Laserfiche WebLink
" MARION COUNTY BUILDING INSPECTION INDIVIDUAL ON-SITE SEWAGE SYSTEM RECORD <br /> ,..x`l 5155 Silverton Rd NE (to be completed by system installer) <br /> . »� SALEM OR 97305 <br /> ., •` ."5'toluiTON1 503-588-5147 PERMIT NO. , J. c 2 2.—O 0 a3_3t 1 t? <br /> LCOUNTY.. http://www.co.marion.or.us/PWBuildinglnspection F` ( d3 -i 1 t •• !V1 D `hr' t(— <br /> SITE ADDRESS: �j` ;, <br /> AS-BUILT PLAN OF CONSTRUCTED SYSTEM: , <br /> Scale: 1"=30 ' T <br /> 1 • North <br /> 6 e r;r l\bk•- �,, i�-� ,,o <br /> • <br /> N`i.-.,,,n,, `V \/ / ,.. --.:-------. ---\ <br /> 0 .,. „ \,i,,, <br /> r° J_—1 f1 <br /> - �""' .r <br /> ci <br /> 4 <br /> Y---- ...-._., <br /> _______ ....—....7 <br /> ____________ <br /> . . <br /> ‘, <br /> (show all details :id dimensions necessa to locate all components of the system in the future) <br /> SYSTEM MATERIALS AND S1''ECIFICATIONS: INSTALLERS CERTIFICATION: <br /> System Design Sewage Flow 0CJ Gallons/Day I HEREBY CERTIFY THAT THE ON-SITE SEWAGE SYSTEM IN- <br /> STALLED AT THE ABOVE ADDRESS WAS CONSTRUCTED IN ACCOR- <br /> TANK Size: •j/60 0 total gallons 0 single compartment DANCE WITH THE REQUIREMENTS OF THE PERMIT AND THE RULES <br /> ���{7-Q [ ] double compartment <br /> THE ENVIRONMENTAL QUALITY COMMISSION. <br /> Manufacturer: <br /> Material: Ge')1AC.ira to ( ] flow-through x I have tested the septic tank and certify it to be watertight. <br /> Effluent Sewer: tt l Header Pipe:Ltit The system was installed by: <br /> Size/Mat'I �rN II pile Size/Mat'I 1 .?() 714 PU( I ]Property Owner(permittee) <br /> - - I I Licensed Sewage Disposal Service <br /> DRAINFIELD rock depth finches) Box(es)Rock and under pipe 'ill. Xl Drop A Concrete DEQ License Number: 3 o�y 7 C 2 <br /> Pipe t\ - <br /> total depth �0 I Distribution I I Plastic R- 7 9 <br /> - DEQ Certification Number: <br /> Drainfield Material(Alternative overt'. <br /> ,perf.pipe) Lk- 2-,7 29 PVC <br /> Total Drainfield Footage 6 Trench Depth Minimum 41�\\Maximum_-14.I\ d <br /> Cm rain Drain Depth Signed:_ .,;r%=r. ----•---------• <br /> Effluent Pump: Pump Model . <br /> Pump cycle eoy, ,t _ pp yy n <br /> times in minutes: on off Gallons per Cycle Company name:_ 4!I .u.k j/ .i`f4'�1J't, :, ' I...,_, <br /> ATT Make and Model (please print)) <br /> Attach an additional sheet for components and materials not listed above. Date: tTl l 1 y 2• I 2,6� _ ___..___—, <br /> (For Marion Count Use Only) The above septic system has been inspected by Marion County. The information has been determined to be accurate <br /> and the syst to is:'[YApproved [ ] Approved with corrections:�( see inspection report [ ]Denied l <br /> Signed: 4,- G _ ___^ Title:_i i! —V) 1 j/y 7"092_ Date:—��--�-�—d'� <br /> MC:S-41 rev:3/03.4/12;5/14;11/17 �rms\Se tic\S-41 As-Built20l5Version2017.doc WHITE:Marion Count YELLOW::Oa' er;PINK:Installer <br /> P ) <br />