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MARION COUNTY BUILDING INSPECTION INDIVIDUAL ON-SITE SEWAGE SYSTEM RECORD <br /> ` <br /> • - 5155 Silverton Rd NE (to be completed by system installer) <br /> °° SALEM OR 97305 <br /> '`"'' -' 503-588-5147 PERMIT NO. S7 -c9-.V,.-008V S 3 <br /> MAR <br /> http://www.co.marion.or.us/PWBuildinglnspection SITE ADDRESS: /2,41`211 i iorz.+" --t ¶'icr,t AfE <br /> AS-BUILT PLAN OF CONSTRUCTED SYSTEM: 7414(c_. t 13 " 511 crG,L[i.%,•%- ; Cyr. /-73«'7 <br /> Scale: 1"= t <br /> North <br /> \ P <br /> ?It- cI <br /> / <br /> mt <br /> to <br /> ',k6' <br /> o — <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 '50 Gallons/Day �t`_5 ``"` STALLED AT THE ABOVE ADDRESS WAS CONSTRUCTED IN ACCOR- <br /> TANK Size: ( ] single compartment DANCE WITH THE REQUIREMENTS OF THE PERMIT AND THE RULES'a total gallons OF THE ENVIRONMENTAL QUALITY COMMISSION. <br /> Manufacturer: LJ.tA.1-e [ ] double compartment <br /> Material: (16'1.tr,4,-irk- [ ] flow-through [)4 I have tested the septic tank and certify it to be watertight. <br /> Effluent Sewer: Header Pipe: The system was installed by: <br /> Size/Marl Size/Mat'l — <br /> [ I Property Owner(permittee) <br /> 04 Licensed Sewage Disposal Service <br /> DRAINFIELD rock depth(inches) Box(es) p�/At. <br /> Rock and under pipe [ ]-Drop [ 1 Concrete DEQ License Number: <br /> Pipe total depth [ 1 Distribution [ I Plastic <br /> DEQ Certification Number: a T- `7 , <br /> Drainfield Material(Alternative or pert.pipe) <br /> Total Drainfield Footage Trench Depth Minimum'- Maximum <br /> Curtain Drain Depth — Signed `- <br /> Effluent Pump: Pump Model <br /> Pump cycle f <br /> times in minutes: on off Gallons per Cycle Company name:, �-,`'+"C•4e*_ S1a,.,2y- 0-- /+,'r.t*L. L,l.. <br /> ATT.Make and Model "" -'~ cI (please print) <br /> i Attach an additional sheet for components and materials not listed above. Date: < -, '`4�..3 <br /> i (For Marion County Use Only) The above septi m has been inspected by Marion County. The information has been determined to be accurate <br /> and the systetnn isi [ pproved [ ]Ap oved w h corrections:see inspection report [ ]Denied <br /> Signed: <br /> F_N 1 A,1P''x W R.,_ isle: ©, - k) 1Of1 [t5 12 Date: 29 is , <br /> MC:S-41 rev:3103;4/12;5/14;11/17 orms\S 1 s-Bui1t2015Version2017.doc WHITE:Marion County;YEL OW:Owner;PINK:Installer <br />