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° MARION COUNTY BUILDING INSPECTION INDIVIDUAL ON-SITE SEWAGE SYSTEM RECORD <br /> • <br /> "'-°�- - 5155 Silverton Rd NE (to be completed by system installer) <br /> —— .. SALEM OR 97305 _ <br /> 503-588-5147 PERMIT NO, t5 c - Z6-oc c3q 7 <br /> MARION <br /> COUNTY <br /> http://www.comarion.or.us/PW/BuildingInspectionSITE ADDRESS:10Q4 3 lanl <br /> ar'1'k Fa rk Lvn, .5�, <br /> AS-BUILT PLAN OF CONSTRUCTED SYSTEM: i...-1/0tAS /Or. ¶7 30 <br /> Scale: 1"= We' \ T <br /> Nu►th <br /> •we-to 'k <br /> . k347, . \ <br /> • <br /> y 1` <br /> '5'44 Sit 6� <br /> deitlen <br /> healCoAc—yGtt%us\ r,f8'i <br /> d1`girri1Vti t v. bolt - cA O <br /> -3irIt j •,s S -C <br /> ll <br /> net') F (7 <br /> /,008g4� wS��-e ci. / t»Se: f <br /> La i" `t3' / RUk <br /> -.-- 1-.7i o e-43,.o✓t r. <br /> • <br /> Stied a <br /> 5 r ►to,do <br /> c <br /> c IIA) n <br /> . <br /> (show all details and dime ions necessary to locate all components f the system in the future) <br /> SYSTEM MATERIALS AND SPECIFICATIONS: INSTALLERS CERTIFICATION: ' 1 <br /> 3Dd Gallons/DaI HEREBY CERTIFY THAT THE ON-SITE SEWAGE SYSTEM IN- <br /> System Design Sewage Flow Y STALLED AT THE ABOVE ADDRESS WAS CONSTRUCTED IN ACCOR- <br /> TANK Size: J,Oa U total gallons 1?q single compartment DANCE WITH THE REQUIREMENTS OF THE PERMIT AND THE RULES <br /> Manufacturer: Lac;,,�e [ ) double compartment OF THE ENVIRONMENTAL QUALITY COMMISSION. <br /> Material: L a rA e•rLte [ ] flow-through N I have tested the septic tank and certify it to be watertight. <br /> Effluent Sewer,3 / n Header Pipe: The system was installed by: <br /> Size/Mat'I q scs, Lin PVC, Size/Mat'I I f Property Owner(permittee) <br /> I I Licensed Sewage Disposal Service <br /> DRAINFIELD rock depth t(inches) Box(es) <br /> Rock and under pipe 6' I I Drop 171 Concrete DEQ License Number: .3$9 4^2. <br /> Pipe total depth IZ ft btl Distribution I 1 Plastic DEQ Certification Number: R1 7St <br /> Drain field Material(Alternative overt.pipe) <br /> Total Drainfield Footage I I is Trench Depth Minimum__ Maximum_ �" <br /> Curtain Drain Depth Signed:_ <br /> Effluent Pump: Pump Model , <br /> Pump cycle <br /> times in minutes: on off Gallons per Cycle Company name: ,a, 11 e�I NoIAAes L L C , <br /> (please print) <br /> All'Make and Model t <br /> Attach an additional.sheet fore• ponents and materials not listed above. Date: Jt)l'�. tLI s 26 Z] _ <br /> (For Marion Coun se Only) The above septic system has been inspected by Marion County. The information has been determined to be accurate <br /> and the syste • ,. •.,t p oved [ J Approved with corrections:see inspection report [ J Denied <br /> Signed: ` 4 Lift i', _ Title: 0 S C. Date: �e 2I <br /> MC:S-4 I rev:3/03:4/12;5/l 11/17 G:\Forms\Septic\S-41 As-Buiht2015Version2017.docl W I TE.:Marion County;YE OW.• er;PINK.:Installer <br />