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... <br /> s. . <br /> MARION Cc/U[4'1'Y BUILDING INSPECTION INDIVIDUAL ON-SITE SEWAGE SYSTEM RECORD <br /> 5155 Silverton Rd..NE (to be completed by system installer) <br /> SALEM OR 97305 • <br /> 503-5884147 PERMITNO. c)4 <br /> MARION <br /> COUNTY . 'f ' <br /> http:/hvww.co.marion.or.us/PW/BuildingInspection sfrE ADDRESS,: Ilk, /hi <br /> AS-BUILT PLAN OF CONSTRUCTED SYSTEM: , <br /> Scale:1"=- ' <br /> --- '.71/'.7 41"741:1-3‘ I r Ars?v,2 frosY9 T ,x0/141/4 <br /> 1 ' North <br /> . -1- • <br /> 1 .v 4, 1 LAI <br /> , z - -0 5'" set- 2f5 . . <br /> • , <br /> ea(.1 1/4 Y icy <br /> 0--, <br /> / <br /> . C) <br /> t <br /> \----**---------------------------"''.. Cli 1 <br /> , t•I Z-1 <br /> .......\\ <br /> t..... <br /> • • <br /> ----. . 6 <br /> i— -‘'S (— •,l Ci <br /> ,,,.. <br /> •., c <br /> 1---. <br /> , . <br /> _liow all details and dimensions necessay to locate all components of the sztem in the future) <br /> SYSTEM MATERIALS AND SPECIFICATIONS. INSTALLERS CERTIFICATION! - <br /> 5 60 I HERE13Y CERTIFY.THAT THE ON-SITE SEWAGE SYSTEM IN- <br /> System Design Sewage Flow - Gallons/Day STALLED AT THE ABOVE ADDRESS WAS CONSTRUCTED IN ACCOR. <br /> TANK Sin: 10e O total gallons ....1).‘„Lingle compartment DANCE WITH THEBEQUIREMENTS OF THE PERMIT AND THE RULES <br /> OF THE ENVIRONMENTAL-QUALITY COMMISSION. <br /> manufacturer Aiet-..--1k- [1 double compartment „ - <br /> Material: CC/v‘C.-. [I flow-through 14have tested the septic tank and.certify it to be watertight. ?"'",,,_t•I <br /> Effluent Sewer:q ( t (:). .N./ s.gizeimmejeatrrii pe, Li,/l g,;_,,c/ Xtrosystem was installed by: <br /> Size/Mal c"....* perty Owner(permittee) cf, <br /> I I Licensed Sewage Disposal Service <br /> '‘DR:AINFIELD I rock depth(inches) Box(es) <br /> Rock anti under pipe .2-: ::PKIN:pp tfinterete DEQ License Number: : <br /> Ptf total depth , I 1 Distribution 1 1 Plastic <br /> DEQ Certification umber <br /> Drainfield Material(Alternative or peal pipe) 'Cl/ 't 61,„Ai 1 <br /> 1 ' 'Total DraInfleld Footage V ttlo' Trench Depth MinimumIth Maximunt <br /> Curtain Drain Deptk Signed: <br /> 6,/----- > <br /> 1 Effluent Pump:Pump Model . <br /> times in minutes: on off Gallons perCycte Company name: elkijr#1 CZYN.L .4.17eUr/hArses) <br /> ik (please print) <br /> Make and Model • <br /> Attach an addidotial sheet for compone and materials-not listed above. Date: r,7-,:.0'-.- -q. _ <br /> (For Marion County Use Only) The above septic system has been inspected by Marion COUnty t66'iifciiiiia:tion has been to be accurate <br /> and(he system is: [?ri Approved iiiirioved with corrections:.see inspection report [ I Denied <br /> L§jgned: 2 0°A I . .I A •I 0_ 11.Eli Itle: ' "-- i I 41111.. . Dats ifijoa,50/t9.4 <br /> MC:S-41 rev:3113;4/12;5/14;11/17 9: 'TimsiSepockS-41'As-Built2015VerSion2017.doc WHITE;Marion County; W: er;P.17Viqnetaller <br /> , . <br />