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MARION COUNTY BUILDING INSPECTION INDIVIDUAL ON-SITE SEWAGE SYSTEM RECORD <br /> ,. 5155 Silverton Rd I\;E (to be completed by system installer) <br /> "~-w?, `` SALEM OR 97305 <br /> --r--.::-.,, 503-588-5147 PERMIT NO.5 5S— 1 GI 0 (}($3 <br /> 3 <br /> . MAR ° <br /> ION <br /> .COUNTY_ ttttp://www.ca.marion.anus/PW/BuildiiigInspection �/ �tj 3� <br /> SITE ADDRESS: 88Z 8 5; IVW ;4i. 5 rf y <br /> AS-BUILT PLAN OF CONSTRUCTED SYSTEM: `5�t 1.1... <br /> J <br /> Scale:1"— <br /> °f <br /> SIN-.V -.12__ FALL s Roryrth <br /> 1 <br /> • <br /> - <br /> -klV <br /> d w <br /> G1 <br /> • <br /> .{z'To tb -' ._ <br /> E. r <br /> ct.EA N6 r I I4-O <br /> Z- - t-;? 57' E` <br /> T1 V <br /> (ay • t a L 1- ]S <br /> 6,,,-,n4 1 1 r <br /> 1?' <br /> w <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 /> I HEREBY CERTIFY THAT THE ON-SITE SEWAGE SYSTEM IN- ' <br /> System Design Sewage Flow Gallons/Day STALLED AT THE ABOVE ADDRESS WAS CONSTRUCTED IN ACCOR- <br /> TANK Size: 1000 total gallons single compartment DANCE WITH THE REQUIREMENTS OF THE PERMIT AND THE RULES <br />• r `� - OF THE ENVIRONMENTAL QUALITY COMMISSION. <br />• Manufacturer: 4�3Cj it —00r14t } pr'poi zisl a double compartment <br /> Material:. f CY--& 'V., [ ] flow-through ]I have tested the septic tank and certify it to be watertight. <br /> Effluent Sewer: `It Header Pipe: The system was installed by: <br /> Size/tMat'I "i PVC-Nov size/mac] ] Property Owner(permittee) <br /> • . J Licensed Sewage Disposal Service <br /> DRAINFiELD :rock depth(inches) • Box(es) <br /> Rock and under pipe I ]Drop I J Concrete DEQ License Number: 3(0 t 7 <br /> Pipe total depth __ i I Distribution i J Plastic '* - <br /> DEQ Certification Number: 3 <br /> Drainfield Material(Alternative or pert:pipe) <br /> Total Drainfield Footage Trench Depth Minimum_ Maximum <br /> Curtain Drain Depth_ Signed: ,• - .,,..._- <br /> Effluent Punip: Pump Model . <br /> Pump cycle • / , <br /> times in minutes: on off Gallons per Cycle _-. Company name:_0 I-5 i s'P/0' I C„ ? Exc.- <br /> ATE Make and Model (please print) a <br /> Attach an additional sheet for components and materials not listed above. Date.: . ,j� tQ019 -- <br /> (For <br /> Q I9 <br /> (For Marion County Use Only) The above septic systein has been itispected by Marion County. The information has been determined lobe accurate <br /> and the system is: f v Approved I ]Approved with corrections:see inspection report [ I Denied <br /> Signed:0�( Ct vcGtte.: f2 i I."" S Title: OI lAke. Q(.U7C/2'L �_' t'1.4 - Dat 0 • _3 . <br /> MC:S-4I rev:3/03;4/12;5114;11/17 :1Forms1SeptithS-41 As-Buil t2015Version2017.doc WtHITE:Marion County; LOW:Owner;PJNKlnstalle <br />