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• <br /> N.,• MARION COUNTY BUILDING INSPECTION INDIVIDUAL ON-SITE.SEWAGE SYSTEM RECORD <br /> •"°;%�` 5155 Silverton Rd NE <br /> (to be completed by system installer) <br /> L�- :'= SALEM OR 97305 // <br /> 503-588-5147 PERMIT NO. /(O c g o & <br /> MARION <br /> COUNTY http://www.co.marion.or.us/PWBuildinglnspection SITE ADDRESSr3• 3g �� , to <br /> 1 �4aiT7 <br /> AS-BUILT PLAN OF CONSTRUCTED SYSTEM: S S4Ctd""" ' • <br /> Scale:1"_ - • t <br /> o North <br /> AVPgo'JED AS-BUIL 30d - II <br /> pwpwING d•�e e93l . <br /> ��9V �; t- <br /> ;,, <br /> isToRy <br /> 1151(� . a— ^_' yV rl . <br /> aS <br /> ,� <br /> IOl c <br /> $ _ ., 9 <br /> 1`I. . <br /> _‘vP . / <br /> qjo-/- <br /> It ic <br /> • <br /> ci • <br /> . <br /> . 14 . . , <br /> (show all details.and dimensions necessary to locate all compon ' s of the system in the future) - <br /> SYSTEM MATERIALS AND SPECIFICATIONS:' INSTALLERS CERTIFICATION: <br /> Design Sewage Flow Gallons/Day I HEREBY CERTIFY THAT THE ON-SITE SEWAGE SYSTEM IN- <br /> System <br /> STALLED AT THE ABOVE ADDRESS WAS CONSTRUCTED IN•ACCOR- <br /> TANK Size: / ACO total gallons [ ] single compartment DANCE WITH THE REQUIREMENTS OF THE PERMIT AND THE RULES <br /> Manufacturer: il..��g o` I <br /> [double compartment OF THE ENVIRONMENTAL QUALITY COMMISSION. <br /> Material: (9c 4 ho.4-e [ ] flow-through krihave tested the septic tank and certify it to be watertight. <br /> Effluent Sewe :,9 i ( I Header Pip tx The system was installed by: <br /> Size/Mafl >C h( L O'V �,I /#( Size/Mat l . ?get I ]Property Owner(permittee) <br /> Licensed Sewage Disposal Service • <br /> DRAIN FIELD _IELD rock depth(igches) Box(es) <br /> Rock <br /> Rock and under pipe 4 / 14Drop 14 Concrete DEQ License Number. S 3 a I? <br /> Pipe total depth lea 1 I Distribution 1 Plastic �' <br /> 2:, 1 j DEQ Certification Number:_ _S) <br /> Drainfield Material(Alternative or pert.pipe) �7 s 7 ) - #cj <br /> Total Drainfield Footage Trench Depth Minimum_ Maximum, • <br /> Curtain Drain Depth Signed: <br /> Effluent Pump: Pump Model . <br /> Pump cycle //�C D�� <br /> times innminutes: on off Gallons per Cycle Company name: ii'�_� � if <br /> ATT Make and Model �]'�j (please/ t) <br /> Attach an additional sheet fo components and .,terials not listed above. Date: —r — IC _ - <br /> (For Marion County I se Only) Th- ..ove septic system has been inspected by Marion County. The information has been determined to be accurate <br /> and the system is: •pproved [ I Approved with corrections:see inspection report [ I Denied <br /> Sign- _ / i.-a Title: d°f„� Date: <br /> )�/ I ' <br /> MC:S-41 rev-./03;4/12;5/14;11/17 ~G:\Forms\Septic1S-41 As-Built2015Version2017.doc WHITE:Marion County;YELLOWOwner;PINK:Installer <br />