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MARION COUNTY BUILDING INSPECTION INDIVIDUAL ON-SITE SEWAGE SYSTEM RECORD <br /> 5155 Silverton Rd NE (to be completed by system installer) <br /> -`�. SALEM OR 97305`` , 503-588-5147 PERMIT NO.(S��15" -3-009 o 9.S - P R ry'+ <br /> MARION'f . <br /> I:O I4f11YL http://www.co.marion.or.us/Pert/Buildinglnspection '� �Gv1 Rc i 1N, £, <br /> • <br /> SITE ADDRESS: [ 73� o <br /> AS-BUILT PLAN OF CONSTRUCTED SYSTEM: Si l ciki, On `�7311 <br /> ~ Scale: 1"_ 20' 1 <br /> North <br /> k®v>rte... 1 <br /> /LI".Sci^ctOc\ iIODD?e,llavl • <br /> :17..±11W4. 4.. CoY,c reI <br /> bl� '© • <br /> Col/0'410� 3 t1 � ���,0 p.on el--... pgc. \ 00 , <br /> NI-- 3 <br /> • 2''6 ti,W0Pvt. 1ni0 .. <br /> 4 \ <br /> C[ec.AvoVt'- ‘ u) it tn�. LrH 1 _ d <br /> i \cr, lihe, [ � , <br /> ---p,\ . . - - —6 . <br /> • ! / !• it ! f / /----1 / <br /> .11111111 <br /> 4 \o rt Roc\ N)1E , <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 /> 3 O Q Gallons/Da i HEREBY CERTIFY THAT THE ON-SITE SEWAGE SYSTEM IN- <br /> System Design Sewage Flowy STALLED AT THE ABOVE ADDRESS WAS CONSTRUCTED IN ACCOR- <br /> TANK Size: 1,66 0 total gallons NI.single compartment DANCE WITH THE REQUIREMENTS OF THE PERMIT AND THE RULES <br /> Manufacturer: Wae'-P <br /> [ ] double compartment OF THE ENVIRONMENTAL QUALITY COMMISSION. <br /> Material: (XMACv'e1`.e.... [ ] flow-through lx] I have tested the septic tank and certify it to be watertight. <br /> Effluent Sewer: et Header Pipe <br /> 2 <br /> �1 The system was installed by: <br /> 2 <br /> Size/Mat'I 5,4,14 6 ?V Size/Mat'l '561., 116 NC. [ 1 Property Owner(permittee) <br /> [$1 Licensed Sewage Disposal Service <br /> DRAINFIELD rock depth(inches) Box(es) <br /> Rock and under pipe • i J Drop I I Concrete DEQ License Number: 3q 9(:.Z. <br /> Pipe total depth i I Distribution i I Plastic DEQ R I 7 ' <br /> Certification Number: <br /> Drainfield Material(Alternative or pert.pipe)nfli'rrc.4e,tr £4 2I G4ry,..v,Aictr <br /> Total Drainfield Footage Kz\ Trench Depth Minimum I B'' Maximum lbel ,..-------� <br /> Curtain Drain Depth Signed: /-" , <br /> Effluent Pump: Pump Model W 1-�r g 2—S 10 . <br /> Pump cycle r k <br /> times in minutes: on off Gallons per Cycle Company name: I l e.t�. 1 l qua e LL( <br /> qqa y (please print) <br /> ATT Make and Model G c o'I i C.e.I ! A1A.S .�-i^C., 9' <br /> Attach an additional sheet for components and materials not listed above. Date: <et.. —/ t 2®Z' <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: [ii Approved , i I Approved with corrections:see inspeectionn report I I Denied <br /> fiianarl u <br /> Title: r/r1-- 10-t-/ -3-O Date: 1 /17D izi-1 <br />