Laserfiche WebLink
_i <br /> giouMARION COUNTY BUILDING INSPECTION INDIVIDUAL ON-SITE SEWAGE SYSTEM RECORD <br /> 5155 Silverton Rd NE <br /> SALEM OR 97305 (to be completed by system installer) <br /> 503-588-5147 PERMIT NO. 555 `11--- ooct I I I <br /> MARION <br /> COUNTY http://www.co.marion.or.us/PW/BuildingInspection SITE ADDRESS: SSK U S1'1E <br /> CT SA LEM,o2 9731 <br /> 'AS-BUILT PLAN OF CONSTRUCTED SYSTEM: <br /> Scale: 1"= SO ' T <br /> North <br /> G - 3 = re . <br /> O — C 4.1/ . <br /> F • <br /> 4°= a, <br /> F — 14 = ` 1 ]8, 10•0 i <br /> VD' <br /> �� pcCK <br /> �G F /do' <br /> ll <br /> w I, E p Ili <br /> , _ <br /> v - <br /> 41' <br /> 6 a 'A\ <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 3/5 Gallons/Day STALLED AT THE ABOVE ADDRESS WAS CONSTRUCTED IN ACCOR- <br /> TANK Size: /00 0 total gallons Y`( single compartment DANCE WITH THE REQUIREMENTS OF THE PERMIT AND THE RULES <br /> Manufacturer: L/�)11cCE <br /> [ ] double compartment OF THE ENVIRONMENTAL QUALITY COMMISSION. <br /> Material: Co1CAZGTE [ ] flow-through I 1 I have tested the septic tank and certify it to be watertight. <br /> Effluent Sewer: �.CL Header Pipe: The system was installed by: <br /> pV <br /> Size/Mat'I tt'I F Size/Mat'l _L a P1/(, b4 Property Owner(permittee) • <br /> - r I Licensed Sewage Disposal Service <br /> DRAINFIELD rock depth(inches) Box(es) <br /> " <br /> Rock and under pipe [� >Z(I Drop )(1 Concrete DEQ License Number: <br /> Pipe total depth_ I)-" 1 I Distribution I I Plastic <br /> DEQ Certification Number: <br /> Drainfield Material(Alternative or pert.pipe) ET- FLO i..) <br /> . Total Drainfield Footage 300 Trench Depth Minimum'p.4{v Marimum_36 II <br /> Curtain Drain Depth_ NI i Signed: <br /> Effluent Pump: Pump Model NIA . <br /> Pump cycle <br /> times in minutes: on off Gallons per Cycle Company name: <br /> ATT Make and Model (please print) <br /> Attach an additional sheet for components and materials not listed above. Date: (n,I L'11-1 <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: PApproved I. ] Approved with corrections: see inspecttiionn report I ] Denied V47.7f <br /> Signed: — it �,Title: ' e 14$ 1 I" IV Date: <br /> MC:S-41 rev:3/03;4 17;5/14; 11/17 G:\Forms\Septic\S-41 As-Built2015Version2017.doc WHITE:Marion County; YELLOW.:Ouwner;PINK:Installer <br />