Laserfiche WebLink
• <br /> iiikiMARION COUNTY BUILDING INSPECTION INDIVIDUAL ON-SITE SEWAGE SYSTEM RECORD <br /> 5155 Silverton Rd NESALEM (to be completed by system installer) <br /> 5 3-88 OR 97305 PERMIT NO. S 5.5-el3 -ao34Z? -f 7 <br /> MARION <br /> COUNTY http: .ww.co.marion.or.us/PW/Buildinglnspection Z �� do r f i jr- <br /> '.. ,SITE ADDRESS: <br /> AS-BUILT PLAN OF CI NSTR e•� ED SYSTEM: P(7hGt <br /> Scale: 1"_ ( ;; ' .74 - T <br /> 5� I / North <br /> I-:. <br /> %7_aaQ g',........c <br /> � 1 fit. <br /> • Q C!' i' <br /> t <br /> Ilill . - ,,,,,. <br /> 10, ® 4 , <br /> .Se 0 ' <br /> o , 1/4 <br /> c <br /> • <br /> • <br /> lot • A C� <br /> 11- <br /> IW.t (show all details and dimensi s necessary t -11 nts of the s stel in the future) • <br /> SYSTEM MATERIALS AND SPECIFICATIONS: INSTALLERS CERTIF' i . <br /> ystem Design Sewage Flow tISCI Gallons/Day I HEREBY CERTIFY THAT THE ON-SIT SEWAGE SYSTEM IN- <br /> STALLED AT THE ABOVE ADDRESS WAS CONSTRUCTED IN ACCOR- <br /> [Q single compartment DANCE WITH THE REQUIREMENTS OF THE PERMIT AND THE RULES <br /> TANK Size: 'I®¢,0 total gallons <br /> OF THE ENVIRONMENTAL QUALITY COMMISSION. <br /> Manufacturer: uJ�e [ ] double compartment. <br /> Material: (0gt.rc. [ ] flow-through 1)41 have tested the septic tank and certify it to be watertight. <br /> Effluent Sewer: Header Pipe: ` The system was installed by: <br /> Size/Mat'I Size/Mat'l I I Property Owner(permittee) • <br /> 54_Licensed Sewage Disposal Service <br /> DRAINFIELD rock depth(inches) Box(es) �/ <br /> Rock and under pipe )([.Drop l4Concrete DEQ License Number: ,3l/L q GJ <br /> Pipe total depth I I Distribution I I Plastic . <br /> DEQ Certification Number: <br /> Drainfield Material(Alternative or perf pi e) <br /> Total Drainfield Footage VolMaximum.1b <br /> g ��� Trench Depth Minimum _ „ �f�� <br /> �f'/� <br /> Curtain Drain Depth Signed: pl{(„in,. 1�'6A <br /> Effluent Pump: Pump Model /]f/4- . <br /> Pump cycle l_ <br /> times in minutes: on 4 f4l_ n off Gallons per Cycle Company name:_ ly e.-th./( 4G,6n4►?'i 5 <br /> ATT Make and Model / l (please print) <br />. Attach an additional sheet for components and materials not listed above. Date: 91 i i I i. / <br /> (For Marion Count Use Only) The above septic system has been inspected by Marion County. The information has been determined to be accurate <br /> and the system s:e(/�Approved I I Approved with corrections: see inspection report I I Denied <br /> Signed: ` Title: ''" 5 Date: <br /> MC:S-41 rev:3/03;4/12;5/14; 11/17 G:\Forms\Septic\S-41 As-Built20l5Version20l7.doc WHITE:Marion County;YE LOW: caner;PINK:Installer <br />