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MARION COUNTY BUILDING INSPECTION INDIVIDUAL ON-SITE SEWAGE SYSTEM RECORD <br /> dm <br /> 5155 Silverton Rd NE <br /> SALEM OR 97305 (to be completed by system installer) <br /> �/ / } <br /> 503-588-5147 PERMIT NO. '� 7c7�/ l <br /> • <br /> MARION <br /> COUNTY htt //www.co.marion.or.us/PW/Buildin Ins ection `fib !t-S1- �o <br /> P� g p SITE ADDRESS: � ��� <br /> AS-BUILT PLAN OF CONSTRUCTED SYSTEM: <br /> Scale: 1"= k5 5-61,01„.L T • <br /> North <br /> __ 3 b7J <br /> 4 ]pp' 4,.., w ar' <br /> fox 0 0 4 96,;\ c 5 <br /> _ `, ,s0.,., . <br /> 9'° O. <br /> . 5\ ‘'''''''''''. '2{4 ":k... :r; ...1 \.', <br /> • <br /> - -p_.' '..rrAdv\,\A ....Jii, . 4 ) CN1 -. <br /> • <br /> ADS <br /> < �, <br /> (s ow all etails and dimensions necessary to locate all components of the system in the future <br /> SYSTEM MATERIALS AND SPECIFICATIONS: INSTALLERS CERTIFICATION: <br /> r <br /> I HEREBY CERTIFY THAT THE ON-SITE SEWAGE SYSTEM IN- <br /> System Design Sewage Flow 31 C Gallons/Day STALLED AT THE ABOVE ADDRESS WAS CONSTRUCTED IN ACCOR- <br /> / <br /> . TANK Size: / D I,D total gallons 'ingle compartment DANCE WITH THE REQUIREMENTS OF THE PERMIT AND THE RULES <br /> n�' [ ] double compartment <br /> OF THE ENVIRONMENTAL QUALITY COMMISSION. <br /> Manufacturer: rL com p <br /> Material: Ve\0�5'4 C- [ ] flow-through 1 have tested the septic tank and certify it to be watertight., <br /> Effluent Sewer: �1I i/ Header Pipe: i� The system was installed by: <br /> Size/Mat'I 3P 3q Size/Mat'l w 3034 Property Owner(permittee) <br /> Licensed Sewage Disposal Service <br /> DRAINFIELD rock depth(inches) Box(es) �( ' <br /> Rock and under pipe )rop Concrete DEQ License Number: 9231 <br /> Pipe total depth I I Distribution I I Plastic �� <br /> DEQ Certification Number.:- . <br /> Drainfield Material(Alternative or perf.pipe) <br /> Total Drainfield Footage 3 �1 Trench Depth Minimum Z Maeimuni ® �� <br /> Curtain Drain Depth No Signed: , <br /> Effluent Pump: Pump Model N 0 <br /> Pump cycle y...,,,,„ <br /> `®� ._ , <br /> times in minutes: on off Gallons per Cycle Company name: 1®a-z:e- 1�,,,,, 9,714 <br /> ATT Make and Model v^' `jse(please <br /> print) <br /> Attach an additional sheet for components and materials not listed above. Date: -Z-®ali <br /> • (For Marion Count 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 ] Approved with corrections: see inspection report [ ] Denied <br /> Signed: ./,/rn A U tle:El-AY/I - Date: g�aoia.v <br /> 4' 1 G:\Fonns\ e tic\ -41 As-Built2015Version2017.doc WHITE:MarionCoun ' YELLOW.:Dwner;PINK:Installer <br /> SIC:S 41 rev:3/03;4/12;5/1 , 11/ 7 G. o p S County; <br />