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Al\i. MARION COUNTY BUILDING INSPECTION INDIVIDUAL ON-SITE SEWAGE SYSTEM RECORD <br /> • <br /> • Silver ton Silton Rd NE.. (to be completed by system installer) <br /> SALEM OR 97305 <br /> • 503-588-5147 PERMIT NO. 1'006 eZ__lj` <br /> ' MARION <br /> COUNTY http://www.co.marion.or.us/PW/Buildinglnspection <br /> SITE ADDRESS: N5 t-kok_k_u_. Sk: De '�-Oi k— <br /> _ AS-BUILT.PLAN OF CONSTRUCTED SYSTEM: <br /> Scale: 1"_ ' • T <br /> 14D.U..+:4.. $ .A' p North <br /> __, _..., <br /> 1 <br /> • <br /> D <br /> ,,L <br /> ., iy, iipi7,,,,..,,,,, /,,,, ,,,,,:. -\NP <br /> ti,...-‘v ' !-' ' <br /> i, <br /> -.C • t� sto . <br /> . . 0. (--E-r-;!43- <br /> ,..A 4 F' <br /> 6 i VI i . . <br /> �e! 5 <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 THAT THE ON-SITE SEWAGE SYSTEM IN- <br /> System Design Sewage Flow Gallons/Day STALLED AT THE ABOVE ADDRESS WAS CONSTRUCTED IN ACCOR- <br /> TANK Size: i COO total gallons ,:single compartment DANCE WITH THE REQUIREMENTS OF THE PERMIT AND THE RULES <br /> Fh <br /> Manufacturer: y [ ] double compartment OF THE ENVIRONMENTAL QUALITY COMMISSION. <br /> Material: [ ] flow-through , IId I have tested the septic tank and certify it to be watertight. <br /> Effluent Sewer: N Header Pipe: ifThe system was installed by: <br /> Size/Mat'I • "I >-ia LI Size/Mat'I S <br /> p� GI t -t4O I I Property Owner(permittee) <br /> 4<1 Licensed Sewage Disposal Service <br /> DRAINFIELD rock depth(inches) Box(es) <br /> Rock and under pipe JK.Drop XLConcrete DEQ License Number: r22e) <br /> Pipe total depth I I Distribution I I Plastic DEQ Certification Number: <br /> Drainfield Material(Alternative or pert.pipe) <br /> • <br /> Total Drainfield Footage • (A Trench Depth Minimum6-10 Maximum.j . l <br /> Curtain Drain Depth Signed: <br /> Effluent Pump: Pump Model <br /> Pump c e • � S <br /> • <br /> times in minutes: on off Gallons per Cycle Company name: 1'� <br /> ATT Make and Model `(please pr t) <br /> Attach an additional sheet for components and materials not listed above. Date:_ �< ` <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: Approved • I I Approved with corrections: see inspection report I I Denied (LW'2/2'Signed: l- ,� Title: Zv2 lt v4 Date: <br /> MC:S-41 rev:3/03;4/12;5/14; 11/17 G:\Forms\Septic\S-41 As-Built2015Version20I7.doc WHITE:Marion County; YELLOW:Owner;PINK:Installer <br />