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• -" MARION COUNTY BUILDING INSPECTION INDIVIDUAL ON-SITE SEWAGE,SYSTEM RECORD <br /> 5155 Silverton Rd NE Op be completed by system installer) <br /> SALEM OR 97305 Ts� <br /> 503-588-5147 PERMITNO.555 -2/ — ©d7/0I <br /> MARION p <br /> hftp://www.co.marion.or.us/PTV/Buildinglnspection SITE ADDRESS:a0 ' 7 LtJ S/ 7 9. <br /> AS-BUILT PLAN OF CONSTRUCTED:SYSTEM: I <br /> Scale:1"= ' C <br /> North <br /> Sec ail-ached •0,10 ln3 <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 /> 1 HEREBY CERTIFY THAT THE ON-SITE SEWAGE SYSTEM IN- <br /> System Design Sewage Flow a 2 5 Gallons/Day STALLED AT THE ABOVE ADDRESS WAS CONSTRUCTED IN ACCOR- <br /> TANK Size: /l 506 total gallons [ ] single compartment DANCE WITH THE REQUIREMENTS OF THE PERMIT AND THE RULES <br /> Manufacturer L(:1 p%;4e. IX double compartment OF THE.ENVIRONMENTAL.QUALITY COMMISSION. <br /> Material: e oYl a cell e 1 ] flow-through xi I have tested the septic tank and certify it to be watertight. <br /> Effluent Sewer:, if n Header Pipe: „. The•system was installed.by: <br /> Size/Maf1 . / /q PLiC.. Size/Mat'I / PL/Co I JProperty.Owner(permittee) <br /> Del Licensed Sewage Disposal Service <br /> DRAINFIELD rock depth finches) Hoses) p <br /> Rock and under pipe t i° 1 1 Drop I I Concrete DEQ License Number: 3 7 to 5 �+ <br /> Pipe total depth I a." I I Distribution l I.Plastic n <br /> /� r DEQ Certification Number: r�S' Q _ <br /> Drainfield Material(Alternative or pert pipe) f-C r leTotal Drainfleld Footage 375 Trench Depth Minimum/A Maxim:n.2 , <br /> :Curtain Drain Depth Signed: CIA,L <br /> Effluent Pump: Pump Model P 3 0r /�/ Head <br /> Pump Cycle (J I/ <br /> times in minutes: on off Gallons per Cycle 45 Company name: (5 (v p rj -rti e.-I0 p <br /> ATI Make and Model (please print) h Le. <br /> Attach an additional sheet for components and materials not listed above.`- Date: . - !T- —,20.:2 <br /> (For Marion County se Only) The above.septic system has been inspected.by Marion County.,The information has been determined to be accurate <br /> and the system i : fev d J J Approved with corrections:see inspection report I' 1 Denied <br /> Signed: �i WI__ <br /> Title: %J5 - Date: o /4- <br /> MC.S-41 rev-3/RP•4/17.•i114•`11/17 0•1Fnrms\Sentir\SS-al Ac=R,iilt7n14Vercinn7flI7 ring WV 11TF.•A,fnr,nn rest nn,•?TT.I.nW=t ..,b.•PINA,1.vrolJar <br />