q.allons perOyelp O .4company iiaine: iZobtLe, Hitt .421,Asi-vi4.4.iik,
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<br /> ATT Maki and Midi! ,(plepe prigt).14 -..* i..
<br /> Attach an additional Sheet forcemponents and materials-not listed nionve. ,bate: 2 tt I 245Z i
<br /> 6 un 7 i "Cotin i.V se Ont ,e above Septio system has been inspected by Marion County: The information has been determined to be accurate t
<br /> -and the system is f 1 A".',roved [ ]ApprOved*ith corrections:see Inspection report i,J Penieil. ,4
<br /> §-igneil: 11.4 rift/ / title: Ofts16-e-Ok4t.qX. ..4X- _.._. .__ . .. Date:::.atts1)A_
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<br /> ,smc:"S41 rev:3/Q3;4/1;,;5/1414l/J7 ..--OilTorres\Sentie)S4 tr AOullOOlVersieri2O17.dep 'll/HITE:Mario?1c-s4m0;.,.,Y41.0fr907t7;JR.Wippukdigr
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