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iiiiiMARION COUNTY BUILDING INSPECTION INDIVIDUAL ON-SITE SEWAGE SYSTEM RECORD <br /> 5155 Silverton Rd NE (to be completed by astern installer) <br /> SALEM OR 97305 /I � � <br /> 503-588-5147 PERMIT NO. Q( <br /> MARION <br /> COUNTY http://www.co.marion.or.us/PW/Buildinglnspection ? / l� <br /> SITE ADDRESS: �� ;(�Oi� LzN- <br /> AS-BUILT PLAN OF CONSTRUCTED SYSTEM: <br /> Scale: l"= [.lyr)vvSp1i44er- 1' <br /> North <br /> A :-t - Z7 r <br /> 1/'1 i _ <br /> \LI) <br /> . ; zec� <br /> ti <br /> . Nth 1 7 0 , <br /> -- ,_ <br /> 441/ . \\CO5 t ",6 <br /> • <br /> L, t k-5 [ • <br /> i sDo 4 <br /> (show all details and dimensions necessary to locate all components of the system in the ftture) <br /> SYSTEM MATERIALS AND SPECIFICATIONS: INSTALLERS CERTIFICATION: <br /> I HEREBY CERTIFY THAT THE ON-SITE SEWAGE SYSTEM IN- <br /> System Design Sewage Flow t•/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: t . ;.1. 5 [IT double compartment OF THE ENVIRONMENTAL QUALITY COMMISSION. <br /> Material: C-6vtC, [ ] flow-through [Chave tested the septic tank and certify it to be watertight. <br /> Effluent Sewer: i // Header Pipe: , .t The system was installed by: <br /> Size/Mat'l f/q P✓( - Size/Mat'l I-( PVC I I Property Owner(permittee) <br /> — r2ricensed Sewage Disposal Service <br /> DRAINFIELD rock depth(inches) Box(es)Rock and under pipe IN-Drop I I Concrete DEQ License Number: 3 BS- 'f <br /> Pipe total depth I I Distribution I I Plastic <br /> DEQ Certification Number: <br /> Drainfield Material(Alternative or pert.pipe) 2 C le.)LAD <br /> Total Drainfield Footage Trench Depth Minimum /6 Maximum_30 • <br /> Curtain Drain Depth_ tN/'4 . Signed: <br /> Effluent Pump: Pump Model V1' 50 . <br /> Pump cycle ,, <br /> times in minutes: on off Gallons per Cycle Company name:_ 0�A3C i _ Ce) . IA <br /> ATT Make and Model (please print) <br /> Attach an additional sheet for components and materials not listed above. Date: G // __ <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: 4 Appro [ i Approved with corrections: see inspection report I l Denied <br /> Signed: Title: ( 14 Vv rU/1(7gL Date: 02api <br /> 4 12•5 14. 11/17 G:\Forms\Setic\S-41 As-Built2015Version2017.doc WHITE:Marion County; YELL PINK:Insta11er <br /> MC:S 41 rev:3/03; / / p ty, OW:Owner; <br />