Laserfiche WebLink
dikiMARION COUNTY BUILDING INSPECTION INDIVIDUAL ON-SITE SEWAGE SYSTEM RECORD <br /> 5155 Silverton Rd NE <br /> SALEM OR 97305 (to be completed by system installer) <br /> 503-588-5147 PERMIT NO. 2/-603/6;•Co <br /> MARION <br /> COUNTY http://www.co.marion.or.us/PW/Buildinglnspection x/7(/9 /?1 2 DA R S <br /> SITE ADDRESS: f 17 <br /> AS-BUILT PLAN OF CONSTRUCTED SYSTEM: � <br /> Scale: 1"= � 2 • /� , 5J T <br /> North <br /> A-tS 31' <br /> A- P 58' <br /> n - C 71 ' <br /> A- F 8(o' • <br /> '�'? <br /> A - 6 8o' 3g2 /U�9 <br /> vl t�- l4 72 v-4. �i <br /> N A Z' (99 ' -� v <br /> _F -o-i-E-14' D A n <br /> y c- 8 58' .4 9, e 61 <br /> c - I IV ' 1 , 1 v <br /> C- e- 31 , % ‘4-4\ <br /> C- F 3y' %‘ \ ‘ <br /> C - G 9os ' cas \\ <br /> C` 121 ' ‘�,\ <br /> 2 \ <br /> 1 <br /> 51461,5- p. 1. ir'i N 1�• <br /> 11 <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 /> I HEREBY CERTIFY THAT THE ON-SITE SEWAGE SYSTEM IN- <br /> System Design Sewage Flow i'5 Gallons/Day STALLED AT THE ABOVE ADDRESS WAS CONSTRUCTED IN ACCOR- <br /> TANK Size: 000 total gallons bc] single compartment DANCE WITH THE REQUIREMENTS OF THE PERMIT AND THE RULES <br /> WA [ ] double compartment OF THE ENVIRONMENTAL QUALITY COMMISSION. <br /> Manufacturer: <br /> Material: Cotuc!ter(% [ ] flow-through Kj I have tested the septic tank and certify it to be watertight. <br /> Effluent Sewer: y„ m Header Pipe: �� The system was installed by: <br /> Size/Mat'I Se MVO/ VG Size/Mat'I 3 !vC >c,N t10 I I Property Owner(permittee) <br /> 64)Licensed Sewage Disposal Service <br /> DRAINFIELD rock depth(inches) Box(es) /� <br /> " DEQLicense Number: �Co�23 <br /> Rock and under pipe (9 �'Drop IA Concrete <br /> Pipe '' Q Z Z� t'7 <br /> total depth /Z I I Distribution I I Plastic ff�� <br /> DEQ Certification Number: <br /> Drainfield Material(Alternative or perf.pipe) <br /> Total Drainfield Footage ZZ8' Trench Depth Minimum Zy"Maximum 3/_1' <br /> A <br /> Curtain Drain Depth Signe 111MMEr <br /> „...-- <br /> Effluent <br /> rEffluent Pump: Pump Model �..-- <br /> Pump cycle >'" <br /> times in minutes: on off - Gallons per Cycle Company name: /0/J PA) <br /> ATT Make and Model /Y^ (please p�rJint) <br /> Attach an additional sheet for components and materials not listed above. Date: ( ' JR ) I <br /> (For Marion Count Use Only)The above septic system has been inspected by Marion County. The information has been determined to be accurate <br /> and the system is: Approved I I Approved wit corrections: see inspection report I Denied � � ^ I <br /> Signed._ J `--� Title. Date: <br /> G( <br /> MC:$4I' 4/TC_"riCrl`,'^11c'14 G:\Forms\Septic\S-41 As-Built2015Version20l7.doc WHITE:MarionCounty; YELLOW:Owner;PINK:Installer <br />