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\ - <br /> ftMARION COUNTY BUILDING INSPECTIONSALEM INDIVIDUAL ON-SITE SEWAGE SYSTEM RECORD <br /> 5155 Silverton Rd NE (to be completed by system installer) <br /> 503-588-5147 <br /> OR 97305 PERMIT NO. DJ 0050 66 <br /> •MARION <br /> COUNTY http://www.co.marion.or.us/PW/Buildinglnspection <br /> SITE ADDRESS: j 1 d Mum rj, /1d SE <br /> AS-BUILT PLAN OF CONSTRUCTED SYSTEM: <br /> Scale: 1"_ G 1 ft ') 16�6\ a ; \\ North <br /> ►1 <br /> � -1- �, <br /> 120 <br /> 4—A! i <br /> t,... t..4,4.4 V y e <br /> Ili <br /> 0.-I.f,r_{.. I r <br /> t''. <br /> • <br /> • <br /> l - <br /> (show all details and dimensions necessary Aril a l components of the system in th future) <br /> SYSTEM MATERIALS AND SPECIFICATIONS: INSTALLERS CERTIFICATION: <br /> I HEREBY CERTIFY THAT THE ON-SITE SEWAGE SYSTEM IN- <br /> System Design Sewage Flowb Gallons/Day STALLED AT THE ABOVE ADDRESS WAS CONSTRUCTED IN ACCOR- <br /> TANK Size: /SS 00 total gallons fjQ single compartment DANCE WITH THE REQUIREMENTS OF THE PERMIT AND THE RULES <br /> j� [ ] double compartment OF THE ENVIRONMENTAL QUALITY COMMISSION. <br /> ��Ctily melt Manufacturer: With 6r�, , Ae - <br /> uu [ ] flow-through FA have tested the septic tank and certify it to be watertight. <br /> Material: Crike.t�tF�-t, <br /> Effluent Sewer: .i Header Pipe: c The system was installed by: <br /> Size/Mat'I 1-1 3039 Size/Mat'I L 1 at Lj [ I Property Owner(permittee) <br /> I I Licensed Sewage Disposal Service <br /> DRAINFIELD rock depth(inches) Box(es) <br /> (let.) .s 3 (� <br /> Rock and under pipe F7 ( .) VI Drop Concrete DEQ License Number: . / 7 <br /> Pipe total depth I I Distribution I I Plastic <br /> DEQ Certification Number: ,.2Li/9 <br /> Drainfield Material(Altemative or peril pipe) <br /> Total Drainfield Footage 00 Trench Depth Minimum ail Maximum 36 /.� <br /> Curtain Drain Depth VA Signed:_ ,./ <br /> Effluent Pump: Pump Model A . <br /> Pump cycle K J l <br /> times in minutes: on off Gallons per Cycle Company name:_�rCJU ttet I j� &Gave,'cOr <br /> (please prinQj <br /> ATT Make and Model AJA <br /> Attach an additional sheet for components and materials not listed above. Date: , <br /> (For Marion Covw 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: proved I ) Approved with corrections: see inspection report I I Denied <br /> 1i— 5r 1 o2Its fi9C4 Date: 5—/z V'W <br /> Signed: Title: <br /> MC:S-41 rev:3/03;4/12;5/I4; 11/17 G:\Forms\Septic\S-41 As-Built2015Version20l7.doc WHITE:Marion County; YELLOW:Owner;PINK:Installer <br />