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MARION COUNTY BUILDING INSPECTION INDIVIDUAL ON-SITE SEWAGE SYSTEM RECORD <br /> iiki <br /> 5155 Silverton Rd NE <br /> SALEM OR 97305 (to be completed by system installer) <br /> t <br /> 503-588-5147 PERMIT NO. r_ V 5J - 2 2 "00 3 q 59 <br /> MARION //�� �, f <br /> COUNTY http://www.co.marion.or.us/PW/BuildingInspection SITE ADDRESS: "f q 2 y A L K.) il e <br /> AS-BUILT PLAN OF CONSTRUCTED SYSTEM: <br /> Scale: 1 = A - < = 15 e T <br /> / North <br /> , g- L o 30' <br /> 7 qq�L`Lt A- D : Zs ' A-6 ,W <br /> / 6- p = 3V' A-N%8Li' - <br /> ` o d NI e.,) -o m� A- E = "7 1 ' A Z.1 r ' <br /> V r <br /> 0 <br /> a / i3- c' = 7 I ' <br /> .. <br /> -6 w� � ,s1,�� glo 6-G = G 7' / <br /> AS d U NTT <br /> V Ly <br /> ti 4E- 1 Ott-7 <br /> • <br /> , <br /> I kff ass <br /> 4, \ <br /> ‘ifA L. A N L <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 LSD Gallons/Day STALLED AT THE ABOVE ADDRESS WAS CONSTRUCTED IN ACCOR- <br /> TANK Size: I b 00 total gallons (single compartment DANCE WITH THE REQUIREMENTS OF THE PERMIT AND THE RULES <br /> � f ] double compartment OF THE ENVIRONMENTAL QUALITY COMMISSION. <br /> Manufacturer: A R Ave..., <br /> Material: e.01AGrL14— [ ] flow-through $I have tested the septic tank and certify it to be watertight. <br /> Effluent Sewer: 1 Header Pipe: L'�. The system was installed by: <br /> Size/Mat'I 14L Size/Mat'l V. I I Property Owner(permittee) <br /> IA Licensed Sewage Disposal Service <br /> DRAINFIELD rock depth(inches) Box(es) <br /> Rock and under pipe X Drop oncrete DEQ License Number: 3,1 23 1 <br /> Pipe total depth I I Distribution I I Plastic <br /> DEQ Certification Number: 2 S7 Z, <br /> Drainfield Material(Alternative or pert.pipe) A I letrl ekt Ne_ . <br /> Total Drainfield Footage j 5-5i Trench Depth Minimum 2 y Maximum-3 y I <br /> Curtain Drain Depth_ Signed: L <br /> Effluent Pump: Pump Model . <br /> Pump cycle <br /> times in minutes: on off A �G fallons per Cycle Company name: Kt el TD(7ZG Xe4Ud j (,1,1 <br /> ATT Make and Model 'C h Le) 0 QT (please print) <br /> O <br /> Attach an additional sheet fo,components and materials not listed above. Date: 0 1/1 5/ Z. <br /> (For Marion County se Onl_y)The above septic system has been inspected by Marion County. The information has been determined to be accurate <br /> and the system AAroved i I Approved with corrections: see inspection report I I Denied <br /> Signed: Title: Date:3 gt az <br /> MC:S-41 re :3/03;4/12;5/14;11/17 G:\Forms\Septic\S-41 As-Built20l5Version2017.doc WHITE:Marion County; Y LLO :Owner;PINK:Insta11er <br />