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dibiMARION 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 /> 503-588-5147 PERMIT NO. O '7D-00 908 Z. <br /> MARION <br /> COUNTY http://www.co.marion.or.us/PW/Buildinglnspection <br /> SITE ADDRESS:364 Cgsile /f,,e Aires 04' <br /> AS-BUILT PLAN OF CONSTRUCTED SYSTEM: <br /> Scale: 1"_ T <br /> North <br /> C <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: �Od j 4! total gallons X single compartment DANCE WITH THE REQUIREMENTS OF THE PERMIT AND THE RULES <br /> [ ] double compartment OF THE ENVIRONMENTAL QUALITY COMMISSION. <br /> Manufacturer: G .� <br /> Material: COrlerag [ ] flow-through WI I have tested the septic tank and certify it to be watertight. <br /> Effluent Sewer: (,/w 2 L/ Header Pipe: •� The system was installed by: <br /> Size/Mat'l I /��I Size/Mat'I y ion I I Property Owner(permittee) <br /> Al Licensed Sewage Disposal Service <br /> DRAINFIELD rock depth(inches) Box(es) <br /> Rock and under pipe ,CT Drop I I Concrete DEQ License Number: 3 fit?3 6 <br /> Pipe total depth I I Distribution DPI Plastic <br /> DEQ Certification Number: R I 73 8 <br /> Drainfield Material(Alternative or .pipe) tQ/e .a£z-Now <br /> Total Drainfield Footage nch 15epth Minimum if MaximumZ7 <br /> Curtain Drain Depth/vd Signed: +/ <br /> Effluent Pump: Pump Model 0 <br /> Pump cycle , / <br /> times in minutes: on � o ��iailons pe Company name:,I„ o," e 1O. v <br /> ATT Make and Model (please print) <br /> Attach an additional sheet for comp_onents and materials not listed above. Date: i i/2011 <br /> lFor Marion Count e Onl The above septic system has been inspected by Marion County. Tl a information has been determined to be accurate <br /> and the system is: .-41p I ed I I Approved with corrections: see inspection report I I Denied <br /> Signed: / 7 Title: ��`) .0 Date: <br /> �V <br />