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., APPROVED AS-BUILT <br /> • <br /> ..r... <br /> . DRAWING <br /> . HISTORY <br /> .... MARION COUNTY BUILDING INSPECTION E c-ctwI <br />/ 355 COURT ST NE/PO BOX 14500 <br /> —SALEMSR-4 309 fi0 - �'.tit! saa14) <br /> • - INDIVIDUAL ONSITE SEWAGE SYSTEM RECORD <br /> (to be completed by system insta <br /> SITE g(Dl Rue A.E. sr PERMIT NO. oq — 0 5 <br /> AS-BUILT PLAN OF CONSTRUCTED SYSTE : <br /> y.. oft*rs ois..- 1 6 Norte <br /> t <br /> ...'"..--7 ""."*.; <br /> i 1 /� 1 O <br /> i 1 1 ! �t I t % <br /> V ‘2*- - % A % .. i . <br /> \ % % <br /> 1 % ' v v <br /> •% � • <br /> 1 I <br /> 551_4 . <br /> i(show all details and dimensions nectlssary to locate all components of the system in the future) <br /> SYSTEM MATERIALS AND SPECIFICATIONS: INSTALLERS CERTIFICATION: <br /> System Design Sewage Flow: 150 Gallons/Day I HEREBY CERTIFY THAT THE ON-SITE SEWAGE SYSTEM IN- <br /> • •. STALLED AT THE ABOVE ADDRESS WAS CONSTRUCTED IN ACCOR- <br /> Septic Tank:Size: Marl COACIr fil: DANCE WITH THE REQUIREMENTS OF THE PERMIT AND THE RULES <br /> a t°flO qq OF THE ENVIRONMENTAL QUALITY COMMISSION: <br /> Dosing Tank:Size: t VMarl Mfg. [J I have tested the septic tank and certify it to be watertight. <br /> Effluent Sewer:Size t7�f Mat'1: 5034 f JL... The system was installed by: <br /> [J Property Owner(petmitee) <br /> Binges): [J Distribution; DI Drop/ [I Concrete;$Plastic • KLicensed Sewage Disposal Service <br /> Drainileld Pipe:Size: ;Material:Header:air Meo;Perf DEQ License Number. 33$3es <br /> DEQ Certi 'on Number.__ <br /> Total Drainlleld Footage:150 ;Rock Depth:Total: - ;Under Pipe: I <br /> � Signed: <br /> �� <br /> Alternative Dralnfleld Materials: aa1G 14 r."4:11-.4ar <br /> Trench Depth:Minimum: .l.y;Maximum:_2.y ;Curtain Drain DepthMau t Company name:VI tLd (2.- 5e.e/(iC,C„ZMCo <br /> (please print) <br /> Effluent Pump:Pump Model: ;Static Head in System FL y OA <br /> Date: /"a • `f . <br /> Pump Cycle Time: ;Gallons per Cycle: <br /> Attach an additional sheet for components and materials not listed above. c <br /> (For Marion County Use Only) <br /> mfrTh ove septic system has been inspected by Marion County.The information has been determined to be accurate and the system is: <br /> Approved <br /> [j Approved with corrections:see inspection report <br /> [i D••. . <br /> Signed: l�' Title: Date: ere�__ /mas►' /' I <br /> MC:S-41 WHITE:Marion County;YELLOW:Owner;PINK Installer <br /> rev:8/00,6/O1;3/03 <br />