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3 <br /> MARION COUNTY BUILDING INSPECTION INDIVIDUAL ON-SITE SEWAGE SYSTEM RECORD <br /> 5155 Silverton Rd NE (to be completed by system installer) <br /> SALEM OR 97305 <br /> • <br /> 503-588-5147 PERMIT NO. 2 2. -c O Z 9 2 7 <br /> "1M9ARlON" <br /> 'CO.UNTY htt //www.co.marion.or.us/PTV/Buildin Ins <br /> p' g p-ection <br /> SITE ADDRESS: 14 it.Z r=aufe\ LA.? SE .3cCreocSzpe. <br /> i AS-BUILT PLAN OF CONSTRUCTED SYSTEM: <br /> Scale: 1"= `155 ' - T <br /> x 313.4fi 1 vt i- <br /> - I • x North <br /> • <br /> • , <br /> ., ' �:9QI l a <br /> I, 1.5O$C <br /> I <br /> h r+!R `� AI V. . `t,. <br /> -N " 41 Ft-4 ro � * u 1. <br /> ta- is <br /> a • <br />, —I • a [ ici i mg.6 • . <br /> 4 I <br /> • <br /> I ©a - a '. .:d�- I v�� , • r <br /> SSI IOn <br /> � <br /> • <br /> • <br /> 3. <br /> mmu 9 <br /> (show all details and dimensions n?r ssary°to locate all corn ronents of the system in t - __ -- <br /> SYSTEM MATERIALS AND SPECIFICATIONS: I INSTALLERS CERTIFICATION: <br /> 1 I HEREBY CERTIFY THAT THE ON-SITE SEWAGE SYSTEM IN- <br /> System Design Sewage Flow 4/50 Gallons;Dad STALLED AT THE ABOVE ADDRESS WAS CONSTRUCTED IN ACCOR- <br /> TANK Size: �Oa total gallons l stnale compartment DANCE WITH THE REQUIREMENTS OF THE PERMIT AND THE RULES <br /> Manufacturer:i.rAle...A.Alt (�rav svmwe (;,'� <br /> [ ] rouble compartment <br /> OF THE ENVIRONMENTAL QUALITY COMMISSION. <br /> Material: Corete,� i 1 flow-through Y I have tested the septic tank and certify it to be watertight. <br /> Effluent Sewer: , Header Pipe: The system was installed by: <br /> p ,i <br /> Size/Mat'I '-I 3411 i Pw._ Size/Mat'I '-1 340344 Nr.. I I Property Owner(permittee) <br /> ICI Licensed Sewage Disposal Service <br /> DRAINFIELD rock depth(inches) Box(es) I • <br /> Rock and under pipe I 1 Drop l l Concrete DEQ License Number: 3 1 mo,' <br /> Pipe total depth IN Distribution t%4 Plastic <br /> DEQ Certification Number: <br /> Drainfield Material(Alternative or perf.pipe) 5.1.. F 1v e••••/ <br /> Total Drainfield Footage 34,® 1 Trench Depth Minimum IS" Maximum Z..9 ' <br /> Curtain Drain Depth Signed: <br /> Effluent Pump: Pump Model _ <br /> Pump cycle <br /> times in minutes: on off Gallons per Cycle Company name:_ ROc_1t 1.1i\\ C_rar+Si-`o►eu,'Ion <br /> (please print) <br /> ATT Make and Model <br /> Attach an additional sheet for components and materials not listed above. Date:_ 7 - 2.4o- Zz- <br /> (For Marion County 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: I Approved I I Approved with corrections:see inspection report I I Denied <br /> Signed: /� / Title: ff p/ /c <br /> Vl• 1��.�, �1 J---� �U�� i 19 Date:4 j iTv <br />