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iiiiiMARION 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 /> rJ �a <br /> 503-588-5147 PERMIT NO. L 6‘0",1�/ <br /> COUNMARIOTY <br /> `( b <br /> http://www.co.marion.or.us/PW/Buildinglnspection <br /> SITE ADDRESS: 7967 Jzd r3�tP.rnr1 .4%) <br /> AS-BUILT PLAN OF CONSTRUCTED SYSTEM: DD <br /> Scale: 1"= .7 T <br /> ,/ North <br /> APPROVED AS-BUILT A - , %�- <br /> DRAWING <br /> �tt . �, / t. <br /> _-„,IJCI <br /> N <br /> L1' <br /> -1 ' • <br /> / 1 <br /> ,s <br /> A- t , <br /> I <br /> ,_ <br /> \ i t 1/.1 <br /> I . <br /> III <br /> tC <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 /> I HEREBY CERTIFY THAT THE ON-SITE SEWAGE SYSTEM IN- <br /> System Design Sewage Flow la-0 Gallons/Day STALLED AT THE ABOVE ADDRESS WAS CONSTRUCTED IN ACCOR- <br /> TANK Size: /5-0-c, total gallons ,vr single compartment DANCE WITH THE REQUIREMENTS OF THE PERMIT AND THE RULES <br /> Manufacturer: �.Il�,.� <br /> I double compartment OF THE ENVIRONMENTAL QUALITY COMMISSION. <br /> Material: e..e,,.) <_. ( I flow-through I I I have.tested the septic tank and certify it to be watertight. <br /> 4.Effluent Sewer: Header Pipe: The system was installed by: <br /> Size/Mall 4 ti 1)(,,—n/ Size/Mat'I Xi" Z7Z9 I I Property Owner(permittee) <br /> Licensed Sewage Disposal Service <br /> DRAINFIELD rock depth(inches) Box(es) �J �7 <br /> Rock and under pipe 6'1 14 Drop NConcretc I)EQ License Number: 3,fl -�/ <br /> Pipe total depth /Z" I I Distribution I I Plastic <br /> DEQ Certification Number: <br /> Drainfield Material(Alternative or perf.pipe) Z7Za} <br /> Total Drainfield Footage 37 5 Trench Depth Minimum Z 4 Maximumi,Lj <br /> Curtain Drain Depth L)/A Signed: <br /> Effluent Pump: Pump Model PIA <br /> Pump cycle <br /> times in minutes: on off Gallons per Cycle Company name:_; pe 'c fr S Pw Th <br /> All'Make and Model Jli/j� ) (please print) <br /> Attach an additional sheet for components and materials not listed above. Date: E/,/I Z J <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 'f/ <br /> Si ned: it <br /> Title: / lC% '—S Q 21 Date: 1 <br /> MC:S-4 rev:3/03;4/12;5/14; 11/17 G:\Forms\Septic\S-41 As-Built2015Version2017.doc W/IITE:Marion County; YELLOW:Owner;PINK:Installer <br />