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iiihrMARION COUNTY BUILDING INSPECTION INDIVIDUAL ON-SITE SEWAGE SYSTEM RECORD <br /> 5155 Silverton8 Rd NE (to be completed by system installer) <br /> SALEM 97305 <br /> 5 3- PERMIT NO. ccc—23 —O O O 1 12-PRAT- <br /> MARION <br /> COUNTY http://www.co.marion.onus/PW/Buildinglnspection SITE ADDRESS: 439L j —7(Si Mr SE-I SAC, <br /> AS-BUILT PLAN OF CONSTRUCTED SYSTEM: <br /> Scale: 1"=r T <br /> r <br /> North <br /> i 5.1DT &,�4 /� <br /> HO <br /> \tf / . <br /> -- 6Of . C <br /> A -C i-lol6`r <br /> C. <br /> A - 0 <br /> 3 I O II poi) GAL_Sr#'11 <br /> 4i3 -C 461Q'I Sao GAL Otbiv-t.,- <br /> t <br /> i3_0 `{"�6,, <br /> E-G 36 C <br /> F -Cr 5-2`O i' <br /> E— H 461 g r i E M , +v <br /> F-N 6/ / 91i <br /> M -T 40f I`t I.� �" <br /> xiirk <br /> N -tti3 fC', Cr 3 <br /> M -K S( ' S 11 ` H• Iv K L �. <br /> N ^-K 1-{I l a '' test. ',f. Sic <br /> M —L ?2/ O ' Hew <br /> Se <br /> N-Lc Ito `t <br /> F <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 /> System Design Sewage Flow Gallons/Day I HEREBY CERTIFY THAT THE ON-SITE SEWAGE SYSTEM IN- <br /> STALLED AT THE ABOVE ADDRESS WAS CONSTRUCTED IN ACCOR- <br /> TANK Size: 15 ogotal gallons [ ] single compartment DANCE WITH THE REQUIREMENTS OF THE PERMIT AND THE RULES <br /> Manufacturer: n icwt e 1 <br /> IA double compartment OF THE ENVIRONMENTAL QUALITY COMMISSION. <br /> Material: C.Da G. tY [ ] flow-through Khave tested the septic tank and certify it to be watertight. <br /> Effluent Sewer: it v,, Header Pipe: The system was installed by: <br /> Size/Mat'I C. 1 ' — 1 (� Size/Mat'I 4roperty Owner(permittee) <br /> I I Licensed Sewage Disposal Service <br /> DRAINFIELD rock depth(inches) Box(es) <br /> Rock and under pipe I I Drop I I Concrete DEQ License Number: <br /> Pipe total depth I I Distribution I I Plastic <br /> DEQ Certification Number: <br /> Drainfield Material(Alternative or perf.pipe) E Z' c..J i..) \2 I &d <br /> Total Drainfield Footage `54)r Trench Depth Minimum SO"Maximum'1. <br /> Curtain Drain Depth_ Signed:_ 1V0,_4 g--41111'1'./.7"---- <br /> Effluent Pump: Pump Model fJ keEtAcv Nit 30e)5 I 1 <br /> Pump cycle <br /> times in minutes: on off Gallons per Cycle__ _ Company name:_ <br /> All'Make and Model I ( lleassee�print)Attach an additional sheet for components and materials not listed above. Date: �� `"�: <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: Ilt pproved I I Approved with corrections: see inspection report I I Denied <br /> Signed:��--N._ ___..r Title: I vEilc (-(Z Date: 144 'i c <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:Installei <br />