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ftMARION COUNTY BUILDING INSPECTION INDIVIDUAL ON-SITE SEWAGE SYSTEM RECORD <br /> 5155 Silverton Rd NE SALEM OR 97305 (to be completed by system installer) <br /> 503-588-5147 PERMIT NO. SS 5— 2i7 - Ob . l 9$.- <br /> MARION • <br /> COUNTY http://www co.marion.onus/PW/BuildingInspection (7 �S <br /> SITE ADDRESS: 1�.4 c Qi7�Jj, 1t1 <br /> e•.RI]QJp!AN OF CONSTRIICTF.D SYSTEM: <br /> PL 6{�'- 58451 "E <br /> [2'4 - -o _ . ; <br /> ril <br /> - � _ <br /> ` CC <br /> 'iiiii , Q <br /> C}7 �t ;,t µ JUN— <br /> rri <br /> " 5 <br /> • <br /> f I/ ,� I <br /> i iy� <br /> .10pl -�- N <br /> Q <br /> H <br /> co <br /> to <br /> •S$' \ EXISTING iv . , <br /> "Id 2bi„wiz <br /> GRAVEL <br /> AY <br /> 7� 61Q2� r. • <br /> II <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 /> Design Sewage Flow O� GallonslDay I HEREBY CERTIFY THAT THE ON-SITE SEWAGE SYSTEM IN- <br /> SystemSTALLED AT THE ABOVE ADDRESS WAS CONSTRUCTED IN ACCOR- <br /> TANK Size: (,SOD total gallons [ ] single compartment DANCE WITH THE REQUIREMENTS OF THE PERMIT AND THE RULES <br /> Manufacturer: ,..,c,�--r,-..S [>double compartment OF THE ENVIRONMENTAL QUALITY COMMISSION. <br /> h 14 I have tested the septic tank and certify it to be watertight. <br /> Material: �.,.�•��� [ ] flow-throwg <br /> Effluent Sewer: Header Pipe: The system was installed by: <br /> Size/Mat'! I V'-) ,eft- A/0 Size/Mat'I I I Property Owner(permittee) <br /> ,Ki Licensed Sewage Disposal Service <br /> DRAINFIELD rock depth(inches) Box(es) <br /> Rock and under pipe l 2. `` I I Drop I I Concrete DEQ License Number. 3 7e7C, <br /> Pipe total depth 1 9l ( (Distribution ( (Plastic DEQ Certification Number: 12,[ 'k 15 <br /> Drainfield Material(Alternative or pert.pipe) <br /> Total Drainfield Footagen50 Trench Depth Minimum. RI Maximum_O <br /> • Curtain Drain Depth Signed: --1`-- <br /> Effluent Pump: Pump Model -S C'S D i' . <br /> Pump cycle <br /> times in minutes: on off Gallons per Cycle Company name:- Lo '- cP, t Le- ..t,e,jJ+z\C.$ <br /> ATT Make and Model (please print) <br /> Attach an additional sheet for components and materials not listed above. Date: =7 ' 2 <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: [i/ Approved I I Approved with corrections:see inspection report I ] Denied <br /> Signed: Title: Ok 51 'D-1;534' Date:141ZJ2)-� <br />