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N‘.„,,, MARION COUNTY BUILDING INSPECTION INDIVIDUAL ON-SITE SEWAGE SYSTEM RECORD <br /> �`- 5155 Silverton Rd NE (to be completed by system installer) <br /> SALEM OR 97305 503-588-5147 PERMIT NO. Z!— 00 !r /rr� <br /> MARION <br /> COUNTY http://www.co.marion.or.us/PW/BuildingInspection �j <br /> SITE ADDRESS: 1 75 NJ F.113 j•-/ ry2 <br /> AS-BUILT PLAN OF CONSTRUCTED SYSTEM: <br /> Scale: 1"_ ' <br /> North <br /> SCE. 41-TrA-c-RA-t <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 /> System Design Sewage Flow 3 7.s" Gallons/Day I HEREBY CERTIFY THAT THE ON-SITE SEWAGE SYSTEM IN- <br /> STALLED AT THE ABOVE ADDRESS WAS CONSTRUCTED IN ACCOR- <br /> TANK Size: /cXV total gallons )4 single compartment DANCE WITH THE REQUIREMENTS OF THE PERMIT AND THE RULES <br /> double compartment <br /> OF THE ENVIRONMENTAL QUALITY COMMISSION. <br /> Manufacturer: /NFIt j 4'TdR. [ 1 p <br /> Material: poly P�4LY/J, [ 1 flow-through I4 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'l Size/Mat'l I I Property Owner(permittee) <br /> pot Licensed Sewage Disposal Service <br /> _DRAINFIELD rock depth(inches) Box(es) QZ <br /> Rock and under pipe I I Drop I I Concrete DEQ License Number: 3926 <br /> 6 <br /> Pipe total depth I I Distribution I I Plastic <br /> DEQ Certification Number: <br /> Drainfield Material(Alternative or perf.pipe) 6-/zietJI-16,6s <br /> it <br /> Total Drainfield Footage/3.s Trench Depth Minimum /$MaximumZ 7— <br /> Curtain Drain Depth_ i Si <br /> Effluent Pump: Pump Model L I Sf7 <br /> Pump cycle times in minutes: on off Gallons per Cycle Company name:(/4 PA9 C/v51 eVeri,N („4,ri <br /> M/GI0/6 (please print) <br /> ATT Make and Model vrraJ / <br /> Attach an additional sheet for components and materials not listed above. Date: f�/ 4 r (i _ <br /> (For Marion Count se Only) The above septic system has been inspected by Marion County. The information has been determined to be accurate <br /> and the system is: (j Approved [ ] Approved with corrections: see inspection report [ ]Denied <br /> Signed: iG S-3 -3- Date: T/ I /71- <br /> MC:S-41 rev:3/03;4/12;5/14;11/17 G:\Forms\Septic\S-41 As-BuiIt2015Version2017.doc WHITE:Marion County;YELLOW:Owner;PINK:Installer <br />