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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 5'5$. 11. 00'64 CrO <br /> 503-588-5147 PERMIT NO. <br /> MARION <br /> COUNTY http://www.co.marion.or.us/PW/Buildinglnspection SITE ADDRESS:Cce)5 /fa 4 „C-v`e b°")cic_ <br /> AS-BUILT PLAN OF CONSTRUCTED SYSTEM: �� . <br /> Scale: 1" _ 1% <br /> North <br /> 'fid'd <br /> 7 <br /> 0 —'1;,7 IZ /-.,; <br /> t. <br /> NI <br /> ea `r <br /> . <br /> f <br /> 0 <br /> 1 41 <br /> 7 i <br /> -7.1--, <br /> e <br /> r <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 Gallons/Day I HEREBY CERTIFY THAT THE ON-SITE SEWAGE SYSTEM IN- <br /> ii STALLED AT THE ABOVE ADDRESS WAS CONSTRUCTED IN ACCOR- <br /> Septic Tank:Size/CI . gallons Mat'l(bei 4 Mfg/,c J DANCE WITH THE REQUIREMENTS OF THE PERMIT AND THE RULES <br /> OF THE ENVIRONMENTAL QUALITY COMMISSION. <br /> Dosing Tank:Size 9,3 gallons Mat'lSeft MfgG7,-4-.1" <br /> IA I have tested the septic tank and certify it to be watertight.. <br /> ATT Make and Model Box(es): <br /> r�/ 1 I Distribution The system was installed by: <br /> Effluent Sewer:Size I 7 Mat'I S01I r CO I I Drop <br /> I ]Concrete I ]Property Owner(permittee) <br /> •Drainfield Pipe:Size I ]Plastic (!)'Licensed Sewage Disposal Service <br /> Material:Header Pipe Perforated Pipe_ DEQ License Number:"VO 47 <br /> n <br /> Total Drainfield Footage Trench Depth Minimum Maximum DEQ Certification Number:, <br /> Rock Depth:Total Under Pipe Curtain Drain Depth_ . . <br /> Signed: <br /> / ��„!� <br /> Alternative Drainfield Materials . <br /> Effluent Pump: Pump Model • Company name: .I ' .01... <br /> Pump Cycle minutes minutes (please print) <br /> Time on off Gallons per Cycle / <br /> 17 — <br /> Attach an additional sheet for components and materials not listed above. Date: �� �F <br /> (For Marion Count --- i n • <br /> The above septic :-stem has been in''.ected by Marion County.The information has been determined to be accurate and the system is: <br /> 14Approv,i/104-Appr• ed with corrections: ee inspection report I I Denied <br /> Sign-:. Title: Date: G1 Z� �C <br /> MC:S-41 rev:3/; ;4/12;5/14 WHITE:Marion Count ; YEL OW:Owner;PINK:Installer <br />