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REdO AUG 16 7n23 <br /> disi• MARION COUNTY BUILDING INSPECTIONSALEM INDIVIDUAL ON-SITE SEWAGE SYSTEM RECORD <br /> 5155 Silverton Rd NE (to be completed by system installer) <br /> 5 3-88 OR 97305 PERMIT NO. 55h -23-00305 Q - P R NAT <br /> MARION <br /> COUNTY http://www.co.marion.or.us/PW/Buildinglnspection SITE ADDRESS: 1 t'�.CIO[ l ihu AL \AM RA <br /> Sie <br /> AS-BUILT PLAN OF CONSTRUCTED SYSTEM: . -W J g CI136Q <br /> Scale: 1"= •1' <br /> North <br /> Iva <br /> floute iv Ale_ <br /> A o ,7 - , A .-oB V <br /> o' A 4-0 C- L!5' <br /> . x(Sfn A4-o . ive <br /> 01af 31-oGal i n <br /> o ,', .3 .i-o D Si/ <br /> , <br /> go: o, <br /> D <br /> :—) 0 nDox <br /> , o' �' i <br /> ail t_8'�x <br /> 0 3a ' <br /> .3o r or D..�o}c L <br /> 30' <br /> /0' 11 .DBo'c _ <br /> � JU �f[ p30h <br /> i <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 j5 0 Gallons/Day STALLED AT THE ABOVE ADDRESS WAS CONSTRUCTED IN ACCOR- <br /> TANK Size: aith'Yll total gallons [ ] single compartment DANCE WITH THE REQUIREMENTS OF THE PERMIT AND THE RULES <br /> double com artment OF THE ENVIRONMENTAL QUALITY COMMISSION. <br /> Manufacturer: [ ] p <br /> Material: [ ] flow-through I I I have tested the septic tank and certify it to be watertight. <br /> Effluent Sew Header Pipe: The system was installed by: <br /> ;t Size/Mat'I 30'1=1 `�J[AS11C, Size/Mat'I I I Property Owner(permittee) <br /> [eicensed Sewage Disposal Service <br /> DRAINFIELD rock depth(inches) Box(es) <br /> Rock and under pipe l%eDrop I I Concrete DEQ License Number: 9 <br /> Pipe total depth I I Distribution I/Plastic j ��" <br /> DEQ Certification Number: <br /> Drainfield Material(Alternative or pert.pipe) <br /> Total Drainfield Footage A ibt Trench Depth Minimu44 Maximum ay _ <br /> Curtain Drain Depth Signed:� � LG <br /> Effluent Pump: Pump Model . <br /> Pump c e p y 'U*45 7 Ct i s f� <br /> times in minutes: on off Gallons per Cycle Company name:_ L l-tiW` lA u <br /> ATT Make and Model r (please print) <br /> Attach an additional sheet for components and materials not listed above. Date: C6 41 Qv <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: [ I Approved [ J Approved with corrections: see inspection report [ [ Denied <br /> Signed: Title: S -ST 1( .-2,-,.,- -gi Date: O g f ll- `X3 <br /> MC:S-41 rev:3/03;4/12;5/14; 11/17 G:\Forms\Septic\S-41 As-Built20l5Version20I7.doc WHITE:Marion County; YELLOW:Owner;PINK:Installer <br />