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• <br /> I ?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.5c I 3?Y8—PST <br /> MARION <br /> COUNTY http://www.co.marion.onus/PW/Buildinglnspection SITE ADDRESS:/3„2._ -. .So/A6i%I 151-7 <br /> AS-BUILT PLAN OF CONSTRUCTED SYSTEM: <br /> Scale: 1"= Ye' T <br /> North <br /> ii .SE g-17 , Q/ ws� `t <br /> ...../e____. <br /> (show all details and dimensions necessary to locate all components of the system in the future) <br /> SYSTEM MATERIALS AND SPECIFICATIONS: INSTALLERS CERTIFICATION: <br /> I HEREBY CERTIFY THAT THE ON-SITE SEWAGE SYSTEM IN- <br /> System Design Sewage Flow ym® Gallons/Day STALLED AT THE ABOVE ADDRESS WAS CONSTRUCTED IN ACCOR- <br /> TANK Size: /SCE® total gallons [ ] single compartment DANCE WITH THE REQUIREMENTS OF THE PERMIT AND THE RULES <br /> bg�l. IX.double compartment OF THE ENVIRONMENTAL QUALITY COMMISSION. <br /> Manufacturer: <br /> Material: r Iy [ ] flow-through 1$1 I have tested the septic tank and certify it to be watertight. <br /> Effluent Sewer:it Header Pipe:�r The system was installed by: <br /> Size/Mat'l .2 i/VC_ScA W IP Size/Mat'l. f VC Scii /C1, ] ] Prgperty Owner(permittee) <br /> QQ,Licensed Sewage Disposal Service <br /> DRAINFIELD rock depth(inches) _ Box(es) 61— <br /> Rock and under pipe I J Drop I I Concrete DEQ License Number: 3 2�,2, . - <br /> Pipe total depth I I Distribution I I Plastic <br /> DEQ Certification Number:t 2 6 z <br /> Drainfield Material(Alternative or.perf.pipe) { 2—Fie,t✓ <br /> Total Drainfield Footage /3> / Trench Depth Minimums t Maximums. <br /> Curtain Drain Depth Signed: -- <br /> Effluent Pump: Pump Model Zoe1//l1/1 -5-3 . <br /> Pump cycle <br /> times in minutes: on off Gallons per Cycle Company name: 6'$c',7 5rn--1Ge-S, I--Le- <br /> ATT Make and Model (please print) <br /> Attach an additional sheet for components and materials not listed above. Date: ®e A® a_Z,.� <br /> (For Marion County 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: Approved 1 1 Approved with corrections: see inspection report ] ' Denied <br /> /_n ' 7/(67 <br /> Signed: � � Title: �t �� l(Jv� 1-� Date: <br /> ..._ _._ ... .. .,... .. vrr r rr..r A,...:...-/-•,........ VCT I/11.V.il....,,..• AIAIV•l.,.r,.!!n.• ' <br />