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'i;h•'� MARION COUNTY BUILDING IN4PECTION INDIVIDUAL ON-S1TE SEWAGE SYSTEM RECORD <br /> 5155 Silverton Rd NE (to be completed by system installer) <br /> ~= SALEM OR 97305 <br /> 503-58S-5147 PERMIT NO. <br /> MARION <br /> COUNTY . http://www-co.marion.or.us/FW/Builtr ection os <br /> p sITE ADDxESs<3 g 58 7 ST" T 1awt, <br /> t AS-BUILT PLAN OF CONSTRUCTED SYSTEM: 9 73, <br /> Scale:1t <br /> PP L illa` North <br /> l� <br /> t _.. �a•uyrs�xlrra: <br /> Daft <br /> 1'` --.1 <br /> i i«00 <br /> ..pv.,,,,,,,i ....., <br /> , ,. <br /> ,,,,,,, <br /> ______,... .. .. J ,,,, <br /> (show all details and dimension.4 necessary to locate all components of the system in the fimue) <br /> SYSTEM MATERIALS AND SPECIFICATIONS: INSTALLERS CERTIFICATION: <br /> System Design Sewage Flow Gallons/Day I HEREBY CERTIFY THAT THE,ON-SITE SEWAGE SYSTEM IN- <br /> System AT THE ABOVE ADDRESS WAS CONSI'RI.IC ThD IN ACCOR <br /> TANK Size 1000 total gallons [1 ingte compartment DANCE WTTH THE REQUIREMENTS OF THE PERMIT AND THE RULES <br /> Manufacturer C] cable compartment OF THE ENVIRONMENTAL QUALITY COMMISSION: <br /> Material: rovI6r r-le_ [] low-through I. J I have tested the septic tank and certify it to be watertight <br /> Effluent Sewer: a Header Pipe: The system was installed by: <br /> Size/Maei AB 5 Size/Mat'I I. (Property Owner(permittee) <br /> I I Licensed Sewage Disposal Service s <br /> DRAINFIELD I rock"d th.(inches) liox(es). <br /> Rock and under pipe 8 [ 1 Drop Concrete DEQ License Number: 39 I ( �' <br /> Pipe total depth " I I.Distributio 1 I I Plastic <br /> DEQ Certification Number: kr;fool <br /> Drainteld Material(Alternative or perf:pipe) • - <br /> Total DrainfleldFootage 3745 Trench Depth Minimum_ Maximuma <br /> Curtain Drain Depth Signed: — L etYi '. Ir ) <br /> IIIV <br /> Effluent Pump: Pump Model • <br /> Pump cycle �� 1 � , L, <br /> times in minutes: on off Gallons per cte 1'bP,IYKI N C i Ji 1 <br /> . p y Company name. G �. Gx a,�a. v <br /> P Y <br /> t 1. <br /> ATT Make and Model C((pleaseprint) <br /> Attach an.additional sheet for components and materials not llstt d above. Date: • - I <br /> (For Marion Conn 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: Approved [ ] roved w Eli correcttions:.see inspectionnn report [ ]Denied <br /> ,Signed:Q Aik a C'y Tale: ' L IQ1 Date: ' ' <br /> MC:8-41 rev_3/03;4/12;5/14;11/17 0:1Forms\Septic\S-41 Astui1t2015 Version2017.doc WHIT$:Marten.County, •W.• er;PI !G'Lrstaller <br />