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lt�� MARION COUNTY BUILDING INSPECTION INDIVIDUAL ON-SITE SEWAGE SYSTEM RECORD <br /> 5155 Silverton Rd NE (to be completed by system installer) <br /> SALEM OR 97305 <br /> MARION 503-588-5147 PERMIT NO. ...S.SS -Z 3 - 2/ •7 ?S <br /> COUNTY <br /> http://www.co.marion.or.us/PWBuildingInspection SITE ADDRESS: &"13 4, JT;'S.42 pt., 5+— 5 40A- <br /> AS-BUILT PLAN OF CONSTRUCTED SYSTEM: <br /> Scale:1"= 'l 56,74.. ,i. <br /> C North <br /> d <br /> r.. .tN2:\ <br /> I L <br /> f b,1:- t 52- . <br /> cs. f <br /> 1 ,Stkn t <br /> . • <br /> 1 ., „,...,,, <br /> —ors-- ]s <br /> .44 t <br /> ._,..._ <br /> • . <br /> . t 1 (1 17' • <br /> - IbN.tJ-2 -"e-'/ <br /> (show all details and dimensions necess to locate all components of the system in the future) <br /> SYSTEM MATERIALS AND SPECIFICATIONS: INSTALLERS CERTIFICATION: <br /> Design Sewage Flow /'/S Gallons/Day I HEREBY CERTIFY THAT THE ON-SITE SEWAGE SYSTEM IN- <br /> SystemSTALLED AT THE ABOVE ADDRESS WAS CONSTRUCTED IN ACCOR- <br /> TANK Size: /000 total gallons [ single compartment DANCE WITH THE REQUIREMENTS OF THE PERMIT AND THE RULES <br /> Manufacturer. 1,00 asp`4 -S [ ] double compartment OF THE ENVIRONMENTAL QUALITY COMMISSION. <br /> Material: ea,�e..--- [ ] flow-through [ 1"have tested the septic tank and certify it to be watertight. <br /> Effluent Sewer: it Header Pipe: The system was installed by: <br /> SizelMat'I }I tD Size/Mat'l i-/' 71 261 I Property Owner(permittee) <br /> I.l-);ieensed Sewage Disposal Service <br /> DRAINFIELD I rock depth(inches) Box(es) <br /> Rock and under pipe PFDroP I I Concrete DEQ License Number: .3 70f'.. <br /> Pipe total depth I I Distribution IX-Plastic <br /> DEQ Certification Number. lZ- I ` Q/ <br /> Drainfield Material(Alternative or pert.pipe) €.u-S7 deol' <br /> Total Drainfield Footage 1-I3l� Trench Depth Minimum?..-) 'Maximum t f <br /> • Curtain Drain Depth • Signed ----- --/ ------- <br /> Effluent Pump: Pump Model - <br /> Pump cycle <br /> times in minutes: on off Gallons per Cycle Company name:_ I--t9 Uxe--- nn <br /> ATT Make and Model (please print) <br /> Attach an additional sheet for components and materials not listed above. Date: f'—.3 I—23 <br /> (For Marion Conn 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 inspectionns(� report I ]Denied <br /> Si ned: Title: /91 J�f�/Z L/v " Date: �1 (8 (VI <br />