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MARION COUNTY BUILDING IiNSPECTION INDIVIDUAL ON-SITE.SEWAGE SYSTEM RECORD <br /> 5155 Silverton Rd.NE (tobe completed by system installer) <br /> • SALEM OR 97305 <br /> 503-588-5147 PERMIT NO.S ..)g +CV l/7., 5' <br /> MARION <br /> COUNTY <br /> http://www.co.marion.or.us/PW/Building1nspection SITE ADDRESS: /2:1 y w -� e <br /> ,ti ,�m°' <br /> AS-BUILT PLAN OF CONSTRUCTED SYSTEM: <br /> Scale: 1"_'e4' 12: <br /> rr <br /> North <br /> Ft <br /> fip G,ktvt. +O tntA 0 ' it. <br /> {lt»:I,5- <br /> 1 iii G; x..' C. 4 <br /> Iy ` I. tot ' <br /> 0 <br /> i <br /> 6 " t <br /> • I <br /> ,381. ity1 <br /> . <br /> (show all details.and dimensions necessary to locate all components of the system in i e future) <br /> SYSTEM MATERIALS AND SPECIFICATIONS: INSTALLERS CERTIFICATION: - €€ <br /> I HEREBY CERTIFY THATTHE ON-SITE SEWAGE SYSTEM IN= <br /> System"Design.Sewage Flow V0&.1 Gallons/Day :. STALLED AT THE.ABOVE ADDRESS WAS CONSTRUCTED.IN ACCOR- <br /> TANKSize: if� total gallons {3 single compartment DANCE WITH THE REQUIREMENTS OF THE PERMIT AND THE RULES <br /> Manufacturer: 1;. , <br /> Cny double compartment OF THE ENVIRONMENTAL QUALITY COMMISSION. <br /> Material: l pay ):flow-through Jji.I have tested the septic tank and certify it to be watertight <br /> Effluent Sewer: •+ Header Pipe: The system was installed by: <br /> SizeiMat'1ry" 27,o Size/Mat' t l 1' I Property Owner(permittee) <br /> w Licensed Sewage Disposal Service <br /> DRAINFIELD rock depth(inches): Box(es) <br /> Rock and under pipe {4 <br /> st_ I l Drop Concrete: DEQ License Number 3DI0 <br /> Pipe total depth 41'' Distribution 1 1 Plastic <br /> DEQ Certification htumber.. <br /> Drainfteld Material(Alternative or pert:pipe) F' Z7„e f ei /� <br /> TotalDrainfield Footage`� IL Trench Depth Minimun>j$ Maximum,V1 <br /> Curtain Drain Depth_{w . Signed:_ C <br /> Effluent:Pump: Pump Model F 300s-a P 4813. <br /> Pump cycle -� <br /> times in minutes: on. off Gallons per:Cycle SO Er- im e,}it Company name: �. c.45.156,4-;a4/ <br /> ATI'Make and Model . (please print); <br /> Attach an additional sheet for , i onen .and materials not fisted above: Date: <br /> (For Marion County .se On The above septic system has been inspected by Marion County. The information has been determined to be accurate <br /> and the system i , , •,ved [ ]Approved with corrections:see inspection report [ J Denied <br /> Signed: � Title: gai _ Date: -5-12`� 1 11 <br /> I <br /> MC:;5-41 . v:;3/03;4/1.2;5/14;11/17 , G:\FortnstSeptic\S-4:1.As_Built2015 ersion2017:doc WHITE:Marion County;YELLOW:Owner;PIi.TK.•Installer <br />