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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, .. 2- 1 t7 <br /> MARiOtI <br /> COUNTY htip://www.co:rnarion.or.us/PW/Bulldinglnspection • <br /> SITE ADDRESS: �0 <br /> AS-BUILT PLAN OF CONSTRUCTED SYSTEM: <br /> Scaler 1"- • <br /> North <br /> • <br /> t� ►�` : <br /> ‘5 0S <br /> • <br /> (show all details and.dimensionsnecessary to locate,all components of the system in the future). ,_ <br /> SYSTEM MATERIALS AND SPECiFICATIONSt INSTALLERS CERTIFICATION: <br /> System Design Sewage Flow Gallons/Day ` I`HEREBY CE RTIFY THAT`THE.ON-SITE SEWAGE SYSTEM IN- <br /> S f ALLED AT THE ABOVE ADDRESS WAS CONSTRUCTED IN ACCOR- <br /> Septic Tank:Size' e gallons Mat'I_ l elMf; ,3e z ." DAVCF WITH THE REQUIREMENTS.OF THE PERMIT AND TI]E RULES <br /> OF THE ENVIRONMENTAL QUALITY'COMM ISSION,. <br /> Dosing Tank:Size ""' gallons Mat'1-�'" 'rF Mfg <br /> /1'I have tested the septic tank and certify it to be watertight: <br /> MT Make and Model Boz(es):, <br /> ...• i 1 Distribution The system was installed by: <br /> Effluent Sewer:Size 'rltitat'l I i Drop <br /> ' ( I Concrete { .l Property Owner(permittee) <br /> Drainliield Pipe:Size .. I" ' Y,✓/ I 1 Plastic Licensed Sewage Disposal Service <br /> Material;Header Pipe `""—'' Perforated Pipe DEQ License Number: (J <br /> Total Drainfield"Footage ---- Trench Depth Mini-num- --.Multiunit DEQ'Certification Number; • <br /> ;ltock.Depth:Total 'Udder Pipe. -- Curtain Drain Depth <br /> Signed: <br /> Alternative Draintield Materials "-"" <br /> �~Efvent.Pump: Pump Model fl Company name:. <br /> Pump Cycle minutes" minutes <br /> Time on__:_... "'. .off._ -^"'" 'Gahons per Cycle (please print) <br /> Attach an additional skeet Tor components.and materials not listed above. Tate' <br /> (For Marion•County Use Only) ' <br /> The above septic system has been:inspected by Marion County.The:information has been:determined to be accurate and the system is: <br /> 1,114,:t)proyed ( ]Approved with corrections:see inspection report I r'Denied <br /> S aned: - Title: 11�/: � / J � iy"f Date: O �✓ , <br /> W� <br /> :MC:'S-4.1 rev 3/43;4/2$/14 WHITE:'Marion County;YELLOW;Owner;PINK'Instalfer <br />