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. <br /> iiimMARION 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. <br /> MARION <br /> COUNTY http://www.co.marion.or.us/PW/Buildinglnspection <br /> SITE ADDRESS:337Aj Z_ eztl (40c,c,I -irt,.e_ <br /> AS-BUILT PLAN OF CONSTRUCTED SYSTEM: 0‹ <br /> Scale: 1"_ T <br /> E--^ e4'( le,A - North <br /> , <br /> . Wpu 1-4._ C o...CK..he_ <br /> 1204l Co"ow..4 <br /> 4 <br /> 4 <br /> 4.4r r <br /> 1 SU>0 5..1 5e4\iL. I ac's-' d <br /> 1� <br /> t ' <br /> Ic h <br /> , <br /> 5%, 9 <br /> ./ <br /> (show — componentssystemfuture) GtJr g.,,,,( -- <br /> all details and dimensions necessaryto locate all of the in the <br /> SYSTEM MATERIALS AND SPECIFICATIONS: INSTALLERS CERTIFICATION: <br /> I HEREBY CERTIFY THAT THE ON-SITE SEWAGE SYSTEM IN- <br /> System Design Sewage Flow L/S() Gallons/Day STALLED AT THE ABOVE ADDRESS WAS CONSTRUCTED IN ACCOR- <br /> TANK Size: )S—C,)0 total gallons [ ] single compartment DANCE WITH THE REQUIREMENTS OF THE PERMIT AND THE RULES <br /> Manufacturer: ()Jai v{ <br /> [aj double compartment OF THE ENVIRONMENTAL QUALITY COMMISSION. <br /> Material: 6„a„LL,� [ ] flow-through ( ] 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'l Size/Mat'l Li 11 5c,I,t t-((D I I Property Owner(permittee) <br /> ixt Licensed Sewage Disposal Service <br /> DRAINFIELD rock depth(inches) Box(es) - <br /> Rock and under pipe S11 I I Drop I I Concrete DEQ License Number: 393 b <br /> Pipe total depth I Z', I I Distribution I I Plastic <br /> DEQ Certification Number: T 7 429 <br /> Drainfield Material(Alternative or perf.pipe) <br /> Total Drainfield Footage(j( ,)th'Trench Depth Minimum 'en Maximum3b <br /> Curtain Drain Depth • Signed <br /> Effluent Pump: Pump Model P 0(D S ' <br /> Pump cycle <br /> times in minutes: on off Gallons per Cycle Company name:_ [--c,p ,<ea AStJ <br /> ATT Make and Model (please print) <br /> Attach an additional sheet for components and materials not listed above. Date: 6 Zi 23 <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 Approv with corrections: see inspection report l I Denied <br /> Signed: e 4 OI z Date: . ' <br /> 1 MC:S-41 rev:3/03;4/12;5/14;11/17 G:\Forms\Septic\S-41 As- uilt2015Version20l7.doc WHITE:Marion County; YELL IW:Oti er;PINK:Installer <br />