Laserfiche WebLink
gillMARION COUNTY BUILDING INSPECTION INDIVIDUAL ON-SITE SEWAGE SYSTEM RECORD <br /> 5155 Silverton Rd NE (to be completed by system installer) <br /> Salem,OR 97305 <br /> 503-588-5147 PERMIT NO. 555-24-002904 <br /> MARION <br /> COUNTY h ww. an://w co arion.or.us/PWBuildin action <br /> >rtP IMP <br /> ' STl'h ADDRESS: 3868 Riverdale Rd S <br /> Salem,Oregon,97302 <br /> AS-BUILT PLAN OF CONSTRUCTED SYSTEM: <br /> Scale:1" =_' T <br /> North <br /> See Attached <br /> (show all details and dimensions necessary to locate all components of the system in the future) <br /> SYSTEM MATERIALS AND SPECIFICATIONS: INSTALLERS CERTIFICATION: <br /> System Design Sewage Flow 375 Gallons/Day I HEREBY CERTIFY THAT THE ON-SITE SEWAGE SYSTEM IN- <br /> - STALLED AT THE ABOVE ADDRESS WAS CONSTRUCIhD IN ACCOR- <br /> Septic Tank:Size 1.000 gallons Mat'1 Existing(Conc.) Mfg DANCE WITH THE REQUIREMENTS OF THE PERMIT AND THE RULES <br /> OF THE ENVIRONMENTAL QUALITY COMMISSION. <br /> Dosing Tank:Size gallons Mad Mfg <br /> [ ]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 4^ Mat'1 PVC 304 [ ]Drop <br /> [ ]Property Owner(permittee) <br /> [ ]Concrete <br /> Drainfield Pipe:Size [ ]Plastic [x]Licensed Sewage Disposal Service <br /> Material:Header Pipe Perforated Pipe- DEQ License Number: 38988 <br /> Total Drainfield Footage 450' Trench Depth Minimum 24^ Maximum 30" DEQ Certification Number: RI 792 <br /> Rock Depth:Total Under Pipe Curtain Drain Depth 48^ //jjam� <br /> Signed <br /> Alternative Drainfield Materials FZ-Flow <br /> Effluent Pump: Pump Model • Company name: New Creation Contracting <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: 8/28/24 <br /> (For Marion County Use Only) <br /> The Bove septic system has been inspected by Marion County.The information has been determined to be accurate and the system is: <br /> Approved ,[ ]Approved with corrections:s/ //,ee inspection report [ ]Denied / <br /> Signed: Title: /l Date: ,` 7 2/c <br /> MC:S-41 rev:3/03;4/12;5/14 WHITE:Marion County;YELLOW:Owner;PINK:Installer <br />