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ibiMARION 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. cS.5 Z I —CO Z N 96 <br /> MARION <br /> COUNTY • <br /> http://www.co.marion.or.us/PW/BuildingInspection SITE ADDRESS: 89/0 WACOiJD-4 ?p /Le—. <br /> AS-BUILT PLAN OF CONSTRUCTED SYSTEM: ) L <br /> Scale: 1"= 1 T <br /> 7570: 7 <br /> z V w , <br /> �-, rz ,D +2 ,t W, <br /> o l . `NIO <br /> E-Q'— r'J <br /> r.... <br /> P y00. <br /> a �i <br /> 76 ) <br /> \Ns WO, <br /> CO• -a 1 w T 4 VIra& �%f <br /> 4_ .1, , <br /> 1�� 11;� ^ <br /> ills8 — <br /> • <br /> � ,,, <br /> ` ,041,P r I I I Z.e4—"- <br /> 1t{I.14' vi. 'i v+1 a <br /> •Z Z• '� <br /> ij <br /> -IL (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 t`/.S ' Gallons/Day STALLED AT THE ABOVE ADDRESS WAS CONSTRUCTED IN ACCOR- <br /> TANK Size: IS-CO total gallons [ ] single compartment DANCE WITH THE REQUIREMENTS OF THE PERMIT AND THE RULES <br /> double compartment <br /> OF THE ENVIRONMENTAL QUALITY COMMISSION. <br /> Manufacturer: A 11(- p <br /> Material: CienJG4.Q7t= [ ] flow-through I14:I have tested the septic tank and certify it to be watertight. <br /> Effluent Sewer: y Header Pipe: a„ The system was installed by: <br /> Size/Nat'l ly PVC j t N y4) Size/Mat'l 1 PAL d-s9 t9a I I Property Owner(permittee) <br /> IkLicensed Sewage Disposal Service <br /> DRAINFIELD rock depth(inches) _ Box(es) 2 `{ <br /> Rock and under pipe b' I I Drop I I Concrete DEQ License Number: 1�.7 J <br /> Pipe total depth /2 ' I I Distribution I I Plastic RI Zs? <br /> DEQ Certification Number: <br /> Drainfield Material(Alternative or pert.pipe) <br /> Total Drainfield Footage 4/4-A1 i Trench Depth Minimum id Maximum z/is <br /> Curtain Drain Depth 13" ir"ZV-i �1 Signed: <br /> ✓ <br /> Effluent Pump: Pump Model ?i J .---- <br /> Pump cycle <br /> times in minutes: on off Gallons per Cycle 6 0 Company name: C�/a'") pip/A) <br /> ATT Make and Model (please print) <br /> Attach an additional sheet for components and materials not listed above. Date:_ 7- 2 2- 2 <br /> (For Marion County se Only) The above septic system has been inspected by Marion County. The information has been determined to be accurate <br /> and the system [ p ov I I Approved with corrections: see inspection report I l Denied <br /> Signed: .7 `•'•..._. Title: flAr5 Date: p12-0 <br /> MC:S-41 rev:3/03;4/12;5/14; 11/17 G:\Forms\Septic\S-41 As-Built2015Version2017.doc WHITE:Marion County; W:Owner;PINK:Installer <br />