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<br /> •MARION:COUNTY BUILDING INSPECTION INDIVIDUAL ON—SITE SEWAGE SYSTEIVtitECOIO
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<br /> 5155 Sjfireit.p1R4,NE (to be completed by system installer)
<br /> • SALEM OR‘01305 .,
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<br /> .503-588-5147 PERMIT NOi,
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<br /> , http://www.co.m a rion.or.us/PW/Buildingl nspection SITE ADDRESS' 3 075 YYI_Oi4.4 0 ' elf 9'7o7 I
<br /> .. .AS-BUILT PLAN OF CONSTRUCTED SYSTEM; 1-:&;ie
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<br /> ...ishow.all,details,t4dimensions nrY to locate al Ledititiniterita of.the,svitemi in the
<br /> -1-SYFFEMMATERIALSANDSPECIVICATICiNSi INSTALLPIOCERTIFICATIOW
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<br /> I HEREBY CERTIFY THAT THE ON-SITE SEWAGE SYSTEM IN-
<br /> System Design Sewage Flow 5).5 Gallons/Day
<br /> STALLED AT THE ABOVE ADDRESS WAS CONSTRUCTED IN ACCOR-
<br /> TANK Size: /5 00 totalgallons
<br /> [ I single compartment . DANCE WITH THE REQUIREMENTS OF THE PERMIT AND THE RULES
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<br /> !.. OF THE ENVIRONMENTAL QUALITY COMMISSION.
<br /> Mannticturer:: :Rva; .. ..._. .... .. . , . ki double compartment
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<br /> Mttit;gal: 1.7444 -,.. . , .. ,,. [ ) flow-through , I ii I 1 I have tested the septic tank and certify it to be watertight.
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<br /> Effluent . A itiikdottiiik 1,1 The system was installed by:
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<br /> Si4iii4atk, - .S.;_e4":.--q, .t."1/-: VS:-. :tiiiiill- qc)..32/ Pv:c._ ,' ! I I Property Owner(permittec) - if
<br /> I I Licensed Sewage Disposal Service
<br /> ,T.DRAINFIELD 11. rock depth(inches)1 . t,Bift(00... r, •, .
<br /> Rock and under pipe '-'IA Drop [ 1 Concrete 1. : DEQ License NUM4663.11715.0,
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<br /> Pipe total depth - iffitStabuticai il.lflEtsii ..' ;!
<br /> • --. .- DEQ Certification Number I 3,475
<br /> Drainfield Material(Alternative or pert:-1401 „ „ ...„ „ .,..., „..- .......—......,--.....-- 1
<br /> I Total Drainfield Footage 11 Of Trench Depth Minimum 211 Maximum/.. •••
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<br /> •• i'. 1 Curtain Drain Depth Sagnid
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<br /> Effluent Pump: Pump Model.Ore ate
<br /> 1 1 Pump cycle y..,. .. 1 .times in minutes: ciii..-- 14' -Ia. off 15 WA, Gallons per Cycle 1 I :, Company tuirne: S-44061y.-Mc :: . -,
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<br /> tO ;AT Make and Model-.04t6vr.,d, . 5tii; .--, T
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<br /> Attach an.additionar,ilieeilor components materials not listed above. ... ... ... . . .Daten. :1,,..71:.4„.....,_. .....„. ..,.,.••.......... ,...,.......,.._ . ....., ., • '
<br /> IFoiNfiiiiiiiiiietiiiiiWIliitthil0 The above septic system Iiiibeeifinkieeted.vigiriiiiCOUrity., The information has been determined to be accurate! •
<br /> '.,andthe sySterD*4/1., Ap roved ".1 : Approved with corrections:-see inspection report j j Denied
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<br /> • ,,„ . ..ritlet C717.-5C-. --::-:: .':-::-;: :::::::.::.--.-Date:,..11..18..174
<br /> MC:441 rev:3/03;'4/1 ;5/14;II/I 7 G:\ForrnskSeptielS-41 AS:Bitila015Versititi2017:d66— ' - - WHITE:Marion Counoc..l'E LLOW:Owner;PIM:Installer
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