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MARION COUNTY BUILDING INSPECTIONSALEM OR INDIVIDUAL ON-SITE SEWAGE SYSTEM RECORD <br /> iiiiii <br /> 5155 Silverton Rd NE (to be completed by system installer)) <br /> 503 588-147 97305 PERMITNO._3S Zit 093eyg PR M r <br /> MARION COUNTY http://www.co.marion.or.us/PW/Buildinglnspection SITE ADDRESS: 37 Pr <br /> Y S l's'JtQ L� Jig <br /> 'AS-BUILT PLAN OF CONSTRUCTED SYSTEM: ,,,LA ItLi0 eC <br /> Scale:1"=.3 ' T <br /> JJ jG North <br /> • <br /> • 6 . <br /> • <br /> .% q o ._ . . <br /> (,.00� <br /> 0.pat ,. . <br /> 0 — G= HS <br /> If. <br /> Q— c <br /> • <br /> • Sl oQ <br /> CslOt _ 1 d <br /> l0 <br /> l�Et41°" 1 • <br /> 4( 1 , 30 1 - UYI <br /> tl1 .L <br /> 1 „ `Bt . . L,he <br /> 1.31( 30'. il; 1`3 t • td <br /> (show all details and dimensions necessary to locate all components of the system in the tun,-). <br /> SYSTEM MATERIALS AND SPECIFICATIONS: INSTALLERS CERTIFICATION:. <br /> System Design Sewage Flow 7 Gallons/Day I HEREBY CERTIFY THAT THE ON-SITE SEWAGE SYSTEM IN- <br /> -_ <br /> 1. 1 STALLED AT THE ABOVE ADDRESS WAS CONSTRUCTED IN ACCOR- <br /> TANK Size: L 41 total gallons Al single compartment DANCE WITH THE REQUIREMENTS OF THE PERMIT AND THE RULES <br /> Manufacturer: 1OG'49d <br /> [ ] double compartment OF THE ENVIRONMENTAL QUALITY COMMISSION. <br /> Material: (datt,rc [ I flow-through I ]I have tested the septic tank and certify it to be watertight. <br /> Effluent Sewer: Header Pipe: if <br /> The system was installed by: 'A.T ever e4f,s <br /> Size/Mat'1 h/t0 le) Size/Mat'l 4 ?���i I I Property Owner(permittee) • <br /> ( Licensed Sewage Disposal Service IeIdee' <br /> DRAINFIELD rock depth(inches) Box(es) . <br /> Rock and under pipe I I Drop --1-1--eoncrete---DEQ-License-Number: 18 <br /> Pipe total depth I I Distribution I I Plastic <br /> DEQ Certification Number: 3..5 <br /> Drainfield Material(Alternative or pert.pipe) r 421 coLt . <br /> Total Drainfield Footage g 06 Trench Depth Minimum 2.61 Maximum . 0 . <br /> Curtain Drain Depth �� Signed:_ <br /> .4'6,, gg,i <br /> Effluent Pump: Pump Model fie V . <br /> Pump cycle ® <br /> times in minutes: on off Gallons per Cycle Company name: M?(�r.ial�% I ("fea,�,-41 nu <br /> l (please <br /> ATT Mahe and Modelodel jlit print) <br /> ��� � <br /> Attach an additional sheet f components and materials not listed above. Date: <br /> (For Marion Conn se Onlvl_,The above septic system has been inspected by Marion County. The information has been determined to be accurate <br /> and the syst is: Appro I I Approved with corrections:see inspection report I I Denied y� ' <br /> Signed: Title:� S 1 �_0i3-i-1' Date:Gaff ,C 1 <br /> MC:S-41 rev:3/03;4/12;5/14;I I/17 G:\Forms\Septic\S-41 As-BuiIt2015Version2017.doc WFIITE:Marion County;YELLOW:Owner;PINK:Insialler <br />