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MARION COUNTY BUILDING INSPECTION INDIVIDUAL ON-SITE SEWAGE SYSTEM RECORD <br /> 5155 Silverton lid NE (to be completed by system installer) <br /> SALEM OR 97305 <br /> 503-588-5147 PERMIT NO. 555 "`0Oi <br /> 11/1 <br /> .MARION- <br /> . COUNTY o <br /> http://wWw.co.marion.onus/PW/Buildinglnspection SITE ADDRESS: of Q. <br /> AS-BUILT PLAN OF CONSTRUCTED SYSTEM: <br /> Scale:l"_ t <br /> North <br /> W 4:511 /91— 11,-Se F- <br /> -= . A Ail ,W <br /> 3 <br /> _ t a w.LL <br /> A TM*Viti . .,.•:',7, <br /> a .. C/54 '�id t <br /> • <br /> Al ' ' . ! ` ea .de ti -8 %( <br /> too ' '� ;- / '� A-C. Lie' <br /> �3 . - sit- <br /> . - ---- 4)( c- „0...hrst4,,,,,,,....4.1.,,, _ <br /> .: .: .A.0 4- F (.54.o <br /> (show all details and dimensions nee s oc ents of the system in the future) <br /> SYSTEM MATERIALS AND SPECIFICATIONS:. INSTALLERS CERTIFICATION: <br /> Irk ({ � I HEREBY CERTIFY THAT THE ON-SITE SEWAGE SYSTEM IN- <br /> System Design Sewage FlowGallons/Day STALLED AT THE ABOVE ADDRESS WAS CONSTRUCTED IN ACCOR- <br /> TA'lK;Size: /000,�,� total gallons IA single compartment. DANCE.WITH THE REQUIREMENTS OF THE PERMIT AND THE RULES <br /> Manufacturer. lfr 17 double compartment OF THE ENVIRONMENTAL QUALITY COMMISSION. <br /> Material: c )t e- [ [ flow-through 1$1 have tested the septic tank and certify it to be watertight. <br /> Effluent Sewer:: t� Header Pipe: • The system was installed by: <br /> Size/Mat'1 I( VA 11 I<Size/Mat'I II pI/Cx�Yo I I Property Owner(petmittee) <br /> %Licensed Sewage Disposal Service <br /> DRAINFIELD rock de th finches) Box(es) <br /> Rock and under pipe (il 4 Drop 44 Concrete DEQ License Number. g2-Z5-7 <br /> Pipe total depth it' I Distribution I I Plastic <br /> Drainfield Material(Alternative o�erf-pipe) 3 r Tarifa S DEQ Certification Number: <br /> ,... <br /> Total Drainliield Footage:y. -5 Trench.Depth Minimum,: ,'tMaximumle n <br /> Curtain Drain Depth Signed: _ - _ <br /> Effluent Pump: Pump Model �fv <br /> Pump cycle r - <br /> times in minutes: on off Gallons per Cycle Company name: _ -� <br /> (please print) <br /> ATI'Make and Model <br /> Attach an additional sheet for components and materials not listed above. Date:____kh.. ... <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 .i. i Approved with corrections:see inspection report [ I Denied <br /> Signed: 1-I l' t,t,l,vt.7 :`";, Title:( : .4 s I if i= ; ,• Date: t _if /r <br /> MC:S-4l rev:3/03:4/12.5/14.1`1/17 -Cr\FnrmclSentic\S.41 AFRuiiW?115Vercinn1fl17 fine Wr77TF•i.f.;,..r„..„...•vcr rnnAch.......::PIT!rr.t».....71.._ <br />