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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 <br /> 503-588-5147 PERMIT NO. <br /> MARION . <br /> COUNTY http://www.co.marion.or.us/PW/BuildinglnspectionSITE ADDRESS: ^ .i a4iL, /c-.�� ` rat <br /> AS-BUILT PLAN OF CONSTRUCTED SYSTEM: <br /> Seale I"= r �; <br /> PYop 1= . North <br /> , g ..1 ( I . <br /> ii, <br /> go' 3o` 1 <br /> i <br /> v <br /> iO' l..�, <br /> S• <br /> Lb ,. _ s_z <br /> 13 <br /> ,ctTT <br /> 3 > Zvf <br /> Nest <br /> �. <br /> (show 41 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 INACCOR- <br /> (e]'singl e.compartment DANCE WITH THE REQUIREMENTS OFTf1E PERMIT AND THE RULES <br /> TANICSize: 0 0e1L total gallons <br /> OF THE ENVIRONMENTAL QUALITY COMMISSION. <br /> Manufacturer. 6 rai .., r: e -d f► [1 double compartment <br /> Material: Cz, <br /> [ ] flow-through. havetested the septic tank and certify it to be watertight <br /> f-GEffluent Sewer: „ Header Pipe: I "IA- The system was installed'by: <br /> Size/Matl V Lt j0 Size/Mat'1 ` I Iy fo I a• re t +ti9 I,I Property Owner(permittee) <br /> censed SewageDisposal Service <br /> DRAINFIELD rock depth(inches) Box(es) <br /> Rock and under pipe. [ I Drop [I Concrete DEQ License Number, Y(F o:.C— <br /> Pe total depth ( 1.Distribution [ I Plastic & <br /> DEQCertification Number: 8 <br /> Diainfield Material(Alternative or pert.pipe)t 2. MAN ui/p9.404 rZ r r e <br /> Total Drainfield Footage f 3f Trench Depth MinimumL Maximum Y d. i A-- s� a'�- <br /> Curtain Drain Depth Signed: <br /> Effluent Pump: Pump Model S-e - 14'+'g.JCef14 Sj eCs <br /> Pump cycle f - <br /> times in minutes: on. off Gallonsper (,7 t+ <br /> _ Cycle Company name:_. . ✓ .d . �CL�vs�� .1 h;C .- <br /> (please print) <br /> ATt Make and Model Or'e-t.+tv. AV 20 <br /> Attach:an.additional sheet for components and materials not listed.above. Date: G-)7 7.2-z <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: ] - s pro vz [r I proved with corrections:see inspection'report [ .]Denied <br /> .� <br /> Signed.�. (/Li Dat 6 ���e: <br /> MC:S-41:rev' /03;4/12-;5/14;11/17 G:\P-ornis-S—eptic\S-41 As-Bui1t201.5Version2017.doe WhiTkfiirrion County:YE OW 0 ner:FINlClnstaller <br />