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I • <br /> MARION COUNTY BUILDING INSPECTION INDIVIDUAL ON-SITE SEWAGE SYSTEM RECORD <br /> • '''-----::: 5i55 Silverton Rd NE (to be completed by system installer) <br /> SALEM OR 9730S <br /> MARIO 503-588-5147 PERMIT NO. ,-5-5 5 - 2. ).._-6:74> 5 2 2.9' <br /> N- • <br /> COUNTY <br /> • <br /> - http://mvw.co.marion.or.us/PW/HundingInspection SITE ADDRESS: A- <br /> AS-BUILT PLAN OF CONSTRUCTED SYSTEM: <br /> i .. <br /> • • • • • • • • <br /> ' • • ft wao . . • .. .1 • • •• • • • • • • • • • •• • • • • '• - <br /> • • • • . . <br /> ' ' 'le• s . . . . . . . . <br /> • • • 9% . . . . ). . . . .. ,,, 4).'.. . . • . . . . . _ <br /> fi ..,,,1/4_ Elv . ,. , <br /> , e <br /> S . <br /> • <br /> il <br /> ; 1 <br /> y 114 <br /> • -f - . . . . . • <br /> •,, <br /> . . . . <br /> .,,,,ek • - . . . -: . . , <br /> , . . . . . . . .. . . . . . _ y• . . . . ..i <br /> _. .. <br /> i . . . . . • . if>i) • . . . inii..-• . . . . . • wo, . . . . <br /> -. . • • . . . . ..1 . . . . . . . .' . . . . . • 4 •'14. • • .' '$ <br /> i ZP i )4 <br /> I • . . . « act . . . . . . . . . . i . \ . . .4 . . . _ . .$.... . , . : 1 <br /> . - . . . A • • • • • . . 6 i . . . • . • • • • . .. <br /> NY' t <br /> . <br /> • <br /> • Ch • . • 1 <br /> ' b. • • • I• 0 • <br /> • • . . . . .• •• • • 4 • 0 1 4 . . . . , <br /> - - - - - kaaurr au udtaus'iuni biludismuls netessety to-locale all components ot the system in the future <br /> SYSTEM MATERIALS AND SPECIFICATIONS: INSTAI,LERS CERTIFICATION: <br /> I HEREBY CERTIFY THAT THE ON-SITE SEWAGE SYSTEM IN- <br /> System Design Sewage Flow Gallons/Day <br /> STALLED AT THE ABOVE ADDRESS WAS CONSTRUCTED IN ACCOR- <br /> /WO total gallons E l double compartment <br /> TANK Si <br /> Or single compartment DANCE WITH THE REQUIREMENTS OF THE PERMIT AND THE RULES <br /> Manufacturer; 4e'S <br /> ..• ze: <br /> OF THE ENVIRONMENTAL QUALITY COMMISSION. <br /> 14-1Ac-t <br /> . • Material: . Cor4.4...C. [j flow-through , I J I have tested the septic tank and certify itto bewatertight. <br /> •Effluent Sever: et Header Pipe: _ <br /> Size/Mat li ?,06r/.302.3 4/ Afe-sizeimart cr-7.-fil P," . The sYSter11 was installed by: <br /> I I Property Owner(permittee) <br /> pd Licensed Sewage Disposal Service sip /24,Je .9%,•-.50 I- 4 <br /> DRAINPIELD I rock depth(inches) Box(es) I <br /> , ia• <br /> Rack and under pipe (0.- • I I Drop l)(Concrete DEQ License 14urnber: A>4$/%1...3 <br /> Pipe total depth „ite-../If • kfbistriburion I I Plastic! DEQ Certification Number: o_._-_ .-34.1 <br /> Drainfield Matetial.(Altemative orperf.pipe) <br /> i Total Drainfield Footage f 2...9' Trench Depth Minimum.2A/ Maximum-3 <br /> Curtain Drain Depth Signet_ t----- <br /> Effluent Pump: Punip Model . <br /> Pump cycle <br /> . <br /> times in minutes: on off Gallons per Cycle Company namç i•-e-"-.4.---°-- i)I N.,— ag •tb..t., e-.5 <br /> (please print) <br /> AT T Make and 1Vrodei <br /> l <br /> Attach an additional sheet for components and materials not listed above. Date: _6-2-3 <br /> ,.._ <br /> (For Marion Coun 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:.N.:'Approved [ ]Appr,ved with corrections:see inspection report [ I Denied <br /> - <br /> Signed:_ i j_ _Di,.. _fli k :, v.0 Lni(31-crfa - <br /> Date: (12,ppi___MC:S-4I rev. 03;4/12;5/14;11/17 GAFermeiseptielS-41 As-Om:2015W-rsion2017..doc - - WH1TE:Marion COMO,:Y OW: nen PINIC:Installer <br /> . - <br /> 1. .. <br />