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MAAION COUNTY BUILDING INSPECTION 5155 Silverton Rd NE INDIVIDUAL ON-SITE SEWAGE SYSTEM RECORD <br /> SALEM OR 97305 (to be completed by system installer) <br /> porno,. <br /> ARION 503-588-5147 G ,J i *n <br /> D�N�TT1 r PERMIT NO. 555 —pac�. —o '-too P&1�+`T <br /> http://www.co.marion.onus/PW/Buildinglnspection 2 j�J ' Ar <br /> SITE ADDRESS:1755 UI 4L l_l� N� <br /> AS-BUILT PLAN OF CONSTRUCTED SYSTEM: <br /> ------- 1nOoOo b , 0?- °170 71 <br /> scale: its_ , <br /> i ort1 <br /> 1. <br /> • 7 9 ;.-2..._4__-. 0 <br /> 0' <br /> �- _ e`iL.t. <br /> k <br /> O <br /> s �aVL �® tom <br /> r.- to g ( . ,04 <br /> til <br /> ri ` <br /> q <br /> a iC <br /> rip <br /> \L--_--2.0° i: 2._ 'no k.0 <br /> \IN)0:N 1rgt...// \...,_,- j . <br /> 1 a(3 p a rn,P ' ,r\\ - .)c\ A1,- t,.k1 <br /> (show all details and i pensions necessary to locate all-e6mponents of the system in the future) au>($tc60 <br /> SYSTEM MATERIALS AND SPECIFICATIONS: INSTALLERS CERTIFICATION: <br /> System Design Sewage Flow q 5CD Gallons/Day I HEREBY CERTIFY THAT THE ON-SITE SEWAGE SYSTEM IN- <br /> l ©O STALLED AT THE ABOVE ADDRESS WAS CONSTRUCTED iN ACCOR- <br /> TANK Size: total gallons [ ] single compartment DANCE WITH THE REQUIREMENTS OF THE PERMIT AND THE RULES <br /> Manufacturer: W O\� 14double compartment OF THE ENVIRONMENTAL QUALITY COMMISSION. <br /> Material: Cs)A.Cf`e.ft. [ ] flow-through I [I have tested the septic tank and certify it to be watertight. <br /> Effluent Sewe • i I Header Pipe: t� The system was installed by: <br /> Size/Marl nb.5 Size/Mat'I ;on' f f/C. I I Property Owner(permittee) <br /> I I Licensed Sewage Disposal Service <br /> DRAINFIELD rock depth(inches) Box(es) !l , <br /> Rock and under pipe ,[ rop I 1 Concrete DEQ License Number: 39 I 6 <br /> Pipe total depth 11 Distribution 1 1 Plastic Q <br /> y,� E2 �lou� DEQ Certification Number: DO I O <br /> Drainfield Material(Alternative or perf.pipe)Total Drainfield Footage 375 Trench Depth Minimum it <br /> O Maximum ail __„ /_e <br /> Curtain Drain Depth Signed: <br /> Effluent Pump: Pump Model O(`e`/1C0 93005)I . <br /> Pump cme q/�x. LTx��h �� C <br /> times in n minutes: on off Gallons per Cycle Company name: 1 V <br /> ATT Make and Model (please print) <br /> Attach an additional sheet for components and materials not listed above. Date: /0 / t7� <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 Approved with corrections:see inspection report [ [Denied / <br /> Signed'. __ Title: A6 O2 ' g> Date:_9 ` 2 <br /> MC:S-41 rev:3/03;4/12;5/14;11/17 G:\Forms\Septic\S-41 As-Built2015Version2017.doc WHITE:Marion County;YELLOW Owner:PINK:lrrsrollc <br />