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• MARION COUNTY BUILDING INSPECTION INDIVIDUAL ON-SITE SEWAGE SYSTEM RECORD <br /> iiimi <br /> 5155 Silverton,Rd.NE (to be completed by system installer) <br /> -SALEM OR 97305 <br /> • .- 503-588-5147 PERMIT NO: c.SS-2:14± 00cg3.% <br /> MARION <br /> COUNT httpt//wwvti.co.marion.or.us/PW/Buiidinglnspection SITE ADDRESS: �-10 ` <br /> ADDRESS- IS �f'GLt1N 'YcL•ek , <br /> AS BUILT PLAN OF CONSTRUCTED SYSTIMVii <br /> Scale :I"= C <br /> North <br /> yC <br /> 17,rrint?.wo.i <br /> D <br /> r <br /> 37\>\\\., <br /> i .\\\ <br /> A- ( t 1: 94,4:,::4 <br /> TS — L II-A fh<c, <br /> (show all details and dimensions necessary to locate all components&the,system in the future) <br /> SYSTEM MATERIALS AND SPECIFICATIONS: INSTALLERS CERTIFICATION: <br /> I HEREBY CERTIFY THAT THE ON-SITE SEWAGE SYSTEM IN <br /> System Design Sewage Flow 1 'S Gallons/Day STALLED AT THE ABOVE ADDRESS WAS CONSTRUU LW IN ACCOR <br /> TANK Size: . .6 el Iota gallons igssingle compartment DANCE WITH THE REQUIREMENTS OF THE PERMIT ANOTHE RULES <br /> amnelrt OF THE ENVIRONMENTAL QUALITY COMMISSION. <br /> r:Manufactur ry double comp <br /> l r- I l p <br /> Material: t CS,;S; L_ [ I. flow-through )4 have tested the:.septic tank and certify it to be watertight. <br /> Effluent Sewer: .. Pleader Pipe The system was installed by: <br /> Size/Mat'l . (•'� ' t't..Size/Mat.I I Property Owner(permittee) <br /> PI-Licensed Sewage Disposal.Service <br /> DRAINFIELD I rock depth.(inches) Buz(es) <br /> Rock and under pipe I I Diop, 1 I Concrete DEQ License Number:er 3 S' . <br /> PiPe total depth 1 1 Distribution . 1 I:Plastic -�1 ``"' <br /> .. .. . . DEQ Certification 3ti3umber. .z.J <br /> Drainfield Material(Alternative or pert:pipe) <br /> Total Dranfleld.Footage. :Trench Depth Minimum Maximum_ <br /> Curtain Drain Dept Signed: <br /> •Effluent Pump:Pump Model <br /> Pump cycle • <br /> •times in minutes: on off Gallons per Cycle Co �O� a1 <br /> Company name:. � R <br /> ATT Make and"Model (please print) <br /> Attach an-additional sheetforcomponents and materials not listed above. is Date: '21 —e).. <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: Jy ft Approved .pp i.ved with corrections:see inspection report l T Denied <br /> Signed: II4, .i -co ./ itie: -' ) 101` 0 ( Date: — <br /> Mt-S-41 rry l/11i-dli?°•SIti1-'r:1"n7 P.•\F........ic�::ac A .A.r0..:wrn}cv:..».Inr-�wA...... .,...'.a. .r,-� • 2 n .... .. <br />