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i <br /> �,,,���� Marion County Public Works 23-o0 g36�i'�M I <br /> ��Il��'ai,,,r Building Inspection Division } <br /> �---.3:...... ..,"`_ 5155 Silverton Rd NE � �� <br /> . ��" Salem OR 97305 <br /> no . <br /> (503) 588-5147 Fax(503) 588-7948 �� ® � 2023 <br /> http://www/co.marion.or.us <br /> fVIAI IGt� CI UNTY <br /> i3UlLDlNG INSPECTION <br /> ON-SITE SYSTEM MATERIAL LIST <br /> (DIRECTIONS&DEFINITIONS ON BACK) <br /> ADDRESS /Oo/ ' • CA-awl, r,m_tp io TAX LOT# <br /> J SECTION TOWNSHIP RANGE LOT <br /> 1. SEPTIC TANKS . <br /> �t i'!/ CAPACITY, /O C100 MATERIAL CO67 e .n.64-e. <br /> ❑ SEPTIC TANK: MFG. J <br /> ❑ DOSING TANK:MFG. CAPACITY MATERIAL <br /> ❑ SEPTIC/DOSING TANK: 0 SINGLE COMPARTMENT 0 TWO COMPARTMENT 0 FLOW-THROUGH <br /> MFG. CAPACITY MATERIAL <br /> MFG.'S SPECS. INCLUDED <br /> 2. PUMPING ASSEMBLIES <br /> PUMP 1: MFG. MODEL (INCLUDE PERFORMANCE CURVE) 0 <br /> PUMP 2: MFG. MODEL (INCLUDE PERFORMANCE CURVE) 0 <br /> CONTROL PANEL: MFG. MODEL 0 <br /> HYDROSPLITTER: MFG. MODEL (INCLUDE ORIFICE CALCULATIONS) 0 <br /> EFFLUENT FILTER: MFG. MODEL 0 <br /> DISTRIBUTION VALVE:MFG. MODEL ❑ <br /> 3. EFFLUENT TRANSPORT PIPING / . <br /> /❑ GRAVITY EFFLUENT SEWER: LENGTH .7 DIAMETER 1-1)/ MATERIAL Ail 5 FALL(IN INCHES) (? <br /> ❑ PRESSURE PIPING: LENGTH DIAMETER MATERIAL 'PSI <br /> 4. DISPOSAL FIELD(DRAINFIELD) <br /> DISTRIBUTION TECHNIQUE: 0 EQUAL 0 LOOP 0 SERIAL 0 PRESSURIZED • <br /> TOTAL LINEAR FOOTAGE: <br /> DRAIN MEDIA: 0 GRAVEL-LESS ABSORPTION METHOD ROCK&PIPE 0 OTHER <br /> TOTAL DEPTH 11• DEPTH BELOW PIP C ' <br /> TRENCH DEPTH(FROM ORIGINAL GROUND SURFACE): MIN MAX <br /> CAPPING FILL DEPTH(DEPTH OF CAP): <br /> SETBACKS FROM WELLS: SEPTIC TANK SAND FILTER OR ATT UNIT DRAINFIELD <br /> 5. DEWATERING SYSTEMS(IF REQUIRED) <br /> O CURTAIN DRAIN 0 TILE DEWATERING <br /> TRENCH DEPTH: <br /> DRAIN MEDIA: 0 ROCK&PIPE 0 OTHER • ` <br /> TOTAL DEPTH DEPTH BELOW PIPE 0 FILTER FABRIC STATE CERTIFIED <br /> PERFORATED PIPING: DIAMETER MATERIAL Environmental Health Specialist <br /> 4.v,,•94 EH-S-10227575 <br /> 6. ADVANCED TREATMENT UNITS ItZ. <br /> O SAND FILTER 0 'RGF 0 ATT: TYPE_ • \ ti� I <br /> Aldan 8ammes I <br /> G:IFORMS\SEPTIC\FORMS\S-60 MATERIALS LIST.DOCX Rev 3/18 Z 1/2./'( 7. <br />