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MARION COUNTY BUILDING INSPECTION INDIVIDUAL ON-SITE SEWAGE SYSTEM RECORD <br /> illibi <br /> 5155 Silverton Rd NE <br /> SALEM OR 97305 (to be completed by system installer) <br /> 503-588-5147 PERMIT NO. 013 — 00 y g 3 l <br /> MARION <br /> COUNTY http://www.co.marion.or.us/PW/Buildinglnspection <br /> SITE ADDRESS: �j �� �:ip�l�1�Lj <br /> aC�ja <br /> J AS-BUILT PLAN OF CONSTRUCTED SYSTEM: 1YT L L <br /> Sc e: 1"= T <br /> I' North <br /> I / t <br /> • / / <br /> I <br /> '5' <br /> I 1 <br /> I. / <br /> e / ` fl <br /> / / I <br /> / A�� <br /> 84 =9.9 <br /> 9 ii <br /> I I <br /> -C = 6",4K 1.71j <br /> ---- ,...N <br /> a ✓j• <br /> c' i I _ ._. , <br /> 4,,,,(7,,,,,-,.. <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 Sewageag Flow Gallons/Day STALLED AT THE ABOVE ADDRESS WAS CONSTRUCTED IN ACCOR- <br /> TANK Size: i®® 0 total gallons [ I single compartment DANCE WITH THE REQUIREMENTS OF THE PERMIT AND THE RULES <br /> / double compartment OF THE ENVIRONMENTAL QUALITY COMMISSION. <br /> Manufacturer: kja r{es <br /> Material: 0 p,y-%C er--f-e [ l flow-through I I I have tested the septic tank and certify it to be watertight. <br /> Effluent Sewer: L Header Pipe: The system was installed by: <br /> Size/Mat'I /� SC I7 I yQ Size/Nat'l I I Property Owner(permittee) <br /> I I Licensed Sewage Disposal Service <br /> DRAINFIELD rock depth(inches) Box(es) <br /> Rock and under pipe '*----- ler6rop j4'Concrete DEQ License Number: e. 0 i'3 <br /> Pipe total depth 'f l I Distribution I I Plastic DEQ Certification Number: _TSi/) <br /> Drainfield Material(Alternative or perf.pipe) <br /> Total Drainfield Footage Trench Depth Minimum---Maximum' <br /> Curtain Drain Depth Signed: <br /> Effluent Pump: Pump Model ha, r / <br /> Pump cycle �e /�? lG <br /> times innminutes: /on off Gallons per Cycle Company name:_ � �P <br /> ATT Make and Model (pleas d print) <br /> Attach an additional sheet for components and materials not listed above. Date: <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 system issVLApproved I I Approved wit coections: see inspection report I I Denied <br /> Signed Title: lig L \ 2 ? q7c72-3 <br /> Date: <br /> MC:S-41 rev:3/03;4/12;5/14;11/17 G:\Forms\Septic\S-41 As-Built2015 Version2017.doc WHITE:Marion County; YELLOW:Oivner;PINK:Installer <br />