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. MARION COUNTY BIIIIIIINOtINSPECTION INDIVIDUAL ON-SITE SEWAGE SYSTEM RECORD
<br /> ' siss Silverton Rd.NE (to:be completed by system Installer):
<br /> • Salem)OR 97305
<br /> so3-51.38....51.47 pskivirtNo,555-23,004157:
<br /> MARION
<br />, • COUNTY
<br /> '. httptftwww.te.Malion.citt.iii/PVV/RuildirigItiapection 8ITEADDREss:12120:Itig411.$L .NE Woodburn
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<br /> SYSTEM MATERIALS-AND SPECIFICATIONS:: INSTALLERS CERTIFICATION:,
<br /> SyStem DesignSeivage:Firow 15° .Gallons/D.ay I HEREBY CERTIFY THAT THE ON,SITE SEWAGESYSTEM IN- '
<br /> • STALLEE.AT•THE..ABQVEADDEESSVAS,GONSTEUCTED:IN ACCOR:,•Con-c-t0-te Waite Corierete
<br /> 'Septic Tank.Size 1500 gallons Matl ' Mfg ' DANCE WITH THE REQUIREIONTS'OETEEpEINIT AND.THE RELES
<br /> OF THE.ENVIRONMENTAL QUALITY COMMISSION.
<br /> :Dosing Tank:.Size ,, _ gallOns Mel Mfg
<br /> pa I have tested the septic tank and certify to be watertight;
<br /> ATT.Malreand Model B (e.9; ,
<br /> • [[Distribution, Thesystert wast installed by:
<br /> Effluent Sewer:Size 4" ABS Mat'l [ [Di7pp
<br /> [ I Property Owner(pemiittee)
<br /> 1 1 Concrete ,. ,
<br /> Draintield Piper.Siie 4" [ ]Plestie Da Licensed Sewage Dispo.5a1 Service
<br /> Material:Header Pipe 26 4"30-34 PerfoMted Pipe DEQ License Number;37918
<br /> Total Drainfield..FOOtilge 1S6'- Traidi•Depth matt=1E" Maximum 24' DEQ Certification Numbec,.R1194 i
<br /> "
<br /> RockDeptIpToml 1.2 Under 6"-Pipe Curtain Drain Depth
<br /> Signed: , . 7.'''''''.-",''...---7."-7;
<br /> Alternative Draiiitield Materials
<br /> 'Effluent Purim: Pump Model. - 'company name: A,Affordable Septic Service
<br /> . Pomp:Cycle minutes :minutes
<br /> (please•
<br /> print).-
<br /> Time on ..: off Gallons pet Cycle.
<br /> 6/25/2024
<br /> '
<br /> Attachm
<br /> an additionalsheet forcoponents and mit ...ate.
<br /> ,materials listerlobove.
<br /> (For Marion Count*Use Oniv)
<br /> Thp(above septic system hes:been inspected by lytarion County:The-information has been'detennined to.be-acetiratetand thetS.ysteilti:i$::
<br /> [A Approved [ 1 A oved with correctio si see inspection report 1 i Denied
<br /> „ Signed: Title:: k,.-. 1- VI--3-3rag. Date:1-1
<br /> MGitS41.,retr:'3/03;412:5/14 WHITEMorrion County:YELLCFP:'awner;PINIOItidtill&"
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