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iikliMARION 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 /> MARION 503-588-5147 - PERMIT NO_. <br /> COUNTY ^�� 1 t <br /> htip:llrvww.ea.mmrion.ar.usfPW,Auildinglnspection SITE A DDRESS: 71.6U a )Ct1/41'1 .r C-kr 5-, �„J <br /> AS-BUILT PLAN OF CONSTRUCTED SYSTEM1Am O� c� <br /> SYSTEM.: <br /> Scale: <br /> - t <br /> Northif <br /> Otv^-i... <br /> 11;oo0 ciqttiJ.tt <br /> . t encrt:te*A4K. <br /> t. s <br /> c <br /> ti , <br /> 0 fl <br /> 0 <br /> L <br /> `r�ts>'' <br /> r\w <br /> (show 1 details and.dimensions necessary to locate all componentsenof the sys em in the future) _. <br /> SYSTEM MATERIALS AND SPECIFICATIONS: INSTALLERS CERTIFICATION: <br /> I HEREBY CERTIFY THAT THE ON-SITE SEWAGE SYSTEM IN- <br /> Stem <br /> Ya Design� Sewage Flow Gelions€Da Y STALLED AT THE ABOVE ADDRESS WAS CONSTRUCTED IN ACCOR= <br /> TANK Size: 1 MO total gallons visingte compartment DANCE WITI!THE REQUIREMENTS OF THE PERMIT AND THE RULES I <br /> Mneurneturcz; %j) t 3tC 0 f)(V,If lt- l j double compartment OF�THE ENVIRONMENTAL QUALITY COMMISSION, <br /> Material: Cofv,Ye- - 1 l flow-through Jrl i have tested the septic tank and certify it to be watertight. <br /> Effluent Sewer: ,t t Header Pipe, The system was installed by: <br /> SizeMarl +v/ Size/Mat'I .3't pi().L- 1 i)1OPerty Owner(permittee) <br /> Licensed+Sewage Disposal Service <br /> DRAINFIELD rock depth(inches) Bastes) ` rr��'IL <br /> Rock end under pipe 14rop Z"1 I I Concrete DEQ License Number: t� D <br /> Pipe total depth I I Distribution I I Plastic DEQ Certification Number: <br /> Drentfireld Material(Alternative or pert:pipe) e•-Z f I OL <br /> Total Dm-infield Footage Trench Depth Minimum VA Maximum"J 0 <br /> Curtain Drain Depth .. Signed: ...,.."//"------" <br /> #r"----"/C--- <br /> Effluent Pump: pump Model 1 <br /> PutnP ale <br /> Career in n intoes: on off Gallons per Cycle Company name: 1\1O'V'0 . e..1-4 G(X t\ i:.Lt. ` <br /> ATT Make and Model NI I I'S" `1Pleaste print) <br /> Attach an additional sheet for components and materrinis.not listed above.. Date: U, k‘(please <br /> Z t <br /> ITor.Marion County Use Only) The above septic system has been inspected by Marion County. The information has been determined to be accurate <br /> anal the system is: Approved 1 I Approved With corrections:see inspection report I I Denied I <br /> Si cd Title: e. Pi- CT 0(----SCPDate /115-7.2 ( <br /> Me-s,,43 re°a:3103;4112,;5/l4;11117 U WortmISepit S-+€I As-D uilt2.0l5Version2Oi 7.doc oldie,Marion County:YELLO1V-Ormar;PJMCbnsret tar <br />