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MARION COUNTY BUILDING INSPECTION INDIVIDUAL ON-SITE SEWAGE SYSTEM RECORD <br /> 5155 Silverton Rd NE SALEM OR 97305 (to be completed by system installer) <br /> 503-588-5147 PERMIT NO. 2 - ('ot-.u.s-1,„ <br /> MARION <br /> COUNTY http://www.co.marion.or.us/PW/Buildinglnspection <br /> SITE ADDRESS: `? 0 )(..,ythc„vc—t.. ,A-ix__ <br /> AS-BUILT PLAN OF CONSTRUCTED SYSTEM: ©t "C +t ) <br /> Scale: 1"_ '4----- <br /> t Vi -D <br /> It i -1-‘ (_.______s________tfr:—.qu._.yz_ 1.--; <br /> , , , tpe ,.,,, <br /> ,0 7 s i 61,4 . 1 l D' 1-0t2-1 <br /> .<1; v <br /> i 1 di--'Z'let-x 0. <br /> bt <br /> 7' tr ' <br /> O O. r <br /> Cc3 5))(Drop'1302Q7-9 II,........ <br /> -\Nbv-A -- - _ \\,:\ DI 5T..)D PoAA C:,(v..,p,...tx.,...,Ad- .‘ <br /> -Jo <br /> r <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 /> 3� Gallons/Da I HEREBY CERTIFY THAT THE ON-SITE SEWAGE SYSTEM IN- <br /> System Design Sewage Flow y STALLED AT THE ABOVE ADDRESS WAS CONSTRUCTED IN ACCOR- <br /> TANK Size: [SOO total gallons [ ] single compartment DANCE WITH THE REQUIREMENTS OF THE PERMIT AND THE RULES <br /> Manufacturer: �4;V.a— <br /> [ ] double compartment OF THE ENVIRONMENTAL QUALITY COMMISSION. <br /> Material: (U, QJ-- [ ] flow-through 1X1 I have tested the septic tank and certify it to be watertight. <br /> Effluent Sewer: Header Pipe: The system was installed by: <br /> Size/Mat'I Size/Mat'l I 1 Property Owner(permittee) <br /> [d Licensed Sewage Disposal Service <br /> DRAINFIELD rock depth(inches) Box(es) <br /> Rock and under pipe Drop I I Concrete DEQ License Number: ?jiL3b <br /> Pipe total depth I I Distribution I I Plastic <br /> DEQ Certification Number: U X1 <br /> Drainfield Material(Alternative or perf.pipe) P<2._ Rp1/4_,_., <br /> Total Drainfield Footage O° Trench Depth Minimum 30"Maximum VZ. <br /> Curtain Drain Depth_ 2 Signed: <br /> Effluent Pump: Pump Model PC—3(pos- <br /> Pump cycle _ <br /> times in minutes: on off Gallons per Cycle Company name: ee..,� <br /> (please priIft) <br /> ATT Make and Model <br /> Attach an additional sheet for components and materials not listed above. j Date: 5 /2_ 2--3 <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: VI.Approved [ I A roved with corrections: see inspection report [ ] Denied <br /> Signed: tle:Et- 117 I Date: <br /> MC:S-41 rev:3/03;4/12;5/14;11/17 G:\FormstSeptic\S-41 As-Built20l5Version2017.doc WHITE:Marion County; YE LOW/Owner;PINK:Installer <br />