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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 /> --~-- 503-588-5147 PERMIT NO. /q-000 836 <br /> MARION I <br /> COUNTY http://www.co.marion.or.us/PW/BuildingInspectionSITE ADDRESS: 75''2 7 mos (-Gr2 <br /> AS-BUILT PLAN OF CONSTRUCTED SYSTEM: <br /> Scale: 1"=1/6 ' <br /> North <br /> I <br /> _. go' bot s - °�'' <br /> ) 00 `* <br /> .d scs "C to <br /> 0,/ - -1O <br /> X90, 10' 13_c 5�( <br /> , � <br /> 9 <br /> 3-D la1 ,c <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 /> S�2.S Gallons/DayI HEREBY CERTIFY THAT THE ON-SITE SEWAGE SYSTEM IN- <br /> System Design Sewage Flow STALLED AT THE ABOVE ADDRESS WAS CONSTRUCTED IN ACCOR- <br /> TANK Size: t,5)O total gallons [set single compartment DANCE WITH THE REQUIREMENTS OF THE PERMIT AND THE RULES <br /> Manufacturer: it) 1--Le$ [ ] double compartment OF THE ENVIRONMENTAL QUALITY COMMISSION. <br /> Material: COI/VC— [ ] flow-through [XI have tested the septic tank and certify it to be watertight. <br /> Effluent Sewer: a 7 Header Pipe: The system was installed by: <br /> Size/Mat'l L/ 3O c7 if Size/Mat'l p L/y' ?d,;‘,/ I ]Property Owner(permittee) <br /> - I4-Licensed Sewage Disposal Service <br /> DRAINFIELD rock depth(inches) Box(es) r� <br /> Rock and under pipe (Drop ( Concrete DEQ License Number: J 6 i le <br /> Pipe total depth I I Distribution I I Plastic <br /> DEQ Certification Number: A2.t 3 <br /> Drainfield Material(Alternative or perf.pipe) ,2—Mau) <br /> Total Drainfield Footage-rt./0Trench Depth Minimum �y MaximumZ6d <br /> (la <br /> Curtain Drain Depth Signed: --j'-`' <br /> Effluent Pump: Pump Model . <br /> Pump cycle <br /> times in minutes: on off Gallons per Cycle Company name:_ 9444 Xe- " C---- <br /> ATT Make and Model (please print) <br /> Attach an additional sheet for omponents and materi s not listed above. Date: <br /> (For Marion Count , , i-1V) The above •-ptic system has been inspected by Marion County. The information has been determined to be accurate <br /> and the system is: I+ . oved •pproved with corrections: see inspection report [ ]Denied <br /> Signed: ` —.' _ Title:_ea& Date: 2 'd i I <br /> MC:S-41 rev: .'0 ,0175/14;11/17 G:\Forms\Septic\S-41 As-Built2015Version2017.doc WHITE:Marion County;YEL OW.: wner;PINK:Installer <br /> — - - <br />