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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, �, <br /> - 503-588-5147mAttiou PERMIT NO. -00g-70i <br /> C UN http://www.co.marion.or.us/PW/Buildingluspectiou Its ectionSITE ADDRESS:��� �� ��yt <br /> �.1L� � t�cet0 6 r. <br /> AS-BUILT PLAN OF CONSTRUCTED SYSTEM: <br /> Scale: 1"=Sn N\Lf <br /> f North6 <br /> r437$ti' 3upe4d <br /> 0 . to <br /> O-e�rO Wci tC.Covicr.ctir <br /> 30t St.keAt —p b <br /> deg... 0 B zi `' <br /> -S _ fill I My <br /> __ j6 _ pie err 1„i �- - _ - tt2!_ <br /> I ]c 1 `b. r ! N 4 <br /> 4 <br /> r <br /> ` _� iv yAY ::, R O <br /> De vt. 2 .-' <br /> 415 t;A s r .tet` 4 g'l .$ tl,. :c, , +A ink fi' Y *lb i.$ <br /> l 1i. t r F >r ; , , <br /> Sus cb� f <br /> tr6 ft-Aki, ' RI !:i 9-1):: <br /> Of = �v ( £kt°e::^t yp i <br /> fiti _ <br /> ore_ At f'Jti, li <br /> I (show all details and dimensi hs necessary to ipcate all components ofthe system in the future) <br /> SYSTEM MATERIALS AND SPECIFICATIONS: INSTALLERS CERTIFremtION: <br /> I HEREBY CERTIFY THAT THE ON-SITE SEWAGE SYSTEM IN- <br /> System Design Sewage Flow '-SSD Gallons/Day STALLED AT THE ABOVE ADDRESS WAS CONSTRUC t ED IN ACCOR- <br /> TAN K Size: 1,606 total gallons l single compartment DANCE WITH THE REQUIREMENTS OF THE PERMIT AND THE RULES <br /> OF THE ENVIRONMENTAL QUALITY COMMISSION. <br /> Manufacturer: Oita t-c.-,. [ 1 double compartment <br /> Material: a et kA c..er c."a”c... [ ] flow-through fri I have tested the septic tank and certify it to be watertight. <br /> Effluent Server: Reader Pipe: The system was installed by: <br /> Size/Mat'I Size/Mat'I I j Property Owner(permittee) <br /> iyd Licensed Sewage Disposal Service <br /> DRAINFIELD I rock depth(inches) Boxes) <br /> 1 t DEQ License Number 3 `i 4 Z <br /> Rock and under pipe � 1 )Drop '�Concrete <br /> Pipe total depth l - I I Distribution I I Plastic i 7 <br /> DEQ Certification Number: R <br /> Drainfield Material(Alternative or perf.pipe) <br /> Total Dra€rtield Footage I 461 Trench Depth Minimum <br /> Ei Maximum 1'1t‘ /9' <br /> -tzRes aieaw tt Signed:_ _"- • <br /> De th .. <br /> C rt to Ifszai P .� <br /> Effluent Pump: Pump Model f .3 ,, I t <br /> Pump cycle !&& q g <br /> times in minutes: on , g off i�,1 Gallons per Cycle2 Company name: 59 if e.E Mori S LLC a <br /> p (please print) <br /> ATT'Make and Model /So V a{aii E x 20 X <br /> Attach an additional sheet for components and materials not listed above. Date: Del Zy -20/1 <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: iO Approved I ] Approved with corrections:see inspection report I I Denied q <br /> ``���� \^ ' n t i ZOl <br /> 1 Signe Q,f-tdAG'_(2,_ ,`l l/`• /_ Titl-0 tva-t i`Q V vG Q,f/U Zt. � -a P-4 St Date: e <br /> MC:S-41 rev:3/03;4/12:5/14;11/17 1:WForns\Septic\S-41 As-Built2015Version2017.doc WHITE:Mruion Counly;YELLOW:Owner;PINKInstaller <br />