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4wMARION COUNTY BUILDING INSPECTIONSALEM INDIVIDUAL ON-SITE SEWAGE SYSTEM RECORD <br /> 5155 Silverton Rd NE (to be completed by system installer) <br /> '''503-588-5147 9730PERMIT NO. Sec i v- owe a Io r18 Y <br /> MARION <br /> COUNTY hftp://www.co.marion.orms/PW/BuildingInspectionSITE ADDRESS: I 2-14 r LEAH 1..N A✓, VitOOOt3"4✓ <br /> AS-BUILT PLAN OF CONSTRUCTED SYSTEM: <br /> Scale: 1"= NDS T ' <br /> North <br /> S+NaP <br /> 1- 0 <br /> S H Ctrl SE . r <br /> k <br /> N sPTt P <br /> v Psp <br /> (2-14EW ertP <br /> C. F <br /> ,.- <br /> • di <br /> d a 3 l - E = ZZ' IA NE*.3 = 95 L <br /> '0 . it 64 L. F : 130' L1Nt:�H =IF' ] <br /> ' GI— H �•200 <br /> Itr' t.l Nlf �s 3p' )4 <br /> � .t s" <br /> 1- 64,1,-L.0 4i4IWFieit) 0+' <br /> �' L"S = r3' a O .CA 6c,.., <br /> if-— L. = 34' I' z t✓c c <br /> ?eoPFlP-r/ t.IIJ H <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 q Gallons/Day I HEREBY CERTIFY THAT THE ON-SITE SEWAGE SYSTEM IN- <br /> STALLED AT THE ABOVE ADDRESS WAS CONSTRUCTED IN ACCOR- <br /> TANK Size: 1 0 0 0 total gallons i(single compartment DANCE WITH THE REQUIREMENTS OF THE PERMIT AND THE RULES <br /> COa CCM-T [ ] double compartment OF THE ENVIRONMENTAL QUALITY COMMISSION. <br /> Manufacturer: <br /> Material: C 0 t4C IL61'1c [ ] flow-through VI have tested the septic tank and certify it to be watertight. <br /> Effluent Sewe :,I Header Pipe: I� The system was installed by: <br /> Size/Mat'l al it 6S Size/Marly 2'l2 1 I I Property Owner(permittee) <br /> DRAINFIELD rock depth(inches) Box(es) <br /> X Licensed Sewage Disposal Service <br /> Rock and under pipe (I ,_ XDrop )(Concrete DEQ LicenseNumbel: S;t <br /> i le <br /> Pipe total depth I I Distribution I I Plastic <br /> DEQ Certi t a on Number: <br /> Drainfield Material(Alternative or pyrf.pipe) `1 t 212-1 pg-it� <br /> Total Drainfleld Footage y5-0 Trench Depth Minimum IV' Maximum_14'' <br /> Curtain Drain Depth_ Signed:. <br /> Effluent Pump: Pump Model _ . v zi <br /> Pump cycle �4 C /�/ E, LL Ltimes in minutes: on off Gallons per Cycle Company name: /�C_ / G. <br /> / <br /> P 1 easi print) <br /> I / <br /> ATT Make and Model , `+ <br /> Attach an additional r components and materials not listed above. Date: <br /> (For Marion 'ounty -se Only) The above septic system has been inspected by Marion County. The information has been determined to be accurate <br /> and the syste is: I • pproved [ ] Approved with corrections:see inspection report [ I Denied <br /> Signe.• Title: Date: S I[ <br /> MC:S-41 r :3/03;4/12;5/14;11/17 G:\Forms\Septic\S-41 As-Built2015Version20l7.doc WHITE:Marion County; YELLOW.Owner;P/NK:Installer. <br />