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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. ., — •l % —e.Z) & 'i 7 <br /> MARION <br /> COUNTY http://www.co.marion.or.us/PW/Buildinglnspection <br /> SITE ADDRESS: k.5O kprus P �zs,kg <br /> AS-BUILT PLAN OF CONSTRUCTED SYSTEM: Or '53 <br /> `yg-- <br /> Scale: 1"_ ' <br /> North <br /> s <br /> • P : I . <br /> t 'sa so <br /> s _i <br /> .3. <br /> pi _P <br /> �-' Is0 <br /> #• <br /> Ir. <br /> • <br /> • <br /> (show all details and dimensions necessary to locate all components of the system i - future) <br /> SYSTEM MATERIALS AND SPECIFICATIONS: INSTALLERS CERTIFICATION: <br /> System Design Sewage Flow +45 0 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: /ca}}0�. total gallons [.}'Sthgle compartment DANCE WITH THE REQUIREMENTS OF THE PERMIT AND THE RULES <br /> Manufacturer: 1' .F �..t-, a ,r [ 1 double compartment OF THE ENVIRONMENTAL QUALITY COMMISSION. <br /> Material: P\e„,St* [ 1 flow-through I KI have tested the septic tank and certify it to be watertight. <br /> Effluent Sewer Header Pipe: The system was installed by: <br /> Size/Mat'I h► ,�O.. pitbc.JJ Size/Mat'l_3031/272, I I Property Owner(permittee) <br /> / lerEicensed Sewage Disposal Service <br /> DRAINFIELD rock depth(inches) Box(es) <br /> Rock and under pipe [ ]Drop [ ]Concrete DEQ License Number: ,3>t 3 <br /> Pipe total depth [ ]Distribution [)(Plastic <br /> DEQ Certification Number: 1P-,-.1• 1612 <br /> Drainfield Material(Alternative or perf.pipe) ears y 4jpt)-3 <br /> Total Drainfield Footage 230 Trench Depth Minimum 24" Maximum tri ;34araisli <br /> Curtain Drain Depth • Signed:1 LIJ <br /> Effluent Pump: Pump Model <br /> Pump cycle <br /> times in minutes: on off Gallons per Cycle _ Company name:_ 1 Hs_ Ju2-111+'L-4 <br /> ATT Make and Model (ple se print) <br /> Attach an additional sheet for components and materials not listed above. Date:.6,—/67-- // <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: Approved [ ] Approved with corrections: see inspection report [ ]Denied <br /> Signed:Cayel.(�.. f.HDate( II, 20/ <br /> MC:S-41 rev:3/03;4/12;5/14;11/17 \Forms\Septic\S-41 As-Built2015Version2017.doc WHITE:Marion County;Y LOW.:Owner,PINK:Installer <br />