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r4 <br /> dirMARION COUNTY BUILDING INSPECTION INDIVIDUAL ON-SITE SEWAGE SYSTEM RECORD <br /> 5155 Silverton Rd NE SALEM OR 97305 (to be completed by system installer) <br /> 503-588-5147 PERMIT NO. S C S '271"oo a b 9 <br /> MARION <br /> COUNTY http://www.co.marion.or.us/PW/Buildinglnspection SITE ADDRESS: 2961.2_ Vtgekr ea J , ?CI4.)I, \ <br /> AS-BUILT PLAN OF CONSTRUCTED SYSTEM: <br /> Scale: 1"=_a3 (Ave- 2.� �*+ <br /> • \i North <br /> �C <br /> - i-kirlf' <br /> See <br /> A -c-= gs <br /> c 0 a 2—C- :16r I( <br /> Ni- ril <br /> I ti <br /> s <br /> 4216 <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 (Ow Gallons/Day STALLED AT THE ABOVE ADDRESS WAS CONSTRUCTED IN ACCOR- <br /> TANK Size: (Teo total gallons [N.single compartment DANCE WITH THE REQUIREMENTS OF THE PERMIT AND THE RULES <br /> (y��yka,tx,r,♦� c �ys� double compartment <br /> OF THE ENVIRONMENTAL QUALITY COMMISSION. <br /> Manufacturer: (( [ ] p <br /> Material: Cc'-I4 _&-a_ [ ] flow-through Xl 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 ,✓0.S1A (( Size/Mat'I 3o� 8(,/ I I Property Owner(permittee) <br /> IOr(:icensed Sewage Disposal Service <br /> ' DRAINFIELD_ rock depth(inches) Box(es) <br /> Rock and under pipe ‘,j 14,..prop I I Concrete DEQ License Number: Elora <br /> Pipe total depth -3o I I Distribution 4e..Plastic <br /> �� DEQ Certification Number: Z t tz_ <br /> Drainfield Material(Alternative or pert.pipe) I r P� $ I <br /> "Total Drainfield Footage Sea , Trench Depth Minimum Z. Maximum!a <br /> Curtain Drain Depth Signed:_ <br /> Effluent Pump: Pump Model . <br /> Pump cycle �X(ogi"-1�t t_ I �-L <br /> times innminutes: on off Gallons per Cycle_ Company name:_ <br /> ATT Make and Model (please print) <br /> Attach an additional sheet for components and materials not listed above. Date: q' (' 23 <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: lokApproved I I Approved wi corrections:see inspection report I I Denied <br /> Signed: �..-.."—_ _ Title: IDS wzzir. _ Date: I 1° /1,02)1 <br /> 1 <br /> \I(':S-4 I rev:3/03;4/12;5/14;11/17 G:A Forms\Septic AS-41 As-Built2015Vcrsion2017-doc WHITE:Marion County; YELLO(I':Owner;PINK:Installer <br />