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^ rrm,k 017V1/A rim, SYSTEM 4.,.... .... , MARION COUNTY BUILDING INSPECTION INDIVIDUAL ON-hI IL r...,hc.,vv J.,....7E, RECORD <br /> 5155 Silverton Rd NE <br /> - - , (to be completed by system installer). <br /> SALEM OR 97305 <br /> • .• ' ' 503-588-5147 PERMIT <br /> rii,e,ARICA. <br /> "NTY' http://vvww.co.marion.or.us/PW/BuildingInspection <br /> SITE <br /> As-Buivr PLAN OF CONSTRUCTED SYSTEM: <br /> Scale:1"= ' 1* <br /> North <br /> • <br /> •"--, \ <br /> \ • <br /> • <br /> (show all details and.dimensions.11eponMds of the system in the.future) <br /> _ SYSTEM TEI__.—.--AlA --------MA LS AND SPECIFICATIONS: INSTALIFICATION: <br /> I HEREBY CERTIFY THAT THE ON-SITE SEWAGE SYSTEM IN- <br /> System Design Sewage Flow 461f_ Gallons/Day STALLED AT THE ABOVE ADDRESS WAS CONS I RUC 1bl)IN ACCOR- <br /> [ I single compartment DANCE WITH THE REQUIREMENTS OF 1-1- .PERMIT AND THE RULES <br /> TANK size total gallons OF THE ENVIRONMENTAL QUAUTY COMMISSION_ <br /> Manufacturer:k -I ' t: ,t. [1 double compartment <br /> Material: C-e'w__ i.ke= I1 flow-through pg3,i have Iested the septic tank and certify it to be watertight. <br /> ____ <br /> Effluent Sewer: Header Pipe: The system was installed,by: <br /> Si7.e/Mafl 1 4 PA , -,,,, Ur_ Size/Mari_JV 0. (_d__ __ .LN.L-- 1 1 Property Owner(i:Iermittee) <br /> - . 114 Licensed Sewage Disposal Service <br /> DRAINFIELD rock depth(incites) Box(es) <br /> Rock and under pipe__________ VI Drop <br /> Iv1 Concrete DEQ License Number:. <br /> Pipe total depth _ _ _ I I Distribution i I Plastic DEQ Certification Number:_ <br /> Drainfield Material(Alternative or perf. <br /> Total Drab:111dd Footage ign Trench Depthlviinimum 17— Mmtimumre:-..' : <br /> Curtain Drain Depth Signed. <br /> Effluent PUmp:Pump Model <br /> Pump cycle <br /> dines in minutes;on________off_______ Gallons per CYcle---- Company <br /> ATT Make and Model tii0wrt rii _ ( e e print) 1 <br /> -- ---34--'—'"---7--- <br /> Attach lnudlnna"heet for components and materials isted abnre.r __________E_______mte:_u _____ _ <br /> or Marion Con lase Oft The ab• -. ..-ptic system has been inspected by Marion County. The information has been determined to be accurate 1 <br /> and the system is: proved 1 App oved with correetions:see inspection report I 1 Denied 1 <br /> Si...i ed: - AAI VAI At 1 ' i Or. e. <br /> • <br /> 0 <br /> __ '' .4___ _ _ ____AI ________ —___q________0•.. _ _ <br /> MC:S-41 rev:3/03;4/12;5/14-,11/17 G:Worms 1 Septic1S-41 As-Built2015Version2017.doc WH/TE:Airmon Counv:YEL 0117:.viler:PINIC:Instidler <br />