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mow' 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 <br /> MARION 503-588-5147 _ PERMIT NO. /g'-1:56526 <br /> COUNTY htt ://www.co.marion.or.us/PW/Buildin Ins ection �yr <br /> .� P g P ) J J <br /> ,—,� SITE ADDRESS: ��7J �/^�11 ivJC: ('T/"iL 1` <br /> uu <br /> . AS-BUILT PLAN OF CONSTRUCTED SYSTEM: �`./ �� <br /> Scale: l"= Lfar a ,r ��I 4�: d ei5 <br /> 44 1- <br /> , 4-A..,,, ,,,,,,, <br /> v,,� - 1 90 Ni isles ic <br /> ��, jag - s r <br /> _ - <br /> .... <br />, ..... <br />, _ <br /> �� hC- - �/ 1 <br /> Iff ' 4' <br /> _ - l� ___ <br /> ....____,„ <br /> b <br /> M <br /> V • . f <br /> 0)1 <br /> • <br /> [,:.„5- <br /> L. , <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 /> � I HEREBY CERTIFY THAT THE ON-SITE SEWAGE SYSTEM IN- <br /> System Design Sewage Flow 3.5.-- <br /> ` Gallons/Day STALLED AT THE ABOVE ADDRESS WAS CONSTRUCTED IN ACCOR- <br /> TANK Size: /Oa.) total gallons [ ] single compartment DANCE WITH THE REQUIREMENTS OF THE PERMIT AND THE RULES <br /> �� LS j/?double compartment OF THE ENVIRONMENTAL QUALITY COMMISSION. <br /> Manufacturer: <br /> Material: ene yi''4ci [ ] flow-through have tested the septic tank and certify it to be watertight. <br /> Effluent Sewer:,i/,, Header Pipe: .7 i t The system was installed by: <br /> Size/Mat'l t 1 4, t "T C Size/Mat'l /�-1 — <br /> I ]Property Owner(permittee) <br /> .. icensed Sewage Disposal Service <br /> DRAINFIELD rock depth(inches) Box(es) <br /> DEQLicense Number:3,30 ( - <br /> Rock and under pipe 6 [ ]Drop �J'Concrete - <br /> Pipe total depth 2;1'1/ ,. Distribution I ]Plastic DEQ Certification Number: S I '/ <br /> Drainfield Material(Altemative or perf.pipe) <br /> /� 1} Id <br /> Total Drainfield Footage 411i0't Trench Depth Minimum/5 Maxim a49 <br /> 1 1 • Signed: <br /> !� <br /> Curtain Drain Depth !y1(� <br /> Effluent Pump: Pump Model E Pe$b �� <br /> Pump cycle U �`� C �/ <br /> times in minutes: on off Gallons per Cycle 1S Company name:4C I� ��'j i ( 1� <br /> ATT Make and Model (please p t) <br /> Attach an additional sheet components and mat ials not listed above. Date: /6 "" ' �� <br /> (For Marion Coun - Use Only) The..ove septic system has been inspected by Marion County. The information has been determined to be accurate <br /> and the system is:. . % ! ► [ I Approved with corrections: see inspection report [ ]Denied <br /> Signed: • Title: ) Date: 3 )91 i <br /> MC:S-41 rev:3/1•,4/12;5/14;11/17 G:\Forms\Septic\S-41 As-Built 1 Version2017.doc WHITE:Marion County;YEL OW::Owner;PINK:Installer <br />