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iiiiMARION COUNTY BUILDING INSPECTION INDIVIDUAL ON-SITE SEWAGE �'SI'EM RECORD <br /> 5155 Silverton Rd NE <br /> SALEM OR 97305 ( o be completed by-systrkm installer) <br /> 503-588-5147 PERMIT NO. S5 (�,�164'11 <br /> • MARION - -- <br /> COUNTY http://www.co.marion.or.us/per'/Buildinghmspection <br /> SITE ADDRESS:IO02s iVoetk Fotrk LA, 5.E, _ <br /> AS--l.UILT PLAN OF CONSTRUCTED SYSTEM: LljO 3 Ote. 97351 <br /> Scale: 1"= ''fd ' , i T <br /> \ ir <br /> North <br /> .. \ \ <br /> I :A: \ . <br /> --2,- \ <br /> N <br /> °I'r,, its-4�' I;ftt"'• 60 <br /> /etti o,o 0,„„05,1. <br /> \ , <br /> i� <br /> i z ache + ®1i- r �' ;. <br /> tt g„rriuew "1 ' �g d <br /> I "�H.�59�,e ` <br /> I . <br /> .,‘,,,,,,,,,____k <br /> \ a,,,, 4 k <br /> - .. -1-A-----1-------1-1 <br /> I ��'t00 <br /> \ \ 4 <br /> (show all details and�imensians necessary to locate all components o 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 Flow 300 Gallons/Day STALLED AT THE ABOVE ADDRESS WAS CONSTRUCTED IN ACCOR- <br /> TAsK Size: 00® total IK single compartment DANCE WITH THE REQUIREMENTS OF'TEIE?gRMIT AND THE RULES <br /> I gallonsOF THE ENVIRONMENTAL QUALITY COMN:us$QNB!. <br /> I 1 double compartment <br /> Manufacturer: 4..4e-Material: _ efs,A.Cw�$ - <br /> I 1 flow-through 1/1 I have tested the septic tank and certify-4s•be watertight. <br /> • <br /> Effluent Sewe : Header Pipe: tt The system was installed by: <br /> Size/Mat'i '/t�Sek, LtD P u<. Size/Nat'l - 3034 Pie, I 1 Property Owner(permittee) <br /> I I Licensed Sewage Disposal Service <br /> I DRAINFtELI➢ rock depth(inches) )Sox(es) <br /> Rock and under pipe 6't I 1 Drop IA Concrete DEQ License Number: ,y l 9 6 2- <br /> Pipe total depth VIA _ )4 Distribution I I Plastic f3 �7 7S <br /> DEQ Certification Dumber: tc <br /> Drainfield Material(Alternative or pelf pipe) <br /> Total Drainfield Footage1 <br /> t; S.� I Trench Depth MinimomJ� Macimum_3�at !� � <br /> Curtain Drain Depth_ Signed:_ ,,''�°`� '4_,_,___ _ <br /> Effluent Pump: Pump Model <br /> Pump cycle <br /> times in minutes: on __oft Gallons per Cycle _ Company name: 5,q1 ,1 N tots!e 5 L LC <br /> ATT Make and,Model (please print) <br /> • Attach an additional sheet for co ponents and materials not listed above. Date:_IRA c, IN , 20 2. 1 . <br /> f For Marion Costa e Ont T'-above septic system has been inspected by Marion County. The information has been determined to be accurate <br /> and the system is: ' pprIa.,,,,i 14 Approved with corrections: see inspection report I I Denied <br /> Signed: f <br /> ' Title: bei.S111-e: /.,.C• Date: `�' ' cif <br />