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aila MARION 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 /> 503-588-5147 PERMIT NO. cSS- a-000(0f} <br /> MARION 1 f A (�r Q COUNTY http://www.co.marion.or.us/PW/Buildinglnspection V tAh Lve SE Je,1+� 4' f c -`7/SITE ADDRES Q rl <br /> AS-BUILT PLAN OF CONSTRUCTED SYSTEM: <br /> Scale: 1"_ T <br /> P-`' 81 North <br /> 4 E koT <br /> r; � bolo g. L- gZ, <br /> 0')21' <br /> 'r �°' - C) . 10 Q, o <br /> e / 97 <br /> 1 , <br /> t 30 �' <br /> e 30 1- o t Llo <br /> I 4 0 C° E-r— (ol —�L <br /> e <br /> ✓' a 31"' I 9 <br /> lith <br /> AleP I''42'.'-.' 5 <br /> CP' <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� Gallons/Da I HEREBY CERTIFY THAT THE ON-SITE SEWAGE SYSTEM IN- <br /> System Design Sewage Flow y STALLED AT THE ABOVE ADDRESS WAS CONSTRUCTED IN ACCOR- <br /> TANK Size: 1,53O total gallons [ ] single compartment DANCE WITH THE REQUIREMENTS OF THE PERMIT AND THE RULES <br /> Manufacturer: 1A4..1 lien bg.double compartment OF THE ENVIRONMENTAL QUALITY COMMISSION. <br /> Material: Qt441(, <br /> [ ] flow-through I I I have tested the septic tank and certify it to be watertight. <br /> Effluent Sewer: \ 1 `� Header Pipe: The system was installed by: <br /> Size/Mat'I � '+ Soh xrll `v`'. Size/Mat'I I I Property Owner(permittee) <br /> I I Licensed Sewage Disposal Service <br /> DRAINFIELD rock depth(inches) Box(es) p <br /> Rock and under pipe I I Drop I I Concrete DEQ License Number: 3 `431 . <br /> Pipe total depth I Distribution I I Plastic <br /> p>� pipe) �,LF DEQ Certification Number: 2 <br /> Drainfield Material(Altem ti o i e <br /> Total Drainfield Footage 'french Depth Minimumt4'Maximumbt <br /> Curtain Drain Depth Sign <br /> Effluent Pump: Pump Model L,i Alit( .ry SS Sl S <br /> Pump cycle J A.ii-tticm r� bi_ikcPktimes in minutes: on off Gallons per Cycle Company name: • 1, <br /> ATT Make and Model (please print) <br /> Attach an additional sheet for components and materials not listed above. Date: 3/ CZ 2 _ <br /> (For Marion Count Use Only) The above septic system has been inspected by Marion County. The i ormation has been determined to be accurate <br /> and the system is: Approved I I Approved with corrections:0.1-s-r—'_, <br /> see inspection� report I I Denied / <br /> +~ <br /> Si ned: Title: 6 w <br /> ' ✓ Date: 7j4t 7—2 <br /> MC:S-41 rev:3/03;4/12;5/14; 13i G\Porin coticAS-41 As-Built2015Version20I7 doc WHITE:MarionCounjr: }ELL0ii"_Olt Her:I'ISK Instiller <br />