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• <br /> 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 <br /> 503-588-5147 PERMIT NO. 555-24-003165-PRMT <br /> MARION <br /> COUNTY httpJ/www.co.marion.or.us/PWBuildingInspection <br /> SITE ADDRESS: 6725 Skyline Rd S <br /> Salem,Oregon,97302 <br /> AS-BUILT PLAN OF CONSTRUCTED SYSTEM: <br /> Scale:1" =_' <br /> North <br /> See Attached <br /> (show all details and dimensions necessary to locate all components of the system in the future) <br /> SYSTEM MATERIALS AND SPECIFICATIONS: I INSTALLERS CERTIFICATION: <br /> System Design Sewage Flow 45o Gallons/Day I HEREBY CERTIFY THAT THE ON-SITE SEWAGE SYSTEM IN- <br /> STALLED AT THE ABOVE ADDRESS WAS CONSTRUCPhD IN ACCOR- <br /> Septic Tank:Size Exist 1000 gallons Mat'1 cons Mfg? DANCE WITH THE REQUIREMENTS OF THE PERMIT AND THE RULES <br /> Second Tank OF THE ENVIRONMENTAL QUALITY COMMISSION. <br /> Dosing Tank:Size 500 gallons Mat'l Plastic Mfg Infiltrator <br /> [?]I have tested the septic tank and certify it to be watertight. <br /> ATT Make and Model Box(es): <br /> [ ]Distribution The system was installed by: <br /> Effluent Sewer:Size a^ Mat'1 PVC 3034 [ ]Drop <br /> [ ]Concrete [ ]Property Owner(permittee) <br /> Drainfield Pipe Size [ ]Plastic [x]Licensed Sewage Disposal Service <br /> Drainfield all <br /> Existing <br /> Material:Header Pipe Perforated Pipe DEQ License Number: as sa <br /> Total Drainfleld Footage Trench Depth Minimum_ Maximum_ DEQ Certification Number: RI 792 <br /> Rock Depth:Total Under Pipe Curtain Drain Depth_ <br /> Signed: <br /> Alternative Drainfield Materials <br /> Effluent Pump: Pump Model Company name: New Creation Contracting <br /> Pump Cycle minutes minutes (please print) <br /> Time on off Gallons per Cycle <br /> Attach an additional sheet for components and materials not listed above. Date: 7/4/24 <br /> (For Marion County Use Only) <br /> The above septic system has been inspected by Marion County.The information has been determined to be accurate and the system is: <br /> V Approved [ ]Approved with corrections:see inspection report [ ]Denied <br /> ` / <br /> Signed: Inebi � Title: Date: /)/� � <br /> MC:S-41 rev:3/03;4/12;5/14 WHITE:Marion County;YELLOW:Owner;PINK:Installer <br />