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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 c r <br /> 503-588-5147 PERMIT NO. 555--.I 7 0011 761...S <br /> ��� <br /> COUNTY http://www.co.marion.or.us/PW/Buildinglnspection SITE ADDRESS: e�1 9 ` �I"�^ 8191 tafi-gi <br /> Y a5 <br /> AS-BUILT PLAN OF CONSTRUCTED SYSTEM: -Pc 1 'W11ir <br /> Scale: 1"_ LW' <br /> Ad Ou f- North <br /> -G <br /> i <br /> LI 1 <br /> /1 -Ci- LIZ.''/2. <br /> t � j• <br /> 4-r ` ?vim ^if_ E R-L^ .s <br /> c- 1'° r -p^ <br /> 4 , Oil <br /> B. <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 /> System Design Sewage Flow E0 Gallons/Day I HEREBY CERTIFY THAT THE ON-SITE SEWAGE SYSTEM IN- <br /> STALLED AT THE ABOVE ADDRESS WAS CONSTRUCTED IN ACCOR- <br /> . Septic Tank:Size /QJd gallons Mat'l 10fe- Mfg km//ter; DANCE WITH THE REQUIREMENTS OF THE PERMIT AND THE RULES <br /> OF THE ENVIRONMENTAL QUALITY COMMISSION. <br /> Dosing Tank:Size — gallons Mat'l - Mfg r-- <br /> // KI have tested the septic tank and certify it to be watertight. <br /> `Y <br /> ATT Make and Model 2 72- I 7 Box(es): <br /> • II Distribution The s stem was installed b <br /> Effluent Sewer:Size Pk Mat'l [�v L I I Drop y by: <br /> I I ]Concrete [ I Property Owner(permittee) <br /> Drainfield Pipe:Size /,1 I I Plastic V Licensed Sewage Disposal Service <br /> Material:Header Pipe Perforated Pipe DEQ License Number: 344 ! a <br /> N <br /> Total Drainfield Footage ISO Trench Depth Minimum 12 Maximum [?" DEQ Certification Number: ,3 <br /> Rock Depth:Total Under Pipe Curtain Drain Depth ,` r��G�/ <br /> Alternative Drainfield Materials 1'PS$4V'!Z d Signed: DA,"v '1 <br /> Effluent Pump: Pump Model P -30 Company name: $4.0L- L,i C---- <br /> Pump <br /> Pump Cycle minutes minutes (please print) <br /> Time on ..5- off / Gallons per Cycle <br /> Attach an additional sheet for com o •• . s terials not listed above. Date: /0 <br /> (For Marion CountrUse Only) <br /> The bove septic : stem has been• spected by Marion County.The information has been determined to be accurate and the system is: <br /> pprover [ ] • : 'roved with corrections: see inspection report [ I Denied tia <br /> Si:•-.. - 7 Title:J -. Date: ti '--/ <br /> MC:S-41 rev:3/03;4/12;5/14 WHITE:Marion County; YEL OW.•Otivner;PINK:Installer <br />