Laserfiche WebLink
. .. . <br /> . . - <br /> MARION COUNTY BUILDING INSPECTION INDIVIDUAL ON-SITE SEWAGE SYSTEM RECORD <br /> gig 5155 Silverton Rd NE SALEM OR 97305 (to be completed by system installer) <br /> 503-588-5147. PERMIT NO. 0g3- 6 181 <br /> • MARION <br /> COUNTY • ilwww.co.marion.or.us/PW/Burldi http- ngInsgection SUE ADDRESS: 1$O83 • /Jlr_r rei,5 :L-A/' S i t r/erT/,�1 <br /> AS-BUICT.PLAN OF CONSTRUCTED SYSTEM: <br /> Scale:1"=2_t2 r rL 11/R7/w*`/ T <br /> North <br /> 0 -2..., 1,, 61, \ <br /> \ • _ . <br /> • <br /> • <br /> e3 •1:3— III 0," <br /> _ <br /> �.. Q[I `N... <br /> it loo E�'STt"a€� <br /> h'o e.° i ) . le, <br /> t <br /> -as !!1 M k% <br /> r <br /> eD�l `Q <br /> c• <br /> • <br /> • (show all details and dimen§ions nece sary to locate all components of the system in the future) '_ <br /> SYSTEM MATERIALS AND SPECIFICATIONS: INSTALLERS CERTIFICATION: <br /> System Design SewageFIow Gallons/Day I HEREBY CERTIFY THAT TEE ON-SITE SEWAGE SYSTEM IN- <br /> STALLED AT THE ABOVE ADDRESS WAS CONSTRUCTED IN ACCOR- <br /> Septic Tank:Size /500 gallons .Matz !'an CI C7 Mfg kit//4Yt e 77 • DANCE WITH THE REQUIREMENTS OF THE PERMIT AND THE RULES <br /> 6 '4 /G U+G OF THE ENVIRONMENTAL QUALITY COMMISSION. <br /> Dosing Tank:Size gallons Mafi Mfg <br /> • [x[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 y 1: Mat'1 A is 5 [ ]Drop [ ]property Owner(pemuttee) <br /> kt Concrete [ ]Licensed Sewage Disposal Service <br /> Drainfield Pipe:Size 4,' �[ ]Plasticstir <br /> Material:Header Pipe ??c' y 'Perforated Pipe DEQ License Number: '3 '51/ <br /> Total Drainfield Footage 3 75 Trench Depth Minimum Maximum DEQ Certification Number: <br /> Rock Depth:Total Under Pipe Curtain Drain Depth _ <br /> Alternative Drainfield Materials at,. F/on./ <br /> Signed: `"-----.----_ <br /> Effluent Pump: Pump Model Company name:_O I.e 13 erg ,--v,.,r? XC <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: 7/9-6/9V ...- <br /> (For Marion County Use Only) <br /> • <br /> Th ove septic system has been inspected by Marion County.The information has been determined to be accurate and the system is: <br /> [ J Approved [ ]Ap roved with corrections:see inspection.report [ I Denied <br /> Signed Title: -SI- \OZ3Z ' Date: -/V'f 7—1 <br /> MC:S-41 rev:3/03;4/12;5/1.4 WHITE:Marion County;YELLOW:Owner;PINK:Installer <br />