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. <br /> ram' MARION COUNTY BUILDING INSPECTION INDIVIDUAL ON-SITE SEWAGE SYSTEM RECORD <br /> L 5155 Silverton Rd NE (to be completed by system installer) <br /> SALEM OR 97305 r 503-588-5147 PERMIT NO.555 -.?; o 39 Jr"'Or/7r <br /> }};MARION <br /> laCkIVNTLYt_ http:llwww.co.marion.or.us/PW/BuildingInspcction .� <br /> SITE ADDRESS; �i >�/t � d• <br /> AS-BUILT PLAN OF CONSTRUCTED SYSTEM: ,S'/Veitlien 0e 7387 <br /> Scale: 1"=50 ' --\ j I <br /> 0 orivesJ <br /> F� <br /> ",; % o t <br /> • t. <br /> l o <br /> W0 <br /> {/err-31I' t�l <br /> I .., <br /> 111 90' {. 1 <br /> -ti.,._,)rvr li �� �����--- <br /> J�` <br /> (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 THA.ZHE ON-SITE SEWAGE SYSTEM IN • <br /> - <br /> System Design Sewage Flow I Gallons/Day STALLED AT THE ABOVE ADDRESS WAS CONSTRUCTED IN ACCOR- <br /> TANK Size: total gallons [ I single compartment DANCE WITH THE REQUIREMENTS OF THE PERMIT AND THE RULES <br /> �\/ [ I double compartment OF THE ENVIRONMENTAL QUALITY COMMISSION. <br /> Manufacturer. ,�j`r <br /> Material: <br /> [ I flow-through I I I have tested the septic tank and certify it to be watertight. <br /> Effluent Sewer: r�ri Header Pipe: i� The system was installed by: <br /> Size/Mat'I c� 303�( Size/Mat'I 0 a 1 a`I, I I Property Owner(permittee) <br /> Licensed Sewage Disposal Service <br /> DRAINFIELD rock depth(inches) Box(es) . <br /> Rock and under pipe kr-Drop I I Concrete DEQ License Number: ..g e73 • <br /> Pipe total depth — I I Distribution ?Plastic . OM I <br /> DEQ Certification Number <br /> Drainfield Material(Alternative or pert.pipe) ioc-aC y /24-.-. <br /> Total Drainfleld Footage23(9 Trench Depth Minimum ZAf Maximum <br /> Curtain Drain Depth Signed:- ,,__—_______, ,,..----- <br /> Effluent Pump: Pump Model <br /> Pump cycle <br /> times in minutes: on off Gallons per Cycle Company name 40/7 i fy'` B <br /> • <br /> • <br /> ATT Make and Model (please print) <br /> Attach an additional sheet for components and materials nut listed above. Date: -1 ` _ <br /> (For Marion County e Only) The above septic system has been inspected by Marion County. The information has been determined to be accurate <br /> and the system ' : [ A pro d .. [ I Approved with corrections: see inspection report 1 ] Denied <br /> Signed: A� /2.— Title: 00�5 �7 Date: / PP—I__ <br />