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• <br /> • <br /> '� MARION COUNTY BUILDING INSPECTION INDIVIDUAL ON-SITE SEWAGE-SYSTEM RECORD <br /> • " - 5155 Silverton Rd NE (to be completed by system installer) <br /> 1•J SALEM OR 97305 <br /> 503-588-5147 PERMIT NO. S C 5- a a. - 60 c(l q 7— ? lF /o�"t <br /> MARION' <br /> COUNTY http://www.co.marion.or.us/PW/Buildinglnspection (5�- <br /> SITE ADDRESS: S 7( � (•E-v skc� L,,,, /l� <br /> AS-BUILT PLAN OF CONSTRUCTED SYSTEM: <br /> Scale: 1 = So+ T. <br /> North' I <br /> 6 r <br /> s <br /> u To. c_ : o <br /> 0 Ne-c.' Tait -.4 =3a <br /> • <br /> NL� 7®-.t— 4 - gj' • I'C\JLW G <br /> /J c.,-, Tc ink : t / <br /> 3G,c y$ <br /> _ u3 St~Of <br /> oK <br /> 358•a7 ' <br /> (show all details and dimensions nei aari' Ovate all cni o tens . <br /> SYSTEM MATERIALS AND SPECIFICATIONS: INSTALLERS CERTIFICATION: ' <br /> Y sG Gallons/Da I 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: 1 0 0 0 total gallons [ ] single compartment DANCE WITH THE REQUIREMENTS OF THE PERMIT AND THE RULES <br /> Manufacturer: C....� • Cr <br /> [ ] double compartment OF THE ENVIRONMENTAL QUALITY COMMISSION. <br /> Material: C. e C i e.-e [ j flow-through have tested the septic tank and certify it to be watertight. <br /> Effluent Sewer: Header Pipe: The system was installed by: <br /> Size/Mat'l G(€4 ' 3 G 3 '.( Size/Mat'l c( '' 3 0 3 c-( [ I Pro erty Owner(permittee) <br /> icensed Sewage Disposal Service <br /> DRAINFIELD rock depth(inches) Box(es) <br /> Rock and under pipe 1 I Drop I J Concrete DEQ License Number: 3 7 q 0`t' <br /> Pipe total depth I I Distribution I I Plastic <br /> DEQ Certification Number: 7-I I ii 3 6 <br /> Drainfield Material(Alternative or perf.pipe) <br /> Total Drainfield Footage Trench Depth Minimum Maximum <br /> Curtain Drain Depth Signed: DI <br /> Effluent Pump: Pump Model . <br /> Pump cycle <br /> times in minutes: on off Gallons per Cycle Company name:,Accoc-64.In1_e 5 CP.4..i ' S y S-Pe..3 <br /> ATT Make and Model (please print) `` <br /> Attach an additional sheet for components and materials not listed above. Date: 7- ( a- a- - _ <br /> (For Marion Cou tv 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: Approved [ ] Approved with rections: see inspection report [ I Denied re <br /> Signed: ., i Title: I` � tovAirVi Date: <br /> MC:S-41 rev:3/03;4/12;5/1 ;11/g 1_-l'C,G:\Forms\Septic\S-41 As-Built2015Version2017.doc WHITE:Marion County;YELLOW:Owner;PINK.:Installer <br />