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MARION COUNXY‘BUILDING INSPECTION INDIVIDUAL ON-SITE SEWAGE'SYSTEM RECORD
<br /> 5135 SilVertoa.d NE
<br /> SALEM OR 97305 (tO,be completed by system installer)
<br /> MARION
<br /> 503-58g-5147 - PERMIT NO. 555-z2..0-091q0
<br /> . <
<br /> cOUNTY r.,,,...0
<br /> littp:I/www.coanarion.orais/PW/BuildingInspection SITE ADDRESS: 59S149 Agoelico ) Rd.,
<br /> AS-BUILT PLAN OF CONSTRUCTED SYSTEM:
<br /> Scale:1"= '
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<br /> North
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<br /> Mil irci..
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<br /> . . lof we. -Nis..0 q ' :iv -A- ' 161 iiIFT111
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<br /> C71
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<br /> ..' (show all details and dimensions A liiGem-au cuniptrients 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 4919) Gallons/Day STALLED AT THE ABOVE ADDRESS WAS CONSTRUel ED .IN ACCOR-
<br /> TANICSi= 0013,...„
<br /> ,,,.. tPta1 gallon$ 1; single compartment DANCE WITH THE REQUIREMENTS OF 111h PERMIT AND THE RULES ,
<br /> OF THE ENVIRONMENTAL QUALITY COMMISSION.
<br /> Manufacturer: WAIT& [ 1 double compartment
<br /> Material: CiiiiVe grarE— [ I flow-through i /I have tested the septic tank and certify it to be watertight:
<br /> The system was installed by: -Effluent Sewer:- /Aar iv;,(1.,„,,,, Header pipci,Ifie, et,..,.,
<br /> SizeiMael 7, ii.4014/171, sizeimari " A.:ykiy0 I I PrepertyOwner(pernuttee)
<br /> IALicensed Sewage Disposal Service
<br /> DRAINFIELD rock depth(inches) Box(es)
<br /> gXZ57
<br /> Rock and under pipe 1 44 Drop 011 Concrete DEQ License Number:
<br /> Pipe told depth_ n,1 4 ij 1 Distribution 1 I Plastic i_. ...2 1 7
<br /> DEQ Certification Number: 4."-P
<br /> Drainfield Material(Alternative or pert:pipe) i To t - vo zi eito
<br /> A.P ,
<br /> Total Brainfield Footage 04,/ Trench Depth Minimum 4Maximurnl "
<br /> e
<br /> Curtain DrainDepdt Signed: LAIIIIIIII°.° ".., ,
<br /> aneg---:
<br /> EffluentPump: Pump-Model . -------
<br /> Pump cycle . •
<br /> times in Minutes: on off - Gallons per Cycle Company name:_ .. = ilat, 1)/zittAi
<br /> Arr Make and Model _ (p ease print)
<br /> Attach an additional sheetfor compoitents and materials not listed;abovc. Date: o."'"' a is
<br /> (For Marion County Use Only) The above septic.system has been inspected by Marion,County.. Theinformition has been determined to lie accurate
<br /> and the system is: rilApgroved ,1 ]Approved with corrections;see inspection report [ I Denied
<br /> . 0 I k .r,o; \,•---7.-) t, / i, i.,,.....
<br /> Signed t. 1 li r A 0 ! tA / vn., Title:i.----?it"'AA i i il t4 l'',, *.*'-1, ::). Data:If); 4 11--'"
<br /> MC:5-4I rev:3/03:4/17.:-5/14-trit7 -11,1 Fdrinc\Sentiel.q-41 Ac-Ruilt7111 6Wrainn7017 anr 145111W.A41-.4,—r,..i.....VLIT 7 nrihn,........DTAIV.7........11..-
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