Laserfiche WebLink
ON-SITE SEWAGE SYSTEM RECORD <br /> MARION COUNTY BUILDING INSPECTION INDIVIDUAL <br /> dibi <br /> 5155 Silverton Rd NE <br /> SALEM (to be completed by system installer) <br /> OR 97305 503-588-5147 PERMIT NO. 555-23 -®®.;oO PA�v1,A� <br /> i- <br /> MARION <br /> COUNTY htt //www.co.marion.or.us/PW/Buildin Ins ection <br /> P� g P SITE ADDRESS: 176 0,S.-- pill�n l pd <br /> 1/0 <br /> AS-BUILT PLAN OF CONSTRUCTED SYSTEM: <br /> Scale: 1"= T <br /> North <br /> • <br /> ecC(..2 (ljrAji <br /> • <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 /> 307 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: 8 000 total gallons single compartment DANCE WITH THE REQUIREMENTS OF THE PERMIT AND THE RULES <br /> Manufacturer: <br /> DWG! �n j� [ ] double compartment OF THE ENVIRONMENTAL QUALITY COMMISSION. <br /> Material: C,0yt e,ftIC [ ] flow-through 1 I I have tested the septic tank and certify it to be watertight. <br /> Effluent Sewer: ��+ 4Header Pipe: r l The system was installed by: <br /> Size/Mat'I '/ Size/Mat'l ' V Property Owner(permittee) • <br /> 'I Licensed Sewage Disposal Service <br /> DRAINFIELD rock depth(inches) Box(es) <br /> Rock and under pipe 1 I I Drop IX Concrete DEQ License Number: <br /> Pipe i I ,_ <br /> total depth B � I I Distribution I I Plastic <br /> DEQ Certification Number: <br /> Drainfield Material(Alternative or perf.pipe) <br /> Total Drainfield Footage 300 Trench Depth Minimum 14 MaximumZt ���'ey <br /> Curtain Drain Depth Signed: <br /> Effluent Pump: Pump Model . <br /> Pump cycle <br /> times in minutes: on off Gallons per Cycle __ Company name: <br /> (please print) <br /> ATT Make and Model �/!d �� <br /> Attach an additional sheet for components and materials not listed above. Date: /l <br /> (For Marion Co nt 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: proved I I Approved with corrections: see inspection report I ] Denied U <br /> Signed: Title: 6 Date: 11g <br /> MC:S-41 rev:3/03;4/12;5/14; 11/17 G:\Forms\Septic\S-41 As-BuiIt20I5Version20l7.doc WHITE:Marion County; YELLOW:Owner;PINK:Installer <br />