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ftMARION COUNTY BUILDING INSPECTION OR 97305 INDIVIDUAL ON-SITE SEWAGE SYSTEM RECORD <br /> 5155 Silverton Rd NE <br /> SALEM (to be completed by system installer) <br /> 503-588-5147 PERMIT NO. ! -Q01G 4=6- <br /> MARION r. <br /> COUNTY h :/lwww.co.marion.or.us/PW/Buildin Ins ection 3867 dE-' <br /> ttP g P SITE ADDRESS: / ` '�� �D <br /> 'AS-BUILT PLAN OF CONSTRUCTED SYSTEM: J_,13,2'7 -I'! e *7no <br /> Scale: 1"_ ' T <br /> • North , <br /> 4900 p0 <br /> /ArWirr <br /> 51/1" <br /> • <br /> �,4 Q� tAc '' b/4 1 <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 /> S stem Design Sewage Flow I HEREBY CERTIFY THAT THE ON-SITE SEWAGE SYSTEM IN- <br /> } g g 37 Gallons/Day STALLED AT THE ABOVE ADDRESS WAS CONSTRUt_I t:D IN ACCOR- <br /> TANK Size: bee total single compartment DANCE WITH THE REQUIREMENTS OF THE PERMIT AND THE RULES <br /> �, gallons [ ] double compartment OF THE ENVIRONMENTAL QUALITY COMMISSION. <br /> Manufacturer: WAt <br /> Material: Co w7 C.(2—e*e I I flow-through 6I have tested the septic tank and certify it to be watertight. <br /> Effluent Sewer: >> '/ > Bader Pipe: The system was installed by: <br /> Size/Mat'1 (� /'Size/l�fat'I I I Property Owner(permittee) • <br /> I I Licensed Sewage Disposal Service <br /> DRAIN FIELD rock depth(inches) Box(es) £XttT#'J <br /> Rock and under pipet: I I Drop I I Concrete DEQ License Number: SG 7/ / <br /> Pipe total depth_ _ I I Distribution I I Plastic fel g <br /> DEQ Certification Number: <br /> Drainfield Material(Alternative or perf.pipe) .."---. . <br /> Total Drainfield Footage "''— Trench Depth Minimum Maximum . e— <br /> Curtain Drain Depth Sign <br /> Effluent Pump: Pump Model -•----"--` . <br /> Pump cycle <br /> times in minutes: on , off ""— Gallons per Cycle Company name:ZI 1.4° —E v (e1 , /N L. <br /> ATT Make and Model (plleeaseyrint) <br /> Attach an additional sheetfor components and materials not listed above. Date: r 7/ <br /> n ,� Du.Marion Coon Only) The above.septic system has been inspected by Marion County. hc, / _information has been determined to be accurate <br /> and the system is: NfApproved I I Approved with corrections:see inspection report I j Denied i <br /> Sigled:X j Title: ST I______ ` Date: 31 r/Z ' <br /> MC:S-41 rev:3/03;4/12;5/14;11/l7 G:iForms\Septic\S-41 As-BuiIt2015Version2017.doc WHITE:hlarionCounty;YELLOW:Owner;PINK:Installer <br />