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i <br /> '� _. MARION COUNTY BUILDING INSPECTION <br /> ___ ' 5155 Silverton Rd NE <br /> ^�"�' SALEM OR 97305 <br /> MARION INDIVIDUAL ON-SITE SEWAGE SYSTEM RECORD <br /> COUNTY / . (to be(completed by system installer) <br /> SITE ADDRESS: (eFf l u,./,.i Q,Q me S.,1gi4, O& PERMIT NO. ��i 1 -/-co v <br /> ^Y /730$ <br /> AS-BUILT PLAN OF CONSTRUCTED SYSTEM: <br /> Scale: 1"= y0 ' - unnrV � I <br /> ,—.., • T <br /> 'Pr/ North <br /> �� APPROVED A <br /> S BUILT <br /> . is DRAJC WING <br /> I_ • <br /> o <br /> 70 SFr -------7 et„rrpii p <br /> 20_ 54a Gk.' <br /> P•MP raid: <br /> Ito ogAuta.itc(show all details and dimensions necessary to locate all components of the system in the future) <br /> SYSTEM MATERIALS AND SPECIFICATIONS: INSTALLERS CERTIFICATION: <br /> System Design Sewage Flow: 9$O Gallons/Day I HEREBY CERTIFY THAT THE ON-SITE SEWAGE SYSTEM IN- <br /> STALLED AT THE ABOVE ADDRESS WAS CONSTRUCTED IN ACCOR- <br /> Septic Tank:Size: /,BOO GAL:Mat'I Conerei . Mfg: A04 DANCE WITH THE REQUIREMENTS OF THE PERMIT AND THE RULES <br /> r • OF THE ENVIRONMENTAL QUALITY COMMISSION. <br /> ,• <br /> Dosing Tank:Size: SPIO Mat'l ?laaht Mfg:Znfi'I4r..+or yt I have tested the septic tank and certify it to be watertight. <br /> Alternative Treatment Technology The system was installed by: <br /> - Property Owner(permitee) . <br /> Effluent Sewer:Size; / MaL'l:?VC 30311 I I Licensed Sewage Disposal Service <br /> Box(es): I I Distribution; I I Drop / I I Concrete; I I Plastic DEQ License Number: <br /> Drainfield Pipe:Size: a :Material:Header: ci ;Pert_ , DEQ Certification umber. <br /> Total Draint'ield Footage:' FT:Rock Depth:Total:. p :Under Pipe: fit <br /> Signed: <br /> Alternative Drainficld Materials:.Z .ck lied 02 4r•c;n <br /> IroM G7w,s_) <br /> 'Trench Depth:MinimumMaximum_;Maximum_2,�" ;Curtain Drain Depth: Company name: Crt <br /> ,;a+trGiw* (please print) <br /> Effluent Pump:Pump Modell.. -5024 Static Head in System Ft. _/ _/S <br /> Date: <br /> Pump Cycle Time: ;Gallons per Cycle: <br /> Attach an additional sheet for components and materials not listed above. <br /> (For Marion County may) <br /> T above septic syst has been inspected by anion County.The information has been determined to be accurate and the system is: <br /> pproved <br /> I I Approved wit corre ' s:see• ection report . <br /> II Denied /r- <br /> Sign • Title: Cy� Date: t4 a 42 <br /> MC: S-41 rev:3/03;4/12 WHITE:Marion County; YELLOW:Owner;PINK:Installer <br /> r, <br />