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8590734
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Last modified
4/17/2019 10:51:48 AM
Creation date
4/16/2019 2:28:20 PM
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Permits
Permit Address
23597 SANTIAM WAY SE
Permit City
LYONS
Permit Number
555-19-001120-PRMT
Parcel Number
092E17AC00500
Permit Type
Septic
Permit Doc Type
Permit Document
Status
Ready to Film
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i� . MARION COUNTY BUILDING INSPECTION INDIVIDUAL ON-SITE SEWAGE SYSTEM RECORD <br /> 5155 Silverton Rd NE (to be complete44by system installer) <br /> ---•---.1::-_- SALEM OR 97305 :. '.;i;,r!" <br /> 503-588-5147 PERMIT NO.-SS 01_0,1t 20 <br /> MARION <br /> COUNTY <br /> http://www.co.marion.or.us/PW/BuildingInspection SITE ADDRESS: 2,4 3.17 �G/ •iia„ <br /> ..4 - 7 o�71 i <br /> AS-BUILT PLAN OF CONSTRUCTED SYSTEM: <br /> Scale: 1”= to A' <br /> J► <br /> bal si <br /> 't <br /> 74t, ,,I, <br /> 4 <br /> k <br /> k0 bbl` 'es <br /> �h <br /> el 4 <br /> ® ir4`'ti° V * r <br /> L <br /> b�,3� �-' ExtsTtN& t • <br /> $_ .. I4or uNCoVFReD <br /> Nor VEC IFI F PI 'v.. <br /> il�vaOlr <br /> r <br /> (show all des is] anc_dimensionc necess eitist co�onents of the system in the future) <br /> SYSTEM MATERIALS AND SPECIFICATIONS: INSTALLERS CERTIFICATION: <br /> •Design Sewage Flow Gallons/Day I HEREBY CERTIFY THAT THE ON-SITE SEWAGE SYSTEM IN- <br /> SystemSTALLED AT THE ABOVE ADDRESS WAS CONSTRUCTED IN ACCOR- <br /> TANKSize: eB�/ total gallons [4..single compartment DANCE WITH THE REQUIREMENTS OF THE PERMIT AND THE RULES <br /> ] OF THE ENVIRONMENTAL QUALITY COMMISSION. <br /> Manufacturer: v,"-a.;4„......) [ ] double compartment <br /> Material: Ovvt CrG4T_ <br /> [ ] flow-through k] 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'l Size/Mat'l I ]Property Owner(permittee) <br /> c]Licensed Sewage Disposal Service <br /> DRAINFIELD rock depth(inches) Box(es) <br /> Rock and under pipe I ]Drop I I Concrete DEQ License Number: 36 15 e <br /> Pipe total depth I I Distribution I I Plastic <br /> DEQ Certification Number: R-p 'LB <br /> Drainfield Material(Alternative or perf.pipe) <br /> Total Drainfield Footage Trench Depth Minimum Maximum tn�col ,yj <br /> Curtain Drain Depth Signed:_ 1/cs;/ �""/-ke <br /> Effluent Pump: Pump Model . <br /> Pump cycle (� <br /> times in minutes: on off Gallons per Cycle Company name: {'j"ea ed 64-em.e0-4-e`61 <br /> ATT Make and Model / (please print) <br /> Attach an additional sheet for components and materials not listed above. Date: y! 6/i i <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:yl Approved//�� ,,n [ ]] Approved with corrections: see inspection report [ ]Denied <br /> Signed 12. e[-,,qt e �E1-6 Title:P/l.i.r - iJ i'.L14 / 1 Dated 1 /7 <br /> MC:S-41 rev:3/03;4/12;5/14;11/17 G:\Forms\Septic\S-41 As-Built2015Version2017.doc WHITE:Marion County;YELLOW:Owner;PINK.:Installer- <br />
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