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',*� MARION COUNTY BUILDING INSPECTION INDIVIDUAL ON-SITE SEWAGE SYSTEM RECORD <br /> a 5155 Silverton Rd NE (to be completed blly+system installer) • <br /> 5 3-88 SALEM OR 97305 PERMIT NO. 5 5 5 _ dot I —. 0 `0 4 1 <br /> MARION <br /> COUNTY http://www.co.marion.or.us/PW/BuildingInspection SITE ADDRESS: 9S It (ofGnr Pi_ <br /> �f-J <br /> AS-BUILT PLAN OF CONSTRUCTED SYSTEM: SA►eW\ <br /> Scale: 1"= !001 PL <br /> T <br /> North <br /> • <br /> 0 <br /> )al) <br /> 12 <br /> rc V- <br /> 1 <br /> ACP <br /> �de j <br /> ..... ... , . ..,. 76. <br /> gi, <br /> _t_ii i It - ., C>( <br /> V/'a%i‘til-ii <br /> • <br /> vez- 610EY-. 7:1"2,,e, J1 N . <br /> L I- 4i) -o ce . <br /> • <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: )06Q total gallons 1,41single compartment DANCE WITH THE REQUIREMENTS OF THE PERMIT AND THE RULES <br /> Manufacturer:C;l'//ryv��'t'c C u����t'l� <br /> [ ] double compartment OF THE ENVIRONMENTAL QUALITY COMMISSION. <br /> Material: [ ] flow-through IA I have tested the septic tank and certify it to be watertight. <br /> The system was installed by: <br /> Effluent Sewer: i Header Pipe: It c ' <br /> Size/Mat'I kr 3®SY Size/Mat'l `� 3®3� I I Property Owner(permittee) <br /> $ Licensed Sewage Disposal Service <br /> DRAINFIELD rock depth(inches) Box(es) <br /> Rock and under pipe LI t' EZ I I Drop I I Concrete DEQ License Number: 39 1 cl f <br /> Pipe total depth 0 0 ri I I Distribution I I Plastic Q oZy I G) <br /> DE Certification Number: <br /> Drainfield Material(Alternative or perf pipe) e y <br /> Total Drainfield Footage 315 Trench Depth Minimuma'4 Maximum 1 <br /> Curtain Drain Depth_ .'JM Signed:_ op,' <br /> Effluent Pump: Pump Model .N/A . • <br /> Pump cycle t l <br /> times in minutes: on off Gallons per Cycle Company name: 6-ft'KJfLd hrea„t ivl &X6Cy,`/�tiGin L1;, <br /> ATT Make and Model (please print <br /> Attach an additional sheet for components and materials not listed above. Date: 4' Q 2c <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 I I Approved with corrections: see inspection report I I Denied / ,/ <br /> _Signed — Title: 1A S 62 (1 Cat Date: 87`� ` <br /> MC:S-41 rev:3/03;4/12;5/14; 11/17 G:\Forms\Septic\S-41 As-BuiIt2015Version2017.doc WH/TE:Marion County: YELLOW:Owner;PINK:Installer <br />