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. <br /> Nsw MARION COUNTY BUILDING INSPECTION INDIVIDUAL ON-SITE SEWAGE SYSTEM RECORD <br /> '''."1/45155 Silverton Rd NE (to be completed by system installer) <br /> -------- SALEM OR 97305 • <br /> 503-588-5147 PERMIT NO. 55.640—40:.007/11 - PR.M-r <br /> MARION �,�� /� s <br /> COUNTY http://www.co.marion.or.us/PW/Buildinglnspection SITE ADDRESS: 8383 /�t:/�.$—remi k se <br /> AS-BUILT PLAN OF CONSTRUCTED SYSTEM: <br /> Scale: 1"_ ' • t <br /> North <br /> :/a)0 ° p C, n../ <br /> AVL <br /> c �s'li'" E.-6 2 Ze8 C ode <br /> © ow_ <br /> w <br /> • <br /> J <br /> 6.U diWSC" o b AL I'm,K <br /> I . <br /> i ,4is�(,6AN7 <br /> exovir/t. t� <br /> R3 e Cg'—'2Vis \, i i " At ,i ' C76 fcr,''�r'r�rt leaq eff(wie <br /> �1 !/lArvpcltZ tiiiewi <br /> .4 <br /> f(c. \...__ . <br />, `` iziut WA 1 <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 itcp Gallons/Day STALLED AT THE ABOVE ADDRESS WAS CONSTRUCTED IN ACCOR- ' <br /> TANK Size: isztotal gallons [ ] single compartment DANCE WITH THE REQUIREMENTS OF THE PERMIT AND THE RULES <br /> Manufacturer: ds1fArre <br /> double compartment OF THE ENVIRONMENTAL QUALITY COMMISSION. <br /> Material: C'0A^ 7g [ ] flow-through IS I have tested the septic tank and certify it to be watertight. <br /> Effluent Sewer: !a rr Header Pipe: The system was installed by: <br /> Size/Mat'1 /�y �. �Llf��Size/Mat'1 I ]Property Owner(permittee) <br /> I,(]Licensed Sewage Disposal Service <br /> DRAINFIELD rock depth(inches) Box(es) <br /> Rock and under pipe [ I Drop. [ I Concrete DEQ License Number: 313 2; `- <br /> Pipe total depth [ [Distribution [ J Plastic <br /> DEQ Certification Number: Y' c7 - . <br /> 7 <br /> Drainfield Material(Alternative or pert.pipe) ' <br /> Total Drainfield Footage Trench Depth Minimum Maximum _ <br /> J <br /> Curtain Drain Depth_ Signed: <br /> � [�/2 Vic 2 � -- <br /> Effluent Pump: Pump Model 0� //-- <br /> Pumpcycle /i'ii✓1 'eCOhDS (CI / //I <br /> +/p <br /> times in minutes: on Gallons per Cycle Company name: i (/ / 4 <br /> ATI'Make and Model (please punt) <br /> Attach an additional sheet for components and materials not listed above. Date: 2723—Z/ <br /> (For Marion Co ntv 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 /> Signe•: -..... Title: rill S ( I d Z j t4_2 el Date: 57772 r , <br /> MC:S-41 rev:3/03;4/12;5/14;11/17 G:\Forms\Septic\S-41 As-Built2015Version2017.doc WHITE;Marion County;:YELLOW.•Owner;PINK•Installer <br />