Laserfiche WebLink
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. 22-7 011 qZ6 <br /> MARION <br /> COUNTY http://www.co.marion.or.us/PW/Buildinglnspection //TS <br /> SITE ADDRESS: IatOLAND Wy S 1 7P�v ',a/?‘ <br /> AS-BUILT PLAN OF CONSTRUCTED SYSTEM: <br /> Scale: 1"=25'' 1.- <br /> _ t --T <br /> /4O to$4 North <br /> C'71 -1..... „,4_______ <br /> 1 ICli '' <br /> /06e' ----------41). <br /> II WELI.�-$ <br /> Ili- .�.,, r - _(Do ' <br /> � _ _ _ _, <br /> • <br /> 'IV , <br /> 7qd <br /> ,, A- E-- 6-2'-I©,, A — H r T(- 6' <br /> AI A <br /> A- Br 33 '6 /z- �� - = 5$'- 3 , a- !i = 137"- 2 ,, <br /> 13 — 1d 2 ' t" 13--F - (.0 '— to'� <br /> A- 0 - r.12' - 3'' A-6 75'- 7°' <br /> 13 "D' 15—(O,' (show all details and dimensions necessary to locate all components of the system in the future) <br /> SYSTEM MATERIALS AND SPECIFICATIONS: INSTALLERS CERTIFICATION: <br /> • <br /> WS Gallons/Da I HEREBY CERTIFY THAT THE ON-SITE SEWAGE SYSTEM IN- <br /> System Design Sewage Flow y STALLED AT THE ABOVE ADDRESS WAS CONSTRUCTED IN ACCOR- <br /> TANK Size: IOC,0 total gallons [alf single compartment DANCE WITH THE REQUIREMENTS OF THE PERMIT AND THE RULES <br /> f�1 r� [ ] double compartment OF THE ENVIRONMENTAL QUALITY COMMISSION. <br /> Manufacturer: <br /> Material: Gd al ciZL1T6' [ I flow-through i 4 I have tested the septic tank and certify it to be watertight. <br /> Effluent Sewer: ,/ Header Pipe: ', The system was installed by: <br /> Size/Mat'I Li FTC 3034 Size/Mat'l plfc 3034 [✓[ Property Owner(permittee) • <br /> I j Licensed Sewage Disposal Service <br /> DRAINFIELD rock depth(inches) Box(es) Q{�� Q ,(� �q7 �(/ <br /> Rock and under pipe to l4 Drop l�Concrete DEQ License Number: v� �D1 V eel/( leV" , <br /> Pipe total depth 1i. I I Distribution I I Plastic <br /> - DEQ Certification Number: <br /> Drainfield Material(Alternative or <br /> perf.pipe) PEW' P/PE <br /> Total Drainfield Footage 38-7 Trench Depth Minimum 1. Maximum_2-1 . /� <br /> Curtain Drain Depth_ I✓/i4 Si_ ed: A dpip G/ <br /> Effluent Pump: Pump Model PA . . / <br /> Pump cycle times in minutes: on off Gallons per Cycle Company name: Me PLO AR <br /> (please print) <br /> ATT Make and Model Attach an additional sheet for components and materials not listed above. Date: t/%I f i3 <br /> (For Marion Couf <br /> Use Onl 1 The above septic system has been inspected by Marion County. The information has-ben determined to be accurate <br /> and the system is: [ A ved I Approved with corrections: see inspection report [ I Denied <br /> Signed:- Title: a Date: g- - <br /> MC:S-41 rev:3/03;4/12;5/1 ; G:\Forms\Septic\S-41 As-Built20l5Version20I7.doc WHITE:Marion County:,YEL OW: caner;PINK:Installer <br />