Laserfiche WebLink
AuMARION COUNTY BUILDING INSPECTION INDIVIDUAL ON-SITE SEWAGE SYSTEM RECORD <br /> 5155 Silverton Rd NE <br /> SALEM OR 97305 (to be completed by system installer)503-588-5147 PERMIT NO. I -'U Sy <br /> MARION <br /> COUNTY http://www.co.marion.or.us/PW/Buildinglnspection SITE ADDRESS: 7961 /4 P,r/ ,r1pll <br /> AS-BUILT PLAN OF CONSTRUCTED SYSTEM: <br /> Scale: 1"= A T <br /> 1 North <br /> APPROVED AS-BUILT - -SGn <br /> DRAWING , <br /> r <br /> QG/oct ) �„ ,--, Iw " <br /> tIN <br /> t- C` `I J - <br /> C <br /> r- ,CI <br /> / , <br /> N <br /> J <br /> 1 e . <br /> n <br /> 1 <br /> • <br /> \ 1 1 <br /> I \ 1 _ - V <br /> N- 1 C,- <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 q,SO Gallons/Day STALLED AT THE ABOVE ADDRESS WAS CONSTRUCTED IN ACCOR- <br /> TANK Size: /SOS total gallons /single compartment DANCE WITH THE REQUIREMENTS OF THE PERMIT AND THE RULES <br /> Manufacturer: LJ•1 I6i,-,. <br /> y_ [ ] double compartment OF THE ENVIRONMENTAL QUALITY COMMISSION. <br /> Material: C. [ ] flow-through [ I I have tested the septic tank and certify it to be watertight. <br /> Effluent Sewer: Header Pipe: The system was installed by: <br /> Size/Mat'I U it D(.-,>./ Size/Mat'l i/" Z7Z7 I I Property Owner(permittee) <br /> [�L,icensed Sewage Disposal Service <br /> DRAINFIELD rock depth(inches) Box(es) p! <br /> Rock and under pipe 4 1,4 Drop ),,(Concrete DEQ License Number: 3 ./�-7 <br /> Pipe total depth /Z)r _ -I I Distribution I I Plastic DEQ Certification Number: <br /> Drainfield Material(Alternative or perf.pipe) Z7Z, <br /> Total Drainfield Footage 3 7 f Trench Depth Minimum ill Maximum,L Curtain Drain Depth WA Signed:y/ \ <br /> Effluent Pump: Pump Model NIA <br /> Pump cycle <br /> times in minutes: on off Gallons per Cycle Company name: . -j-ste-0 PL .tz\ <br /> J (please print) <br /> ATT Make and Model /I//A <br /> Attach an additional sheet for components and materials not listed above. Date: 4 AZ,_Ci <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 <br /> Title: ���2� Date: i� ( �� <br /> Signed �s� � ` <br /> : <br /> MC S-4 rev:3/03:4/12:5/14: 11/17 G:\Forms\Septic\S-41 As-BuiIt20I 5Version2017.doc WHITE:MarionCounty; YELLOW:Owner;PINK:Installer <br />