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dibiMARION 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. ".05--.23--005®c2L1 PP-flt+! rd1. <br /> MARION <br /> COUNTY http://www.co.marion.or.us/PW/BuildingInspection $78 .guftetr�Ir 5g. tY M, OR- <br /> SITE ADDRESS: 6 <br /> 9'731- <br /> AS-BUILT PLAN OF CONSTRUCTED SYSTEM: <br /> Scale: 1"_ t1O ' % 1 T <br /> �u Qt, s^f�, North <br /> W i""� <br /> Zµi4 <br /> 2 <br /> Ls, ®°, - )D' g_H o `77) APPROVED AS-BUILT <br /> `Lµ . a- GIs' g-D — 61.4' DRAWING <br /> L <br /> L 3 ` 9 :'53 <br /> yl ,$-f — 77/ <br /> e e v 3 �� <br /> • <br /> g 7 , <br /> L1 t,/, <br /> �U 3, 4.1Si <br /> 05• 3 <br /> leD �l W <br /> o 9� dt <br /> 00 A 1 <br /> a OrM e3 0 <br /> W. ! I , <br /> 3N . <br /> ° I a YID1)6f' <br /> S--.Hov $ a <br /> R (show all details and dimensio.s necessary to locate all components of e sy-tem i; the future) <br /> SYSTEM MATERIALS AND SPECIFICATIONS: INSTALLERS CERTIFICATION: t <br /> I HEREBY CERTIFY THAT THE ON-SITE SEWAGE SYSTEM IN- <br /> System Design Sewage Flow `� Gallons/Day STALLED AT THE ABOVE ADDRESS WAS CONSTRUCTED IN ACCOR- <br /> TANK Size: /DCO total gallons pd.single compartment DANCE WITH THE REQUIREMENTS OF THE PERMIT AND THE RULES <br /> Manufacturer: t A),-.�V — /4- EA)y no.srr [ ] double compartment OF THE ENVIRONMENTAL QUALITY COMMISSION. <br /> Material: Cv, C t . [ ] flow-through l I I have tested the septic tank and certify it to be watertight. <br /> The system was installed by: — ub77069 �Yb <br /> Effluent Sewer: Header Pipe: c) y D-�rN,O FttyD em-11 y <br /> Size/Mat'I Size/Mat'l — Ca' co.et, r d IxProperty Owner(permittee) <br /> I I Licensed Sewage Disposal Service <br /> DRAINFIELD rock depth(inches) Box(es) <br /> Rock and under pipe Drop I I Concrete DEQ License Number: it)A- <br /> Pipe total depth I I Distribution I I Plastic Mk <br /> DEQ Certification Number: <br /> Drainfield Material(Alternative or perf.pipe)/i'%-j E_ FiDl..J <br /> Total Drainfield Footage 3 o( ' Trench Depth Minimum.14 Maximum fs <br /> Curtain Drain Depth Signed:_ <br /> lil Xlet-C741 <br /> Effluent Pump: Pump Model AM . <br /> Pump cycle 1401416D WA7 .. <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:_ 0/`;?Da? <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: Approved I I Approved with corrections:� see inspection report I I Denied <br /> Signed: \� Title: l( _i ( t)l 4 f� <br /> Date: U//0(2-7 <br /> MC:S-41 rev:3/03;4/12;5/14;11/17 G:\Forms\Septic\S-41 As-Built2015Version2017.doc WHITE:Marion County: YELLOW:Owner;PINK:Installer <br />