Laserfiche WebLink
i <br /> a , 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 /> -- -• 503-588-5147 PERMIT NO. 55 5-17-c76 1117 <br /> MARION <br /> COUNTY http://www.co.marion.or.us/PW/BuildinglnspectionSITE ADDRESS: 14 <br /> I y® �-s-a t�,��(-,c�, <br /> AS-BUILT PLAN OF CONSTRUCTED SYSTEM: <br /> Scale: 1"= 36 ' / • '(' <br /> 1/—® - 13 North <br /> C- ® - 27' <br /> 0 - 0 <br /> ®a,;--�a \ Lit/ <br /> ,fiu. , <br /> S0 <br /> ,, <br /> eG/ <br /> (show all details and dimensions r•cpssary to locate all components of the system in the future) <br /> SYSTEM MATERIALS AND SPECIFICATIONS: INSTALLERS CERTIFICATION: <br /> System Design Sewage Flow Gallons/Day I HEREBY CERTIFY THAT THE ON-SITE SEWAGE SYSTEM IN- <br /> STALLED AT THE ABOVE ADDRESS WAS CONSTRUCTED IN ACCOR- <br /> TANKSize: I 00 total gallons [(single compartment DANCE WITH THE REQUIREMENTS OF THE PERMIT AND THE RULES <br /> I OF THE ENVIRONMENTAL QUALITY COMMISSION. <br /> Manufacturer: 1_,..t.'4J [ ] double compartment <br /> Material: Loa crc¢G [ ] flow-through [ I I 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 Property Owner(permittee) <br /> 10I Licensed Sewage Disposal Service <br /> DRAINFIELD rock depth(inches) Box(es) / <br /> Rock and under pipe [ I Drop [ I Concrete DEQ License Number: 7 .t .y 9 $ <br /> Pipe total depth I I Distribution [ I Plastic U 2 <br /> DEQ Certification Number: ' /3 if <br /> Drainfield Material(Alternative or perf.pipe) <br /> Total Drainfield Footage Trench Depth Minimum Maximum_ �J f <br /> Curtain Drain Depth Signed:_ 4-2C.� I?< 1 t e.7 <br /> Effluent Pump: Pump Model <br /> Pump cycle <br /> times in minutes: on off :- Cycle Company name: IS-ft/t ] &94[G,,,,,, 9 <br /> ATT Make and Model (please print) <br /> Attach an additional sheet for com'I nents and materials no,•isted above. Date: R • Y1 <br /> f For Marion Coun Use rd nl The - '.ve see,' system has been inspected by Marion County. The information has been determined to be accurate <br /> and the system is: App ov•d ] • roved with corrections: see inspection report [ ] Denied c <br /> Signed: ./K Title: f Date: Li (9 1 t-------- <br /> MC:S-41 reir553;4/1 11/17 G:\Forms\Septic\S-41 As-Built2015Version2017.doc WHITE:Marion County;YELLOW:Owner;PINK.Installer <br />