Laserfiche WebLink
MARION COUNTY BUILDING INSPECTION INDIVIDUAL ON-SITE SEWAGE SYSTEM RECORD <br /> 5155 Silverton Rd NE (to be completed by system installer) <br /> SALEM OR_ . OS88-547973fl5 PERMIT NO. '55—R - 0.6S(a 17 <br /> MARIo <br /> COUNTY http:I/www.co.marion.or.ns/PW/Buildinglnspection SITE ADDRESS: JLat I < 2' ..dQ 124%. /U`F <br /> AS-BUILT PLAN OF CONSTRUCTED SYSTEM: SA.lty-.f C2 9.1 3eiS— <br /> Scale:1"_ ' ' <br /> 'orth <br /> 1 <br /> 1 NA <br /> C. <br /> -fl= -1oI ' <br /> 13©= 32.5" <br /> elr-will <br /> 15' j iii 1-&---4` <br /> t del L-0( + <br /> 3.1 . AP R ('---. AiV <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 6 g..s-- Gallons/Day STALLED AT THE ABOVE ADDRESS WAS CONSTRUCTED IN ACCOR- <br /> t [] single compartment DANCE WITH THE REQUIREMENTS OF THE PERMIT AND THE RULES <br /> TANK Sue 11 � total gallons [ j double compartment OF THE ENVIRONMENTAL QUALITY COMMISSION. <br /> Manufacuuer: .LI-t 141-1 trr <br /> Material: FIG-fi-ria (Xj flow-through V'C]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 L/1 PM- Size/Mat'i r ]fit.C. [ ]Property Owner(permittee) <br /> p l Licensed Sewage Disposal Service <br /> DRAL'1NFIEID 1 rock depth(inches) Box(es) <br /> t' License Number: s l.�i Q' <br /> Rock and under. pipe �D 1 1 Drop [I Concrete DEQ <br /> Pipe .total depth I i" o4 Distribution Del Plastic 0 <br /> DEQ Certification Number: tZT/6 c <br /> Drainficid Material(Alternative or pert pipe) IJe-e <br /> I Total Drai afield Footage j /j Trench Depth Minimum`7 p ! IV.Max � <br /> im _ ''� <br /> Curtain Drain Depth --.' Signed:_ _. <br /> Effluent Pump: Pump Model . <br /> Pump cycle /, <br /> times in minutes: on off Gallons per Cycle Company name: t ✓-e.cavt 5",[c.2r al- R.c n..i. 2.LC <br /> c"J(please print) <br /> ATT Make and Model Attach an additional sheet for components and materials not listed above. Date: 6'e1Z1''• 3 __ _ <br /> (:For Marion Cott Use Only) The above septic system has been inspected by Marion County. The information has been determined to be accurate <br /> • <br /> and the system :: [,Approved I ]Approved with coor,r ctions:see inspection report [ ]Denied <br /> ram, / Z <br /> Signed. _ Title:_ `�" " `�c Date: ,( 7 <br /> MC:S-41 rev:3/03;4/12 5/14;11/17 G:lForms\Septic\S-41 As-Buiit2015Versian2017.doc WHITE:Marion County;YELLOW:Owner;.PINK Installer <br />