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<br /> . 0 . . .:MARION COUNTY BUILDING INSPECTION INDIVIDUAL ON-SITE SEWAGE-SYSTEM RECORD
<br /> 5155 Silverton Rd NE (to be completed by system instalkr)
<br /> SALEM.OR 97305
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<br /> _ARION• 503-58851:47. PERMIT NO. •....t5 •=4..01)
<br /> COUNTY . . .,. - - - '• ' •
<br /> httpiliwww..0.marion;or,ustPW/BuildingInspeetton SITE ADDRESS: 9/9'7 S ;hie/'lc;a: ilhAjil
<br /> AS-BUILT PLAN OF CONSTRUMB*SYSTEM:. . PM
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<br /> (show all details d dimensions necessary to locate all components of the system in the future)SYSTEM:MATERIALBAND. PECIFICATIONS: :INSTALLERS.CERTIFICATION:
<br /> I HEREBY CERTIFY THAT THE.0N-SITESEWAGE SYSTEM INI.
<br /> System DeSign Sewage Fling: Gallons/Day STALLED AT THE ABOVE ADDRESS WAS CONSTRUCTED IN ACCOR-
<br /> WITH THE REQUIREMENTS OF THE PERMIT AND THE RULES
<br /> TANK Size: 49,0i9 total gilton5 ."."q"'-'—‘single compartment DANCE. ' ' -" •-
<br /> OF THE ENVIRONMENTAL QUALITY COMMISSION.
<br /> Manufacturer: 4...i. ‘4•64eV- [ ] double compartment
<br /> Material: (k2,-10' ./P7-14,- H flow;throvii .....kf 11 have..tested the septic tank:and certify'it tO beWatertight;
<br /> Effluent Sewer: i, li :,..., _
<br /> 'Header Pipe: The system:was installed,by:
<br /> Size/Mot 4'i _.,,"614.1-e, Size/Mari I J Property Owner(pennitte4
<br /> jeLiperiset(Sewage Disposal'SnriiiCd
<br /> DRAINFIELD . rock depth,tc,lies). Box(es) . ...,
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<br /> :. Rock and. under pipe t ; krDrop jet Concrete DEQ License Number.3. J f
<br /> '• Pipe' d
<br /> total epth j•..,og . [ f Distribution I I Plastic ,....", .....,4.1
<br /> ;DEQ Certification'Nunibea •-. •i iii •
<br /> Diiiifield Material(Alternative or pert pipe)' -----' '
<br /> Total Prninfic14 Footage,126 Trench Depth Minitnini17 Maximum39/4 -, ,
<br /> COMM DraiuDepth 41 ) , ' Signed: , " • , . . i
<br /> Effluent Ptimpt Pump Model •./.20 . .. .
<br /> 17'[PuP-.CY*. .. 0
<br /> --times in minutes on "- oft --- Gallons per Cycle "--- Company tiani0.1.4-qr.;E.., c........ „--.... -.i. C.„ :
<br /> ATT Mak " (pinase7prt6
<br /> e.and Model .
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<br /> Attach an additional sheet for eomponenta and materials not listed atio*e. . Date.._____ ___
<br /> (For Million ContitY'llse Only') The,above septic system has been inapeeted by Marion.County.'The information hasteen deterrnined to be accurate
<br /> and the system is: Of Approyed I 'my i ovo with c trectioio::sce inspection teport. 'I 1 Denied
<br /> $ipied: ;../1..4 N',4 .,! : OA_ I .i limp: 14.U [-(MLIT6q-J - _ Date:013
<br /> 2/111.,Ar1,-411A.,1111:1- .::::±;:,tiO A I A 4 rt..peIns.,...1,f...,-:., rt,,A.:.
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